CPC Practice Exam C Questions with
Correct Answers
A 47-year-old patient was previously treated with external fixation for a Grade III left
tibia fracture. There is now nonunion of the left proximal tibia and he is admitted for
open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone
was harvested from the iliac crest. The fracture site was exposed and the area of
nonunion was osteotomized, cleaned, and repositioned. Intrafragmentary compression
was applied and three screws and the harvested bone graft were packed into the
fracture site. What are the correct codes for this diagnosis and procedure?
A. 27724, 733.82, 905.4
B. 27758, 823.80, 733.82, 905.4
C. 27722, 733.81, 905.4
D. 27759, 733.82, 905.4 - Answer-A. 27724, 733.82, 905.4
Codes are 27758 and 27759 are not reported with this scenario because the fracture is
not an acute traumatic fracture. The physician is repairing a nonunion tibia fracture
(failure of two ends of a fracture to completely heal). Next you need to find out what type
of graft was used. Your hints are "bone grafting" and "iliac crest," which leads you to the
code 27724. The bone graft was harvested from the iliac crest, and then the graft is
placed at the fracture site of the tibia compressing it for desired position and alignment
and the screws were used to stabilize the fracture. In the ICD-9-CM Index to Diseases,
look for Fracture/nonunion referring you to code 733.82. The late effect code is also
appropriate in this case.
Patient had a dual chamber pacemaker put in two days ago. He is having problems with
the battery and the cardiologist found that it is malfunctioning. He is taken to the
operating suite to replace the pacemaker battery. What CPT® and ICD-9-CM codes are
reported?
A. 33226-76, 996.01
B. 33235-52, 996.61
C. 33228-78, 996.01
D. 33213-58, 996.72 - Answer-C. 33228-78, 996.01
One way to choose the correct choice is by the modifiers. The patient is still in a post-op
period from an initial cardiac procedure and is having an unplanned return to the
operating room due to a malfunctioning pacemaker battery that is going to be replaced
(modifier 78). The ICD-9-CM code is indexed under Malfunction/pacemaker - see
Complication, mechanical, pacemaker. Complications/mechanical/pacemaker/cardiac
guides you to code 996.01.
2-year-old male requires a central venous catheter. Using xylocaine local anesthesia a
percutaneous approach is used in the neck and venous access is achieved. A
subcutaneous tunnel is created from the anterior chest wall to the venotomy site and the
,catheter passed through the tunnel. The CV catheter is then placed at the superior vena
cava and sutured in position. Which procedure code is used?
A. 36568
B. 36555
C. 36557
D. 36560 - Answer-C. 36557
Procedure performed is for placement of a central venous catheter eliminating multiple
choice A. An access device is not inserted eliminating multiple choice D. The
documentation supports that a subcutaneous tunnel is created to place the catheter
guiding you to code 36557.
Pre-Operative Diagnosis: Right lung mass Indications: Patient with a mass in the right
lung mass identified on routine X-ray presents for bronchoscopy and biopsy. Procedure:
The patient was brought to the endoscopy suite and the mouth and throat were
anesthetized. The bronchoscope was inserted and advanced through the larynx to the
bronchus. The bronchoscope was introduced into the right bronchus. Using fluoroscopic
guidance, the tip of the bronchoscope was maneuvered into the area of the mass. A
closed biopsy forceps was passed through the channel in the bronchoscope and then
through the bronchial wall. A tissue sample was obtained. There were no other
abnormalities appreciated in the right side and the bronchoscope was removed. The
specimen was labeled and sent to pathology for testing. The patient tolerated the
procedure well. Pathology indicates that the lung mass is cancer. What are the
procedure and diagnosis c - Answer-B. 31628, 162.9
To narrow down your choices, you can start with coding the diagnosis first. The patient
is having the procedure done due to a lung mass. A specimen was sent to pathology
and came back indicating that the lung mass is cancerous. In the ICD-9-CM Index to
Diseases, look in the Neoplasm Table lung/Malignant/Primary (column). You are
referred to code 162.9, eliminating multiple choice answers C and D. You would not
code 31622 because this is a diagnostic procedure. A diagnostic procedure is not coded
if performed at the same session as a surgical procedure in the same area. A surgical
procedure (biopsy) was performed with the bronchoscopy. Fluoroscopic guidance, is
included in code 31628 and not separately reported.
Preoperative Diagnosis: Lower left inguinal pain Postoperative Diagnosis: Inguinal
hernia Procedure: This 30-year-old patient presented with lower left inguinal pain and
on examination was found to have a left inguinal hernia. The decision to perform a left
inguinal hernia repair was made. The procedure was performed in the outpatient
hospital surgery center. Risks and benefits of the surgery were discussed with the
patient and the patient decided to proceed with the surgery. A skin incision was placed
at the umbilicus where the left rectus fascia was incised anteriorly. The rectus muscle
was retracted laterally. Balloon dissector was passed below the muscle and above the
peritoneum. Insufflation and deinsufflation were done with the balloon removed. The
structural balloon was placed in the preperitoneal space and insufflated to 10 mm Hg
carbon dioxide. The other trocars were placed in the lower midline times two. Th -
Answer-A. 49650-LT, 550.90
, To start narrowing down your choices, you need to identify the type of hernia. The
operative note indicates that it is an inguinal hernia. This eliminates code 49652. Next
does the op note mention if the hernia is recurrent, incarcerated or strangulated? No, so
this eliminates code 49651. Code 49568 (Mesh) would not be coded. According to
CPT® guidelines the mesh is reported only with hernia repair codes 49560-49566.
There is a parenthetical note under add-on code 49568 indicating which codes to report
it with. In the ICD-9-CM Index to Diseases, look for Hernia/inguinal referring you to
550.9X. Your fifth digit is "0" because there is no indication in the op note that the hernia
is recurrent or bilateral.
Preoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis. Postoperative
Diagnosis: Same. Procedure: Tonsillectomy and adenoidectomy. Patient is a 24-year-
old male who was taken to the operating room and put under IV sedation by the
anesthesia department. An initial curettage of adenoids was done and packing was
placed. The left tonsil was then identified and dissected out extracapsular and removed
with scissors. Hemostasis was maintained by packing the left tonsil. Next, the right
tonsil was identified and incision was made. Dissection was done extracapsular and the
right tonsil was then removed. Both the right and left tonsil were sent as specimens as
well as adenoid tissue. What are the procedure and diagnosis codes?
A. 42826, 42831-59, 474.01
B. 42820, 474.02
C. 42821-50, 42836-50-59, 474.00, 474.01
D. 42821, 474.02 - Answer-D. 42821, 474.02
One way to narrow down your choices is by looking up the diagnosis first. In the ICD-9-
CM Index to Diseases, look for Adenoiditis/with chronic tonsillitis, referring you to code
474.02. This eliminates multiple choice answers A and C. The patient is over the age of
12 having a tonsillectomy and an adenoidectomy, which leads to code 42821. It is not
appropriate to report two separate procedure codes for a tonsillectomy and
adenoidectomy, since there is combination procedure code that reports the removal of
both in one. According to CPT® guidelines the codes for tonsillectomy and
adenoidectomy (42820-42836) are intended to represent bilateral procedures. It is not
appropriate to append the 50 modifier when performed bilaterally.
Diagnostic esophagogastroduodenoscopy of the esophagus, stomach, and duodenum
was performed after esophageal balloon dilation (less than 30 mm diameter) was done
at the same operative session. Code the procedure(s).
A. 43249, 43235-51
B. 43249
C. 43220, 43200-51
D. 43220 - Answer-B. 43249
Patient is having an esophagogastroduodenoscopy, eliminating multiple choice answers
C and D, which report an esophagoscopy. Your key terms to look for are "balloon
dilation" which is in code description 43249. Code 43235 is noted as a separate
procedure and a diagnostic procedure which means it is included in a surgical
endoscopy (43249) when performed at the same time, not coded separately
Correct Answers
A 47-year-old patient was previously treated with external fixation for a Grade III left
tibia fracture. There is now nonunion of the left proximal tibia and he is admitted for
open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone
was harvested from the iliac crest. The fracture site was exposed and the area of
nonunion was osteotomized, cleaned, and repositioned. Intrafragmentary compression
was applied and three screws and the harvested bone graft were packed into the
fracture site. What are the correct codes for this diagnosis and procedure?
A. 27724, 733.82, 905.4
B. 27758, 823.80, 733.82, 905.4
C. 27722, 733.81, 905.4
D. 27759, 733.82, 905.4 - Answer-A. 27724, 733.82, 905.4
Codes are 27758 and 27759 are not reported with this scenario because the fracture is
not an acute traumatic fracture. The physician is repairing a nonunion tibia fracture
(failure of two ends of a fracture to completely heal). Next you need to find out what type
of graft was used. Your hints are "bone grafting" and "iliac crest," which leads you to the
code 27724. The bone graft was harvested from the iliac crest, and then the graft is
placed at the fracture site of the tibia compressing it for desired position and alignment
and the screws were used to stabilize the fracture. In the ICD-9-CM Index to Diseases,
look for Fracture/nonunion referring you to code 733.82. The late effect code is also
appropriate in this case.
Patient had a dual chamber pacemaker put in two days ago. He is having problems with
the battery and the cardiologist found that it is malfunctioning. He is taken to the
operating suite to replace the pacemaker battery. What CPT® and ICD-9-CM codes are
reported?
A. 33226-76, 996.01
B. 33235-52, 996.61
C. 33228-78, 996.01
D. 33213-58, 996.72 - Answer-C. 33228-78, 996.01
One way to choose the correct choice is by the modifiers. The patient is still in a post-op
period from an initial cardiac procedure and is having an unplanned return to the
operating room due to a malfunctioning pacemaker battery that is going to be replaced
(modifier 78). The ICD-9-CM code is indexed under Malfunction/pacemaker - see
Complication, mechanical, pacemaker. Complications/mechanical/pacemaker/cardiac
guides you to code 996.01.
2-year-old male requires a central venous catheter. Using xylocaine local anesthesia a
percutaneous approach is used in the neck and venous access is achieved. A
subcutaneous tunnel is created from the anterior chest wall to the venotomy site and the
,catheter passed through the tunnel. The CV catheter is then placed at the superior vena
cava and sutured in position. Which procedure code is used?
A. 36568
B. 36555
C. 36557
D. 36560 - Answer-C. 36557
Procedure performed is for placement of a central venous catheter eliminating multiple
choice A. An access device is not inserted eliminating multiple choice D. The
documentation supports that a subcutaneous tunnel is created to place the catheter
guiding you to code 36557.
Pre-Operative Diagnosis: Right lung mass Indications: Patient with a mass in the right
lung mass identified on routine X-ray presents for bronchoscopy and biopsy. Procedure:
The patient was brought to the endoscopy suite and the mouth and throat were
anesthetized. The bronchoscope was inserted and advanced through the larynx to the
bronchus. The bronchoscope was introduced into the right bronchus. Using fluoroscopic
guidance, the tip of the bronchoscope was maneuvered into the area of the mass. A
closed biopsy forceps was passed through the channel in the bronchoscope and then
through the bronchial wall. A tissue sample was obtained. There were no other
abnormalities appreciated in the right side and the bronchoscope was removed. The
specimen was labeled and sent to pathology for testing. The patient tolerated the
procedure well. Pathology indicates that the lung mass is cancer. What are the
procedure and diagnosis c - Answer-B. 31628, 162.9
To narrow down your choices, you can start with coding the diagnosis first. The patient
is having the procedure done due to a lung mass. A specimen was sent to pathology
and came back indicating that the lung mass is cancerous. In the ICD-9-CM Index to
Diseases, look in the Neoplasm Table lung/Malignant/Primary (column). You are
referred to code 162.9, eliminating multiple choice answers C and D. You would not
code 31622 because this is a diagnostic procedure. A diagnostic procedure is not coded
if performed at the same session as a surgical procedure in the same area. A surgical
procedure (biopsy) was performed with the bronchoscopy. Fluoroscopic guidance, is
included in code 31628 and not separately reported.
Preoperative Diagnosis: Lower left inguinal pain Postoperative Diagnosis: Inguinal
hernia Procedure: This 30-year-old patient presented with lower left inguinal pain and
on examination was found to have a left inguinal hernia. The decision to perform a left
inguinal hernia repair was made. The procedure was performed in the outpatient
hospital surgery center. Risks and benefits of the surgery were discussed with the
patient and the patient decided to proceed with the surgery. A skin incision was placed
at the umbilicus where the left rectus fascia was incised anteriorly. The rectus muscle
was retracted laterally. Balloon dissector was passed below the muscle and above the
peritoneum. Insufflation and deinsufflation were done with the balloon removed. The
structural balloon was placed in the preperitoneal space and insufflated to 10 mm Hg
carbon dioxide. The other trocars were placed in the lower midline times two. Th -
Answer-A. 49650-LT, 550.90
, To start narrowing down your choices, you need to identify the type of hernia. The
operative note indicates that it is an inguinal hernia. This eliminates code 49652. Next
does the op note mention if the hernia is recurrent, incarcerated or strangulated? No, so
this eliminates code 49651. Code 49568 (Mesh) would not be coded. According to
CPT® guidelines the mesh is reported only with hernia repair codes 49560-49566.
There is a parenthetical note under add-on code 49568 indicating which codes to report
it with. In the ICD-9-CM Index to Diseases, look for Hernia/inguinal referring you to
550.9X. Your fifth digit is "0" because there is no indication in the op note that the hernia
is recurrent or bilateral.
Preoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis. Postoperative
Diagnosis: Same. Procedure: Tonsillectomy and adenoidectomy. Patient is a 24-year-
old male who was taken to the operating room and put under IV sedation by the
anesthesia department. An initial curettage of adenoids was done and packing was
placed. The left tonsil was then identified and dissected out extracapsular and removed
with scissors. Hemostasis was maintained by packing the left tonsil. Next, the right
tonsil was identified and incision was made. Dissection was done extracapsular and the
right tonsil was then removed. Both the right and left tonsil were sent as specimens as
well as adenoid tissue. What are the procedure and diagnosis codes?
A. 42826, 42831-59, 474.01
B. 42820, 474.02
C. 42821-50, 42836-50-59, 474.00, 474.01
D. 42821, 474.02 - Answer-D. 42821, 474.02
One way to narrow down your choices is by looking up the diagnosis first. In the ICD-9-
CM Index to Diseases, look for Adenoiditis/with chronic tonsillitis, referring you to code
474.02. This eliminates multiple choice answers A and C. The patient is over the age of
12 having a tonsillectomy and an adenoidectomy, which leads to code 42821. It is not
appropriate to report two separate procedure codes for a tonsillectomy and
adenoidectomy, since there is combination procedure code that reports the removal of
both in one. According to CPT® guidelines the codes for tonsillectomy and
adenoidectomy (42820-42836) are intended to represent bilateral procedures. It is not
appropriate to append the 50 modifier when performed bilaterally.
Diagnostic esophagogastroduodenoscopy of the esophagus, stomach, and duodenum
was performed after esophageal balloon dilation (less than 30 mm diameter) was done
at the same operative session. Code the procedure(s).
A. 43249, 43235-51
B. 43249
C. 43220, 43200-51
D. 43220 - Answer-B. 43249
Patient is having an esophagogastroduodenoscopy, eliminating multiple choice answers
C and D, which report an esophagoscopy. Your key terms to look for are "balloon
dilation" which is in code description 43249. Code 43235 is noted as a separate
procedure and a diagnostic procedure which means it is included in a surgical
endoscopy (43249) when performed at the same time, not coded separately
