CPC EXAM MEDICAL CODING PRACTICE
QUESTIONS AND SOLUTIONS
◉ A 42-year-old male has a frozen left shoulder. An arthroscope
was inserted in the posterior portal in the glenohumeral joint. The
articular cartilage was normal except for some minimal grade III-
IV changes, about 5% of the humerus just adjacent to the rotator
cuff insertion of the supraspinatus. The biceps was inflamed, not
torn at all. The superior labrum was not torn at all, the labrum
was completely intact. The rotator cuff was completely intact. An
anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted. Adhesions were
destroyed with electrocautery and the Bovie. The superior
glenohumeral ligament, the middle glenohumeral ligament and
the tendinous portion of the subscapularis were released. The
arthroscope was placed anteriorly, adhesions were destroyed and
the shaver was used to debride some of the posterior capsule and
the posterior capsule was released
Answer: D. 29825-LT
◉ After adequate anesthesia was obtained the patient was turned
prone in a kneeling position on the spinal table. A lower midline
lumbar incision was made and the soft tissues divided down to
the spinous processes. The soft tissues were stripped away from
the lamina down to the facets and discectomies and
laminectomies were then carried out at L3-4, L4-5 and L5-S1.
Interbody fusions were set up for the lower three levels using the
Danek allografts and augmented with structural autogenous bone
from the iliac crest. The posterior instrumentation of a 5.5 mm
,diameter titanium rod was then cut to the appropriate length and
bent to confirm to the normal lordotic curve. It was then slid
immediately onto the bone screws and at each level compression
was carried out as each of the two bolts were tightened so that the
interbody fusions would be snug and as tight as possible. Select
the appropriate CPT® codes for this visit?
A.
Answer: C. 22630, 22632 x 2, 22842, 20938, 20930
◉ PREOPERATIVE DIAGNOSIS: Displaced impacted Colles
fracture, left distal radius and ulna. POSTOPERATIVE DIAGNOSIS:
Displaced impacted Colles fracture, left distal radius and ulna.
OPERATIVE PROCEDURE: Reduction with application of an
external fixation system, left wrist fracture FINDINGS: The patient
is a 46 year-old right-hand-dominant female who fell off stairs 4
to 5 days ago sustaining an impacted distal radius fracture with
possible intraarticular component and an associated ulnar styloid
fracture. Today in surgery, fracture was reduced anatomically and
an external fixation system was applied. PROCEDURE: Under
satisfactory general anesthesia, the fracture was manipulated and
C-arm images were checked. The left upper extremity was
prepped and draped in the usual sterile orthopedic fashion. Two
small incisions were made over the second metacarpal and after
removing soft tissues including tendinous structures out of
Answer: B. 25605- LT, 20690-51
◉ A 79-year-old male with symptomatic bradycardia and syncope
is taken to the Operating Suite where an insertion of a DDD
pacemaker will be performed. After the anesthesiologist provided
,moderate sedation, the cardiologist performed a left subclavian
venipuncture was carried out. A guide wire was passed through
the needle, and the needle was withdrawn. A second subclavian
venipuncture was performed, a second guide wire was passed and
the second needle was withdrawn. An oblique incision in the
deltopectoral area incorporating the wire exit sites. A
subcutaneous pocket was created with the cautery on the
pectoralis fascia. An introducer dilator was passed over the first
wire and the wire and dilator were withdrawn. A ventricular lead
was passed through the introducer, and the introducer was
broken away in the routine fashion. A second introducer dilator
was passed over the second guide wire and the wire and dilator
were
Answer: A. 33208
◉ Patient has lung cancer in his upper right and middle lobes.
Patient is in the operating suite to have a video-assisted
thorascopy surgery (VATS). A 10-mm-zero-degree thoracoscope is
inserted in the right pleural cavity through a port site placed in
the ninth and seventh intercostal spaces. Lung was deflated. The
tumor is in the right pleural. Both lobes were removed
thorascopically. Port site closed. A chest tube was placed to
suction and patient was sent to recovery in stable condition.
Which CPT® code is reported for this procedure?
A. 32482
B. 32484
C. 32670
, D. 32671
Answer: C. 32670
◉ The patient is a 58-year-old white male, one month status post
pneumonectomy. He had a post pneumonectomy empyema
treated with a tunneled cuffed pleural catheter which has been
draining the cavity for one month with clear drainage. He has had
no evidence of a block or pleural fistula. Therefore a planned
return to surgery results in the removal of the catheter. The
correct CPT® code is:
A. 32440-78
B. 32035-58
C. 32036-79
D. 32552-58
Answer: D. 32552-58
◉ This 67-year-old man presented with a history of progressive
shortness of breath. He has had a diagnosis of a secundum
atrioseptal defect for several years, and has had atrial fibrillation
intermittently over this period of time. He was in atrial fibrillation
when he came to the operating room, and with the patient
cannulated and on bypass, The right atrium was then opened. A
large 3 x 5 cm defect was noted at fossa ovalis, and this also
included a second hole in the same general area. Both of these
holes were closed with a single pericardial patch. What CPT® and
ICD-10-CM codes are reported?
A. 33675, Q21.0
QUESTIONS AND SOLUTIONS
◉ A 42-year-old male has a frozen left shoulder. An arthroscope
was inserted in the posterior portal in the glenohumeral joint. The
articular cartilage was normal except for some minimal grade III-
IV changes, about 5% of the humerus just adjacent to the rotator
cuff insertion of the supraspinatus. The biceps was inflamed, not
torn at all. The superior labrum was not torn at all, the labrum
was completely intact. The rotator cuff was completely intact. An
anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted. Adhesions were
destroyed with electrocautery and the Bovie. The superior
glenohumeral ligament, the middle glenohumeral ligament and
the tendinous portion of the subscapularis were released. The
arthroscope was placed anteriorly, adhesions were destroyed and
the shaver was used to debride some of the posterior capsule and
the posterior capsule was released
Answer: D. 29825-LT
◉ After adequate anesthesia was obtained the patient was turned
prone in a kneeling position on the spinal table. A lower midline
lumbar incision was made and the soft tissues divided down to
the spinous processes. The soft tissues were stripped away from
the lamina down to the facets and discectomies and
laminectomies were then carried out at L3-4, L4-5 and L5-S1.
Interbody fusions were set up for the lower three levels using the
Danek allografts and augmented with structural autogenous bone
from the iliac crest. The posterior instrumentation of a 5.5 mm
,diameter titanium rod was then cut to the appropriate length and
bent to confirm to the normal lordotic curve. It was then slid
immediately onto the bone screws and at each level compression
was carried out as each of the two bolts were tightened so that the
interbody fusions would be snug and as tight as possible. Select
the appropriate CPT® codes for this visit?
A.
Answer: C. 22630, 22632 x 2, 22842, 20938, 20930
◉ PREOPERATIVE DIAGNOSIS: Displaced impacted Colles
fracture, left distal radius and ulna. POSTOPERATIVE DIAGNOSIS:
Displaced impacted Colles fracture, left distal radius and ulna.
OPERATIVE PROCEDURE: Reduction with application of an
external fixation system, left wrist fracture FINDINGS: The patient
is a 46 year-old right-hand-dominant female who fell off stairs 4
to 5 days ago sustaining an impacted distal radius fracture with
possible intraarticular component and an associated ulnar styloid
fracture. Today in surgery, fracture was reduced anatomically and
an external fixation system was applied. PROCEDURE: Under
satisfactory general anesthesia, the fracture was manipulated and
C-arm images were checked. The left upper extremity was
prepped and draped in the usual sterile orthopedic fashion. Two
small incisions were made over the second metacarpal and after
removing soft tissues including tendinous structures out of
Answer: B. 25605- LT, 20690-51
◉ A 79-year-old male with symptomatic bradycardia and syncope
is taken to the Operating Suite where an insertion of a DDD
pacemaker will be performed. After the anesthesiologist provided
,moderate sedation, the cardiologist performed a left subclavian
venipuncture was carried out. A guide wire was passed through
the needle, and the needle was withdrawn. A second subclavian
venipuncture was performed, a second guide wire was passed and
the second needle was withdrawn. An oblique incision in the
deltopectoral area incorporating the wire exit sites. A
subcutaneous pocket was created with the cautery on the
pectoralis fascia. An introducer dilator was passed over the first
wire and the wire and dilator were withdrawn. A ventricular lead
was passed through the introducer, and the introducer was
broken away in the routine fashion. A second introducer dilator
was passed over the second guide wire and the wire and dilator
were
Answer: A. 33208
◉ Patient has lung cancer in his upper right and middle lobes.
Patient is in the operating suite to have a video-assisted
thorascopy surgery (VATS). A 10-mm-zero-degree thoracoscope is
inserted in the right pleural cavity through a port site placed in
the ninth and seventh intercostal spaces. Lung was deflated. The
tumor is in the right pleural. Both lobes were removed
thorascopically. Port site closed. A chest tube was placed to
suction and patient was sent to recovery in stable condition.
Which CPT® code is reported for this procedure?
A. 32482
B. 32484
C. 32670
, D. 32671
Answer: C. 32670
◉ The patient is a 58-year-old white male, one month status post
pneumonectomy. He had a post pneumonectomy empyema
treated with a tunneled cuffed pleural catheter which has been
draining the cavity for one month with clear drainage. He has had
no evidence of a block or pleural fistula. Therefore a planned
return to surgery results in the removal of the catheter. The
correct CPT® code is:
A. 32440-78
B. 32035-58
C. 32036-79
D. 32552-58
Answer: D. 32552-58
◉ This 67-year-old man presented with a history of progressive
shortness of breath. He has had a diagnosis of a secundum
atrioseptal defect for several years, and has had atrial fibrillation
intermittently over this period of time. He was in atrial fibrillation
when he came to the operating room, and with the patient
cannulated and on bypass, The right atrium was then opened. A
large 3 x 5 cm defect was noted at fossa ovalis, and this also
included a second hole in the same general area. Both of these
holes were closed with a single pericardial patch. What CPT® and
ICD-10-CM codes are reported?
A. 33675, Q21.0
