1.

What code would be used to report a massive debridement of an open

abdominal wound,including subcutaneous tissue and muscle?
A. 11000
B. 11010
C. 11042
D. 11043 - Need assistance with the Option

2. The patient is brought to surgery for an open wound of the left leg, the
total extentmeasuring approximately 40 × 35 cm.
DESCRIPTION OF PROCEDURE: The legs were prepped with Betadine scrub and solution and
then draped in a routine sterile fashion. Split-thicknessskin grafts measuring about a 10,000th
inch thick were taken from both thighs, meshed with a 3:1 ratio mesher, and stapled to the
wounds. The donor sites were dressed with scarlet red, and the recipient sites were dressed
with Xeroform, Kerlix fluffs, and Kerlix roll,and a few ABD

pads were used for absorption. Estimated blood loss was negligible. The patient tolerated the
procedurewell and left surgery in good condition.
A. 15120, 15121 × 12, S81.809A, X58.XXXS
B. 15100, 15101, 11010, S81.809A, X58.XXXS
C. 15220, 15221 × 13, S71.109A, S71.101A, X58.XXXS
D. 15100, 15101 × 13, S71.109A, S71.101A, X58.XXXS

3. What code would be used to code the destruction of a malignant lesion on the genitalia measuring
1.6 cm using
cryosurgery?A. 17272
B. 11602
C. 11420
D. 11622

4. What code(s) is used by the radiologist when performing preoperative placement of

a needlelocalization wire of a single lesion of the breast to be excised?
A. 19281, 19125
B. 19125
C. 19281
D. 19296

5. Patient returns for treatment for 8 extensive warts located on the right and left feet. In the last
visit a decision was made to inject each wart with an antigen drug on a monthly basis
until thewarts have resolved. What CPT code is reported?
A. 11900
B. 11900 x 8
C. 11901
D. 17110 x 8

6. The dermatologist has performed Mohs micrographic surgery to excise a melanoma

from the patient calf area. Three stages were performed. First stage and second stage had
8 tissue blocks per stage. The third stage had 3 tissue blocks removed. The appropriate
mapping and documentation wasdone on separate operative report. What CPT codes are
reported?
A. 17313, 17314-51, 17314-51
B. 17313, 17314, 17314, 17315X6
C. 17313, 17314, 17314, 17315
D. 17313, 17315, 17315, 17315
17313 is used for first stage, 13314 is used for additional stage and 17315 is used for additional tissue blocks

7. Mary tells her physician that she has been having pain in her left wrist for several weeks. The
physician examines the area and palpates a ganglion cyst of the tendon sheath. He marks the
injection sites, sterilizesthe area, and injects corticosteroid into\ two areas.

A. 20550-LT × 2, M67.432

B. 20551-LT, M67.442
C. 20551-LT × 2, M67.40
D. 20612-LT, 20612-59-LT, M67.432

8. The physician applies a Minerva-type fiberglass body cast from the hips to the shoulders and
to the head.Before application, a stockinette is stretched over the patient'storso, and further
padding of the bony areas with felt padding was done.
A. 29040
B. 29055
C. 29025
D. 29000

9. OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Open fracture, left humerus, with possible loss of left radial pulse.
PROCEDURE PERFORMED: Open reduction internal fixation, left open humerusfracture.
PROCEDURE:While under a general anesthetic, the patient'sleft arm was prepped with Betadine
and draped in sterile fashion. We then created a longitudinal incision over the anterolateral aspect
of his left arm and carried thedissection through the subcutaneoustissue. We attempted to
identify the lateral intermuscular septum and progressed to the fracture site, which was actually
fairly easily to do because there was some significant tearing and rupturing of the biceps and
brachialis muscles. These were partial ruptures, but the bone was
relatively easy to expose through this. We then identified the fracture site and thoroughly irrigated
it with several liters of saline. We also noted that the radial nerve was easily visible, crossing
along the posterolateral aspect of the fracture site. It was intact. We carefully detected it
throughout the remainder of the procedure. We then were able to strip the periosteum away from
the lateral side of the shaft of the humerus both proximally and distally from the fracture site. We
did this just enough to apply a 6-hole plate,which we eventually held in place with six
corticalscrews. We did attempt to compressthe fracture site. Dueto some comminution,the
fracture was not quite anatomically aligned, but certainly it was felt to be very acceptable. Once
we had applied the plate, we then checked the radial pulse with a Doppler. We found that the
radial pulse was present using the Doppler, but not with palpation. We then applied Xeroform
dressingsto the wounds and the incision. After padding the arm thoroughly, we applied a long-
arm splint with the elbow flexed about 75 degrees. He tolerated the procedure well, and the radial
pulse was again present on Doppler examination at the end of the procedure.
A. 24515-RT, S42.302B, W19.XXXA
B. 24500-LT, S42.302B, W19.XXXA
C. 24515-LT, S42.302B, W19.XXXA
D. 24505-LT, S42.302B, W19.XXXA

10. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Left thigh abscess.
PROCEDURE PERFORMED: Incision and drainage of left thigh abscess.
OPERATIVE NOTE: With the patient under general anesthesia, he was placed in the lithotomy
position. The area around the anus was carefully inspected, and we saw no evidence of
communication with the perirectal space. This appearsto have risen in the crease at the top of the
leg, extending from the posterior buttocks region up toward the side of the base of the penis. In
any event, the area was prepped and draped in a sterile manner. Then we incised the area in
fluctuation. We obtained a lot of very foul-smelling, almoststool-like material (it was not stool, but
it was brown and very foul-smelling material). This was not the typical pus one sees with a
Staphylococcus aureus-type infection. The incision was widened to allow us to probe the cavity
fully. Again, I could see no evidence of communication to the rectum, but there was extension
down the thigh and extension up into the groin crease. The fascia was darkened from the purulent
material. I opened some of the fascia to make sure the underlying muscle was viable. This
appeared viable. No gas was present. There was nothing to suggest a necrotizing fasciitis. The
patient did have a very extensive inflammation within this abscess cavity. The abscess cavity was
irrigated with peroxide and salineand packed with gauze vaginal packing. The patient tolerated the
procedure well and was discharged from the operating room in stable condition.
A. 26990-LT, L03.11
B. 27301-LT, L03.114 ICD is not correct in the options, 27301-LT is the right CPT code
C. 27301-LT, L03.116
D. 26990-LT, L03.116
11. A 35-year old is coming in for trigger point injections for right sided thoracic spine
pain. Fourpoints are injected with Depo with Depo Medrol 40 mg/mg. On the rhomboid
major and levator scapular muscles. Which CPT code is reported for injections?
A. 20605x4
B. 20552
C. 20553
D. 20553 x 3
12. A 32 year old has torn meniscus from a sports injury. The repair is performed with an
arthroscope placed into the patellofemoral joint. It showed grade 2 chondromalacia on the
patellar side of the joint.The medical compartment was entered and a complex posterior
horn tear of the medial meniscus was noted. Repair of the meniscus was carried out to a
stable rim along with shaving the articular cartilage.Next, the lateral compartment was
entered with a similar tissue removing the meniscus with shaving of the articular cartilage to
smooth all surfaces. What CPT code(s) should be reported?
A. 29881, 29877
B. 29883, 29877
C. 29880
D. 29880, 29882

13. This patient returns to the operating room for placement of an additional chest tube for
an anterior pneumothorax due to a contusion lung injury. The same physician had just
placed a chest tube 4 daysearlier.

A. 32551, S27.329A
CPT is correct 32551, But ICD are same in Option A and D
B. 32405, S27.309A
C. 32551-58, S27.329A
D. 32551, S27.329A

14. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Atelectasis of the left lower lobe.
PROCEDURE PERFORMED: Fiberoptic bronchoscopy with brushings and cell washings.
PROCEDURE: The patient was already sedated, on a ventilator, and intubated;so his
bronchoscopy wasdone through the ET tube. It was passed easily down to the carina. About 2
to 2.5 cm above the carina, we could see the trachea, which appeared good, as was the carina.
In the right lung, all segments were patent and entered, and no masses were seen. The left lung,
however, had petechial ecchymotic areas scattered throughout the airways. The tissue was
friable and swollen, but no mucous plugs were noted, and all the airways were open, just
somewhatswollen. No abnormalsecretions were noted at all.
Brushings were taken as well as washings, including some with Mucomyst to see whether we
could getsome distal mucous plug, but nothing really significant was returned. The specimens
were sent to appropriate cytological and bacteriologicalstudies. The patient tolerated the
procedure fairly well.
A. 31622, 31623-51, J98.11
B. 31623, P28.0
C. 31623, J98.11
D. 31624, P28.0

15. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Atherosclerotic heart disease.
 POSTOPERATIVE DIAGNOSIS: Atherosclerotic heart disease.
OPERATIVE PROCEDURE: Coronary bypass grafts ×2 with a single graft from the aorta to the
distalleft anterior descending and from the aorta to the distal right coronary artery.
PROCEDURE: The patient was brought to the operating room and placed in a supine position
under general intubation anesthesia, the anterior chest and legs were prepped and draped in
the usual manner. A segment of greatersaphenous vein was harvested from the left thigh,
utilizing the endoscopic vein harvesting technique, and prepared for grafting. The sternum was
opened in the usual fashion, and the left internal mammary artery was taken down and
prepared for grafting. The flow through the internal mammary artery was very poor. The patient
did have a 25-mm difference in arterial pressure between theright and left arms, the right arm
being higher. The left internal mammary artery was therefore not used. The pericardium was
incised sharply and a pericardial well created. The patient was systemically heparinized and
placed on bicaval to aortic cardiopulmonary bypass with the sump in the main pulmonary
artery for cardiac decompression. The patient was cooled to 26, and on fibrillation an aortic
cross-clamp was applied and potassium-rich cold crystalline cardioplegic solution was
administered through the aortic root with satisfactory cardiac arrest. Subsequent doses were
given down the vein grafts as the anastomoses were completed and via the coronary sinus in a
retrograde fashion. Attention was directed to the right coronary artery. The end of the greater
saphenous vein was then anastomosed thereto with 7-0 continuous Prolene distally. The
remaining graft material was then grafted to the left anterior descending at the junction of the
middle and distal third. The aortic cross-clamp was removed after 149 minutes with
spontaneous cardio version. The usual maneuversto remove air from the left heartwere then
carried out using transesophageal echocardiographic technique. After all the air was removed
and the patient had returned to a satisfactory temperature, he was weaned from
cardiopulmonary bypass after 213 minutes utilizing 5 g per kilogram per minute of dopamine.
The chest was closed in the usual fashion. A sterile compression dressing was applied, and the
patient returned to the surgical intensive care unit in satisfactory condition.
A. 33511, 33517, I70.90
B. 33511, 33508, I25.10
C. 33534, 33508, I25.10
D. 33511, 33517, I25.10

16. A 33 year old patient needs a peripherally inserted venous access device for cancer
treatment. The patient was placed in the supine position. Following the administration of
light anesthesia, the right arm was prepped and draped in the usual fashion. 50 cc of 1
percent Lidocaine with bicarb wasinfused in the skin and subcutaneous tissue and the
basilic vein is punctured. Using seldinger technique the subclavian vein was cannulated on
the first attempt. A j-wire passed easily under fluoroscopic guidance to the subclavian vein.
An incision was made and a pocket made on the fasciafor the port. The catheter was
trimmed to length attached to the port and the port placed in the subcutaneous pocket.
Catheter and port were sutured to the fascia. The wound was closed with 3-0 Vicryl.
A. 36570
B. 36576
C. 36571
D. 36568

17. Pre and Post-operative Dx: Acute MI, severe left main arteriosclerotic coronary artery
disease Procedure performed: IABP right common femoral artery
Description: Patient's right groin was prepped and draped in the usual sterile fashion.
Access was obtained through the skin using a 4 French sheath into the right common
femoral artery. The guidewire was placed and then the intra-aortic balloon pump was
placed after the right common femoral artery has been dilated with the small dilator. The
balloon pump had good waveform. Theballoon pump catheter was secured to his skin
after local anesthesia of 2 cc of 1% Xylocaine was used to numb the area. Balloon pump
was secured with a 0 silk suture. The patient had sterile dressing placed. The patient
tolerated the procedure.
A. 33967
B. 33975
C. 33970
D. 33973

18. The cardiothoracic surgeon takes a patient to the operating room to perform an
open balloonangioplasty of the femoral popliteal artery with atherectomy. During the
same operative session, the surgeon performs an open transluminal peripheral
atherectomy of the iliac artery.

A. 37224, 75964-26
B. 37226, 0238T
C. 37225, 0238T
D. 37228, 75964-26

19. OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Melena. POSTOPERATIVE DIAGNOSIS:

Normal endoscopy. PROCEDURE: The video therapeutic flexible endoscope was passed without
difficulty into the oropharynx. The gastroesophageal junction was seen at 40 cm. Inspection of
the esophagusrevealed no erythema, ulceration, varices, or other mucosal abnormalities. The
stomach was entered and the endoscope advanced to the second duodenum. Inspection of the
second duodenum, first duodenum, duodenal bulb, and pylorusrevealed no abnormalities.
Retroflexion revealed no lesions along the curvature. Inspection of the antrum, body, and
fundus of the stomach revealed no abnormalities. The patient tolerated the procedure well.
A. 45378
B. 43235
C. 49320
D. 43255

20. This 70-year-old male is brought to the operating room for a biopsy of the pancreas. A
wedge biopsyis taken and sent to pathology. The report comes back immediately indicating
that malignant cells were present in the specimen. The decision was made to perform a total
pancreatectomy. Code the operative procedure(s) only.
A. 48100
B. 48155 For Operative Procedure - Only pancreactemy will be coded

C. 48155, 48100-51
D. 48155, 48100-51, 88309
21. The patient was taken to the operating room for a repair of a recurrent strangulated inguinal hernia.

A. 49521

B. 49520

C. 49492

D. 49521-78

22. This 43-year-old female comes in with a peritonsillar abscess. The patient is brought to same
-day surgery and given general anesthetic. On examination of the peritonsillar abscess, an
incision was made and fluid was drained. The area was examined again, saline was applied, and
then the area was packed withgauze. The patient tolerated the procedure well.
A. 42825, J36
B. 42700, J36
C. 42825, J03.90
D. 42700, J35.01

23. What code would you use to report a rigid proctosigmoidoscopy with removal of two
polyps bysnare technique?
A. 45320
B. 45383
C. 45309 × 2
D. 45315
24. A colonoscopy is performed on a patient. The physician removes 3 Polyps by hot
biopsy forcepstechnique in the ascending colon. In the transverse colon a miniscule polyp
is ablated. In the sigmoidare a small polyp is seen and removed in total with cold biopsy
forceps. What CPT codes will be billed for the encounter?
A. 45385, 45384-59, 45380-59
B. 45385 X 3, 45383-51, 45380-51
C. 45384, 45388-59, 45380-59
D. 45385 x 3, 45384-59, 45380-59

25. This 1-year-old boy has a mid-shaft hypospadias with a very mild degree of chordae. He
also has a persistent right hydrocele. The surgeon brought the boy to surgery to perform a right
hydrocele repair andone-stage repair of hypospadias with prepucial onlay flap.
A. 54322, 55040, Q54.9, Q54.4
B. 54322, 55041-51, Q54.9, Q54.4, N43.3
C. 54324, 55060-51, Q54.9, Q54.4, N43.3
D. 54324, 55060, Q54.4, N43.3

26. The pediatric physician takes this newborn male to the nursery to perform a clamp
circumcision.

A. 54160, Z41.2

B. 54150, Z41.2
C. 54160, Z41.2
D. 54150, Z41.2

27. This gentleman has worsening bilateral hydronephrosis. He did not have much of a post
void residualon bladder scan. He is taken to the operating room to have a bilateral cystoscopy
and retrograde pyelogram. The results come back as gross prostatic hyperplasia.
A. 52005, N42.83
B. 52000, N13.30 N40.1
C. 52005-50, N40.0, N13.30
D. 52000-50, N13.30, N40.1

28. This 32-year-old female presents with an ectopic pregnancy. The physician
performs alaparoscopic salpingectomy.
A. 59120, N13.30
B. 59151, N13.30
C. 58943, O00.1
D. 59120, O00.8

29. An oncologist performs a complete radical paravaginectomy and removes the

paravaginal tissues. He also performs a total bilateral pelvic lymphadenectomy and
periaortic lymph nodesampling. Correct coding for this situation would be.
A. 57111
B. 56633, 38770-50-51
C. 57109
D. 57107, 38770-50-51

30. A three-year-old patient presents to the outpatient department of the hospital with his
mother fora repair of an incomplete circumcision. The surgeon administer adequate
anesthesia by using a penile block and removes the remaining foreskin.
A. 54161, 64450
B. 54163, 64450
C. 54162
D. 54163

31. This patient is in for a recurrent herniated disk at L4-S1 on the left. The procedure
performed is arepeat laminotomy and foraminotomy at the L5-S1 interspace.
A. 63030-LT, M51.27
B. 63030-LT, M51.25
C. 63042-LT, M51.25
D. 63042-LT, M51.27

32. What code would you assign to report a left partial thyroid lobectomy, with isthmusectomy?

A. 60210

B. 60220

C. 60212

D. 60225 33. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Paralytic ectropion, left eye.
PROCEDURE PERFORMED: Medial tarsorrhaphy, left eye.
In the operating room, after intravenoussedation, the patient was given a total of about 0.5 mL
oflocal infiltrative anesthetic. The skin surfaces on the medial area of the lid, medial to the
punctum, were denuded. A bolster had been prepared and double 5-0 silk suture was passed
through the bolster, which was passed through the inferiorskin and raw lid margin, then through
the superior margin, and out throughthe skin. A superior bolster was then applied. The puncta
were probed with wire instrument and found notto be obstructed. The suture was then fully tied
and trimmed. Bacitracin ointment was placed on the surface of the skin. The patient left the
operating room in stable condition, without complications, having tolerated the procedure well.
A. 67875-LT, H02.129
B. 67710-LT, H02.139
C. 67882-LT, H02.109
D. 67880-LT, H02.129

34. This 66-year-old male has been diagnosed with a senile cataract of the
posteriorsubcapsular and is scheduled for a cataract extraction by phacoemulsification of
the right eye. The physician has taken thepatient to the operating room to perform a
posteriorsubcapsular cataract extraction with IOL, diffuse of the right eye.
A. 66982-RT, H26.061
B. 66984-RT, H25.041
C. 66983-RT, H25.091
D. 66830-RT, H25.041

35. Patient has estropia of the left eye and presents to operating suite for strabismus
surgery. Thephysician resects the medial and lateral rectus muscles of the eye and
secure it with sutures. Extensive scar tissue noted due a previous surgery. Scar tissue
is released on the inferior rectus muscles. What CPT code will be reported for this
surgery?
A. 67312, 67343
B. 67312
C. 67311,67343
D. 67316

36. Pre-op and Post OP Dx: Chronic Otitis Media

Procedure: After the patient was properly identified, he has brought into the operating room
and placed in supine position. The patient was prepped and draped in the usual fashion.
General anesthesia was administered via inhalation mask, and after adequate sedation was
achieved, a Medium sized speculum was placed in the ear and cerumen was removed
atraumatically using instruments with operative microscope. An incision was made in the
anterior inferior quadrant of theright tympanum and thick mucoid fluid was suctioned. An
Armstrong grommet ventilating tube wasplaced without difficulty followed by antibiotic
drops in cotton balls. Also serous fluid was noted.
The patient was awakened after having tolerated the procedure well and taken to the recovery
room instable
condition.
A. 69436-
50
B. 69436-RT
C. 69433-50
D. 69420-LT

37. A neurological consultation in the emergency department of the local hospital is requested
for a 25- year-old male with suspected closed head trauma. The patient had a loss of
consciousness(LOC) this morning after receiving a blow to the head in a high school basketball
game. He presents to the emergency department with a headache, dizziness, and confusion.
During the comprehensive history, thegirlfriend relates that the patient has been very irritable
and confused since the incident. Physical examination reveals the patient to be unsteady and
exhibit difficulty in concentration when stating monthsin reverse. The pupils dilate unequally.
The physician continues with a comprehensive examination involving an extensive review of
neurological function. The neurologist orders a stat CT andMRI. The physician suspects a
subdural hematoma or an epidural hematoma, and the medical decision making complexity is
high.
A. 99285
B. 99253
C. 99245
D. 99255

38. An obstetrician is requested to provide an office consultation to a 23-year-old female with

first- trimester bleeding. The patient presents with a history of brownish discharge and
occasional pinkish discharge. During the comprehensive history, the patient relates that she has
had suprapubic pain in the past week and cramping. She has felt nausea and has vomited on
three occasions. On one occasion, the nausea was accompanied by dizziness and vertigo. The
physician conducts a comprehensive examination focused on the patient's chief complaint. The
uterus is found to be soft and involuted. There is cervical motion tenderness and significant
abdominal tenderness on palpation. A left pelvic mass is palpated in theleft quadrant. The
physician orders a pelvic ultrasound, a complete CBC, and differential. Considering therange of
possible diagnoses, the medical decision-making complexity is high.
A. 99255
B. 99242
 C. 99245
D. 99235

39. A 56-year-old established male patient presents to his family physician for a checkup at
the local outpatient clinic. The physician conducts a detailed history and physical
examination, and the checkuptakes 45 minutes.
A. 99214
B. 99403
C. 99386
D. 99396

40. Karra Hendricks, a 37-year-old female, is an established patient who presents to the office
with pain inthe RLQ with fever. The physician takes a detailed history and performs a detailed
examination. The medical decision making is noted to be of a low complexity.
A. 99203
B. 99213
C. 99214
D. 99221

41. Sam, a 4-year-old male, was brought to the emergency department by his mother, where Dr.
Black, the emergency department physician, examined the child. Dr. Black has not provided
service to this childin the past. During a problem-focused history, the mother stated that the
child has had a temperature of 101º F for the past 24 hours, has been very fussy, and has been
pulling on his left ear. The physician examined the child during a problem-focused examination
and diagnosed otitis media, for which he prescribed a 10-day course of amoxicillin.
A. 99201
B. 99212
C. 99241
D. 99281

42. Dr. Robertson provided the first month of care planning oversight for home care of a 64-
year-old male patient with advanced pancreatic cancer. He developed a plan that included
home oxygen, intravenous diuretics, and pain control management by means of intravenous
morphine. The time spentin the low intensity oversight for the month was 45 minutes
A. 99378
B. 99374
C. 99375
D. 99380

43. Which HCPCS modifier indicates an anesthesia service in which the anesthesiologist
medically directsone CRNA?
A. QX
B. QY
C. QZ
D. QQ

44. Anesthesia service for a pneumo centesis for lung aspiration,

32420.A. 00522
B. 00500
C. 00520
D. 00524

45. A patient is coming in for arthroscopic knee surgery. Anesthesiologist prepares the
patient at 9.00am and the surgery begins at 9:30 am. The Surgery finishes at 11:30 am and
the anesthesiologist leave patient care at 11:30 am. What is the anesthesia time reported?
A. 2 hours and 15 minutes
B. 2 Hours
C. 2 Hours and 30 minutes
D. 2 Hours and 45 Minutes

46. Pediatric patient that is 6 months old is having a planned tracheostomy. What
anesthesia codeis/are reported?
A. 00350, 99100
B. 00326, 99100
C. 00326
D. 00350, 99140

47. This 69-year-old female is in for a magnetic resonance examination of the brain because of
new seizureactivity. After imaging without contrast, contrast was administered and further
sequences were performed. Examination results indicated no apparent neoplasm or vascular
malformation.
A. 70543-26, R56.00
B. 70543-26, R56.9
C. 70553-26, R56.9
D. 70553, G40.909

48. This patient undergoes a gallbladder sonogram due to epigastric pain. The report indicates
that the visualized portions of the liver are normal. No free fluid noted within Morison's pouch.
The gallbladder isidentified and is empty. No evidence of wall thickening or surrounding fluid is
seen. There is no ductal dilatation. The common hepatic duct and common bile duct measure
0.4 and 0.8 cm, respectively. The common bile duct measurement is at the upper limits of
normal.
A. 76700-26, R10.84
B. 76705-26, R10.13
C. 76775-26, R10.33
D. 76705, R10.84
49. EXAMINATION OF: Chest.
CLINICAL SYMPTOMS: Pneumonia.
PA AND LATERAL CHEST X-RAY WITH FLUOROSCOPY.
CONCLUSION: Ventilation within the lung fields has improved compared with previous
study.A. 71020-26, J15.8
B. 71034, J15.6
C. 71023-26, J18.9
D. 71023, J18.9

50. EXAMINATION OF: Abdomen and pelvis.

CLINICAL SYMPTOMS: Ascites.
CT OF ABDOMEN AND PELVIS: Technique: CT of the abdomen and pelvis was performed without
oralor IV contrast material per physician request. No previous CT scans for comparison.
FINDINGS: No ascites. Moderate-sized pleural effusion on the
right.A. 74150-26, 72192-26 R18.8
B. 74176-26, J91.8
C. 74150-26, 72192-26 J91.8
D. 74176-26, R18.8
51. EXAMINATION OF: Brain.
CLINICAL FINDING: Headache.
COMPUTED TOMOGRAPHY OF THE BRAIN was performed without contrast material.
FINDINGS: There is blood within the third ventricle. The lateral ventricles show mild dilatation with small
amounts of blood.
IMPRESSION: Acute subarachnoid
hemorrhage.A. 70460-26, R51
B. 70250, R51
C. 70450-26, I60.9
D. 70450-26, R51
52. Report both the technical and professional components of the following service: This 68-year-
old male is seen in Radiation Oncology Department for prostate cancer. The oncologist performs
a complex clinical treatment planning, dosimetry calculation, and a complex isodose plan;
treatment devices include blocks, special shields, and wedges. The patient had 5 days of
radiation treatments for 2 weeks, a total of 10 days oftreatment.
A. 77263, 77300, 77307, 77334, C61
B. 77300, 77315, 77334, 77427 × 2, C61
C. 77263, 77307, 77334, 77427 × 2, C61
D. 77263, 77427 × 2, C61

53. This is a patient with atrial fibrillation who comes to the clinic laboratory
routinely for aquantitative digoxin level.
A. 80101, 80102, I50.9
B. 81001, I49.01
C. 80162, I48.91
D. 80162, R00.0

54. This patient presented to the laboratory yesterday for a creatine measurement. The results
came back athigher than normal levels; therefore, the patient was asked to return to the
laboratory today for a repeat creatine test before the nephrologist is consulted. Report the
second day of test only
A. 82540 × 2, R79.89
B. 82550, R79.89
C. 82550, R79.81
D. 82540, R79.89

55. A patient is diagnosed with Ulcerative colitis and brought for screening
for coloncancer. Which of the following tests for fecal occult blood would be
ordered?
A. 82270
B. 82271
C. 82272
D. 82274
56. On examination, the physician notes a gray vaginal discharge, which he places
on one side. He puts a drop of saline and views the slide under the microscope and
determines thatthe patient has bacterial vaginitis. Keeping in mind that the lab test
was performed in the office, and lab setting is regulated by federal rules under the
Clinical Laboratory improvement amendments (CLIA), which of the following is
appropriate billing for the testperformed in MD office.
A. 87210-QW
B. 87210-GA
C. 87205-GA
D. 87205-QW

57. A patient had vaginal hysterectomy for cervical cancer. A surgical

pathology of a gross and microscopic examination was performed on the
uterus, fallopian tubes and ovaries. Which CPT code is reported for this
service?
A 88305
B 88307
C 88309
D 88302

58. Patient's low density lipoprotein (LDL) levels are not responding
adequately to prescription drug management. The PCP collects
and submits a blood sample with the order to the lab for further
analysis usingultracentrifugation. What CPT code is assigned to
report this test?
A. 83719
B. 83698
C. 83701
D. 83704

59. Which code would be used to report an EEG (electroencephalogram)

providedduring carotid surgery?

A. 95816

B. 95819

C. 95822

D. 95955

60. This 40-year-old patient who is a type 2 diabetic is seen in an

inpatientsetting for psychotherapy. The doctor spends 50 minutes face to
face with the patient. The patientis seen for depression.

A. 90834, F32.9, E11.8

B. 90837, F32.9, E11.8

C. 90834, F32.9
D. 90837, F32.9

61. How would you report a screening hearing

test?A. 92551
B. 92555
C. 92553
D. 92620

62. The patient presented for a spontaneous nystagmus test that included gaze,
fixation,and recording and used vertical electrodes:
A. 92541
B. 92547
C. 92541, 92544, 92547
D. 92541, 92547
63. DIALYSIS INPATIENT NOTE: This 24-year-old male patient is on continuous
ambulatory peritoneal dialysis (CAPD) using 1.5%. He drains more than 600 ml. He is
tolerating dialysis well. He continues to have some abdominal pain, but his abdomen
is not distended. He has some diarrhea. His abdomen does not look like acute
abdomen. His vitals, other than blood pressure in the 190s over 100s, are fine. He is
afebrile.At this time, I will continue with 1.5% dialysate. I gave him labetalol IV for
blood pressure. Because of diarrhea,I am going to check stool for white cells, culture.
Next we will see what the primary physician says today. His HIDA scan was normal.
The patient suffers from ESRD.
A. 90947, 90960, N18.6, R19.7
B. 90945, N18.6, R19.7
C. 90960, N18.6
D. 90945, N18.6

64. INDICATION: Hypertension with newly diagnosed acute myocardial

infarction.PROCEDURE PERFORMED: Insertion of Swan-Ganz catheter.
DESCRIPTION OF PROCEDURE: The right internal jugular and subclavian area was
prepped with antiseptic solution. Sterile drapes were applied. Under usual sterile
precautions,the right internal jugular vein was cannulated. A 9 French introducer was
inserted, and a 7 French Swan-Ganz catheter was inserted without difficulty. Right
atrial pressures were 2 to 3,right ventricular pressures 24/0, and pulmonary artery
26/9 with a wedge pressure of 5. This is a Trendelenburg position. The patient
tolerated the procedure well.
A. 93451, 93503-51, I10
B. 93503, I10
C. 93503, 99356, I10, I21.3
D. 93503, I10, I21.3

65. Epi- stands for:

A. Within
B. Upon
C. Inside
D. Outside
66. Insertion of central venous catheter into right atrium is through
A. Aorta
B. Subclavian
C. Femoral
D. Pulmonary Artery

67. Xantho means:

A. Red
B. Green
C. Yellow
D. Black

68. Osteomalacia is a condition:

A. Hardening of bone
B. Softening of bone
C. Discoloration
D. Narrowing

69. The act of turning upward, such as the hand turned palm upward:

A. supination

B. adduction

C. pronation

D. circumduction

70. The middle layer of the skin, also known as the corium or true skin, is the:
A. epidermis.
B. stratum corneum
C. dermis
D. subcutaneous.

71. The shaft of a long bone:

A. diaphysis
B. epiphysis
C. metaphysic
D. periosteum
72. Which of the following is NOT a covering of the chamber walls of the heart?
A. endocardium
B. myocardium
C. pericardium
D. epicardium

73. Admission for hemodialysis and acute renal

failure.A. Z49.31, N17.9
B. Z49.31, N17.0
C. Z49.31, N17.9
D. N17.9, Z49.31

74. Sarcoidosis with

cardiomyopathy.A. D86.9, J99
B. D86.9, I43
C. I43, D86.9
D. D86.9, I43Z03.89 ED86.85

75. Open wound of left

hand.A. S61.402A
B. S61.209A
C. S58.029A
D. S61.401A

76. Fracture of the right patella with

abrasion.A. S82.001A, S80.819A
B. S82.001A
C. S80.819A, S82.001B
D. S82.101A

77. Mr. Hallberger has multiple problems. I am examining him in the intensive critical
 care unit. I understand he has fluid overload with acute renal failure and was
started on ultrafiltration by the nephrologist on duty. He has an abnormal chest x
-ray. He has preexisting type 2 diabetes mellitus and sepsis. We are left with a
patient now who is stillsedated and on a ventilator because of respiratory failure.
Code the diagnosis(es) only.
A. R60.9, N18.9, R83.9, E11.29, A42.9, J96.90
B. R18.8, N17.2, R91.8, E11.29, A42.9, J96.90
C. E86.9, N26.9, R91.8, E11.9, A41.9, J96.90, T67.3XXA
D. E87.70, N17.9, R91.8, E11.9, A41.9, J96.90, R65.20

78. A patient with chronic obstructive pulmonary disease is issued a

medically necessary nebulizer with a compressor and humidifier for
extensive use with oxygendelivery.
A. E0570, E0550 B. E0570, E0560 C. E0585, E0550 D. E0570, E0555

79. A patient presents for trimming of 10 dystrophic

toenails.A. G0127 × 10
B. G0127, G0127 × 9
C. G0127
D. G0127 × 5, G0127 × 5

80. A 14 year old female was burned on her upper arm and require a graft of 15
sq cm of tissue. She is being treated with an acellular dermal matrix, Primatrix,
what HCPCSlevel II code should you report for the supply of the dermal
grafting tissue?
A Q4106
B Q4110 X
15C Q4101
D Q4106 X 15

81. When are providers responsible for obtaining an ABN for a

service notconsidered medically necessary?

A. After providing a service or item to a beneficiary

B.Prior to providing a service or item to a beneficiary

C. During a procedure or service
D. After a denial has been received from Medicare
82. HIPAA was made into law in what
year?A. 1992
B. 1997
C. 1995
D. 1996

83. Which of the following health plans does not fall under HIPAA?
A. Medicaid
B. Medicare
C.Workers compensation
D. Private plans

84. When a physician’s claim form is submitted to an insurance company, which

two maincomponents must the claim link to in order to prove medical necessity?
A. Date of service and work status
B. Provider name and address
C. Modifier and place of service
D. Diagnosis and procedure code(s)

85. What is the standard claim form that is used to report professional services
and suppliesto insurance plans?
A. ANSI ASCX12-N
B. CMS-1500
C. CMS-1444
D. UB-04

86. What reimbursement method does the abbreviation RBRVS stand for?
A. Resource Based Relative Value Scale
B. Relative Based Resources Value System
C. Revenue Balanced Relative Value Scale
D. Resource Balanced Relative Value System
87. What document does an insurance company create and send back to the
provider andpatient to detail the results of processing a claim?
A. Fiscal Intermediary Results
B. Explanation of Benefits
C. Explanation of Benefactor
D. Encounter Form

88. Sickle-cell anemia and thalassemia are both types of:

A. Iron deficiency anemia
B. Hereditary hemolytic anemia
C. Aplastic anemia
D. Coagulation defects

89. Which place of service code should be reported on the physician’s claim for a
surgicalprocedure performed in an ASC?

A. 21
B. 22
C. 24
D. 11

90. What is PHI?

A. Physician-health care interchange
B. Private health insurance
C. Protected health information
D. Provider identified incident-to
91. A 70-year-old with significant pelvic prolapse and grade IV cystocele who has
failed previous primary repair and is status post hysterectomy. She presents for
anterior repair and colpopexy. Procedure: Patient placed in the dorsal lithotomy
position and general anesthetic was induced without problems. A midline incision is
made from just above is made from justabove the bladder neck to the vaginal cuff.
She is noted to have a grade IV cystocele. Vaginalflaps were dissected to the level of
the pubocervical fascia. Her vaginal mucosa was in good condition but near the
urethra and bladder neck it was a little thinner. There is significant scarring on the
left side from previous procedures. Ishcial spine is identified and swept fiber fatty
tissue off of the sacrospinous ligament bilaterally. No scarring or adhesions in this
area. Anterior needles were passed into place on the elevate mesh and these were
fixed in a manner similar to the MiniArC. They were passed along just below the
bladder neck toward the obturaton foramen and fixed in place. An anterior support
was created without tension at the viscourethral junction. Apical needles were then
used to pass the apical arms into place. There were gently fixed into place along the
sacrospinous ligament approximately 2cm away from the ischial spine. This was
done bilaterally. They passed in a single pass and were fixed in place confirmed by
gentle tugging on both arms. Three Vicryl sutures had been placed and the vaginal
apex were then passed over into the mesh and tied down. The apical arms were
placed through the eyelets of the mesh and passed down toward the sacrospinous
ligament bilaterally to create good apical support. Eyelet fasteners placed bilaterally
and mesh arms trimmed providing excellent apical and anterior support. Vaginal
mucosa was closed and vaginal packed placed. No complications. What CPT®
code(s) describe(s) this procedure?

A. 57250, 57280
B. 57240, 57282
C. 57240, 57283
D. 57250, 57283

92. Preoperative Diagnosis: Right hydronephrosis Postoperative Diagnosis: Right

hydronephrosis
Operation: Cystoscopy and right retrograde pyelogram Procedure: Patient prepped
and draped in the dorsolithotomy position. Placed under general anesthesia a 23
French cystoscope was passed into the bladder. No tumors were visualized. Urine
from the bladder was sent for urine cytology. Then a 6 French access catheter was
passed into the right uretal orfice. Contrast was injected and there were no filling
defects noted. There was no fixed tumor and no stone. There was mild hydroureteral
nephrosis against the bladder. There was a narrowing at the UVJ no abnormalities.
Renal pelvis barbotaged with saline and renal pelvis urine sent to pathology for urine
cytology. After the retrograde pyelogram was performed the access catheter was
removed.

A. 52000-RT, 74420-26
B. 52281-RT, 74425-26
C. 52007-RT, 74400-26
D. 52005-RT, 74420-26
93. OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Missed abortion with fetal demise, 11 weeks.
POSTOPERATIVE DIAGNOSIS: Missed abortion with fetal demise, 11 weeks.
PROCEDURE: Suction D&C.
The patient was prepped and draped in a lithotomy position under general mask
anesthesia, and the bladder was straight catheterized; a weighted speculum was
placed in the vagina. Theanterior lip of the cervix was grasped with a single-tooth
tenaculum. The uterus was then sounded to a depth of 8 cm. The cervical os was
then serially dilated to allow passage of a size 10 curved suction curette. A size 10
curved suction curette was then used to evacuate theintrauterine contents. Sharp
curette was used to gently palpate the uterine wall with negative return of tissue,
and the suction curette was again used with negative return of tissue. The
tenaculum was removed from the cervix. The speculum was removed from the
vagina. All sponges and needles were accounted for at completion of the procedure.
The patient left the operating room in apparent good condition having tolerated the
procedure well. Pathology report indicated benign polyp.
A. 59812, O03.9
B. 59812, O07.4
C. 59820, O02.1
D. 59856, O02.1

94. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Right ureteral stricture.
POSTOPERATIVE DIAGNOSIS: Right ureteral stricture.
PROCEDURE PERFORMED: Cystoscopy, right ureteral stent
change.
PROCEDURE NOTE: The patient was placed in the lithotomy position after
receiving IV sedation. He was prepped and draped in the lithotomy position. The
21 French cystoscope was passed into the bladder, and urine was collected for
culture Inspection of the bladder demonstrated findings consistent with radiation
cystitis, which has been previously diagnosed. There is no frank neoplasia. The
right ureteral stent was grasped and removed through the urethral meatus; under
fluoroscopic control, a guide wire was advanced up the stent, and the stent was
exchanged for a 7 French 26-cm stent under fluoroscopic control inthe usual
fashion. The patient tolerated the procedure well.
A. 51702-LT, N13.5
B. 51702-RT, N30.90
C. 52332-RT, N30.90
D. 52332-RT, N13.5

95. This patient is a 52-year-old female who has been having prolonged and heavy
bleeding.
SURGICAL FINDINGS: On pelvic exam under anesthesia, the uterus was normal size
andfirm. The examination revealed no masses. She had a few small endometrial
polyps in the lower uterine segment.
DESCRIPTION OF PROCEDURE: After induction of general anesthesia, the patient
was placed in the dorsolithotomy position, after which the perineum and vagina were
prepped, thebladder straight catheterized, and the patient draped. After bimanual
exam was performed, a weighted speculum was placed in the vagina and the
anterior lip of the cervix was grasped with a single toothed tenaculum. An
endocervical curettage was then done with a Kevorkian curet. The uterus was then
sounded to 8.5 cm. The endocervical canal was dilated to 7 mm with Hegar dilators.
A 5.5-mm Olympus hysteroscope was introduced using a distention medium. The
cavity was systematically inspected, and the preceding findings noted. The
hysteroscope was withdrawn and the cervix further dilated to 10 mm. Polyp forceps
was introduced, and a few small polyps were removed. These were sent separately.
Sharp endometrial curettage was then done. The hysteroscope was then reinserted,
and the polyps had essentially been removed. The patient tolerated the procedure
well and returned to the recovery room in stable condition (Pathology confirmed
benign endometrial polyps).
Pathology confirmed benign endometrial
polyps.A. 58558, 57460-51, N92.0, N84.0
B. 58558, N92.0, N84.0
C. 58558, 57558-51, N92.0, N84.0
D. 58558, N92.1, D49.5

96. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Possible recurrent transitional cell carcinoma of the
bladder.
POSTOPERATIVE DIAGNOSIS: No evidence of recurrence.
PROCEDURE PERFORMED: Cystoscopy with multiple bladder biopsies.
PROCEDURE NOTE: The patient was given a general mask anesthetic, prepped, and
drapedin the lithotomy position. The 21 French cystoscope was passed into the
bladder. There was ahyperemic area on the posterior wall of the bladder, and a
biopsy was taken. Random biopsies of the bladder were also performed. This area
was fulgurated. A total of 7 cm2 of bladder was fulgurated. A catheter was left at the
end of the procedure. The patient tolerated the procedure well and was transferred
to the recovery room in good condition. The palthology report indicated no evidence
of recurrence.
A. 52224, Z85.51
B. 51020, 52204, Z80.59
C. 52234, Z85.51
D. 52224 × 4, D41.4

97. This 41-year-old female presented with a right labial lesion. A biopsy was taken,
and theresults were reported as VIN-III, cannot rule out invasion. The decision was
therefore made to proceed with wide local excision of the right vulva.
PROCEDURE: The patient was taken to the operating room, and general anesthesia
was administered. The patient was then prepped and draped in the usual manner in
lithotomy position, and the bladder was emptied with a straight catheter. The vulva
was then inspected.On the right labium minora at approximately the 11 o'clock
position, there was a multifocal lesion. A marking pen was then used to mark out an
elliptical incision, leaving a 1-cm borderon all sides. The skin ellipse was then
excised using a knife. Bleeders were cauterized with electrocautery. A running
locked suture of 2-0 Vicryl was then placed in the deeper tissue.
The skin was finally re approximated with 4 0 Vicryl in an interrupted fashion. Good
hemostasis was thereby achieved. The patient tolerated this procedure well. There
were nocomplications.
A. 56605, C51.9
B. 56625, D07.1
C. 56620, D07.1
D. 11620, C51.9
98. Indications: 15-year-old boy was burned in a fire and assessed to have received
burns to 75 percent of his total body surface area. He was transferred to a burn
center for definitive treatment. Once stable, he was brought to the OR. Procedure:
Due to extent of the patient’s burns and lack of sufficient donor sites, his full-
thickness burns will be excised and covered with xenograft (skin substitute graft),
and a split-thickness skin biopsy will be harvested for preparation of autologous
grafts to be applied in the coming weeks, when available. After induction of
anesthesia, extensive debridement of the full-thickness burns was undertaken.
Attention was first directed to the patient’s face, neck, and scalp. A total of 500 sq
cm in this area received full-thickness burns. The eschar involving this area was
excised down to viable tissue. Hemostasis was achieved using electrocautery.
Attention was then turned to the trunk. A total of 950 sq cm in this area received full-
thickness burns. The eschar involving this area was excised down to viable tissue.
Hemostasis was achieved. Attention was then turned to thearms and legs. A total of
725 sq cm received full-thickness burns. The eschar involving this area was excised
down to viable tissue. Hemostasis was achieved. Attention was then turned to the
hands and feet. A total of 300 sq cm in this area received full-thickness burns. The
eschar involving this area was excised down to viable tissue. All involved areas were
then covered with xenograft. Finally a split thickness skin graft of 0.015 inches in
depth was harvested using a dermatome from a separate donor site. A total of 85 sq
cm was recovered. What procedures codes would be reported service?
A. 15200, 15201 x 123, 15004, 15005, 15002, 15003

B. 15275, 15276 x 31, 15271, 15272 x 66, 15004, 15005 x 16, 15002, 15003 x 7

C. 15277, 15278 x 7, 15273, 15274 x 16, 15004, 15005 x 7, 15002, 15003 x 16, 15040

D. 15130, 15131 x 7, 15135, 15136 x 16, 15004, 15005 x 7, 15002, 15003 x 16

99. Procedure Diagnosis: Basal cell carcinoma, left chin. Procedure: Wide local
excision of
3.0 cm with 0.3 cm margin basal cell carcinoma of the left chin with a 4 cm closure.
Procedure: The patient’s left chin was examined. The site of intended excision was
marked out. The site was then prepped. The patient was then prepped and draped in
the usual fashion. A 15 blade scalpel was then used to make an incision in the
previously marked site. It was carried down to the subcuticular fat. The lesion was
then sharply dissected off underlying tissue bed using a 15-blade scalpel. It was
tagged for pathologic orientation. The hyfrecator was used for hemostasis. The
wound was then closed by advancing the tissue surrounding thelesion and closing in
layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin. The
skin closure was in a running subcuticular fashion. Steri-Strips were then applied.
What are the procedure and diagnosis codes?

A. 11644, 12052-51, C44.319

B. 11643, 12013-51, C44.319
C. 11444, 12052-51, D49.2
D. 11443, 12013-51, D49.2

100. PRE OP DIAGNOSIS: Left Breast Abnormal MMX or Palpable Mass; Other
DisordersOf Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast
FINDINGS: Lesion is located in the lateral region, just at or below the level of the
nipple on the 90 degree lateral view. There is a subglandular implant in place. I
discussed the procedurewith the patient today including risks, benefits and
alternatives. Specifically discussed was the fact that the implant would be displaced
out of the way during this biopsy procedure.
Possibility of injury to the implant was discussed with the patient. Patient has signed
the consent form and wishes to proceed with the biopsy. The patient was placed
prone on the stereotactic table; the left breast was then imaged from the inferior
approach. The lesion of interest is in the anterior portion of the breast away from the
implant which was displaced back toward the chest wall. After imaging was
obtained and stereotactic guidance used to target coordinates for the biopsy, the left
breast was prepped with Betadine. 1% lidocaine wasinjected subcutaneously for
local anesthetic. Additional lidocaine with epinephrine was then injected through the
indwelling needle. The SenoRx needle was then placed into the area of interest.
Under stereotactic guidance we obtained 9 core biopsy samples using vacuum and
cutting technique. The specimen radiograph confirmed representative sample of
calcification was removed. The tissue marking clip was deployed into the biopsy
cavity successfully. This was confirmed by final stereotactic digital image and
confirmed by post core biopsy mammogram left breast. The clip is visualized
projecting over the lateral anterior left breast in satisfactory position. No obvious
calcium is visible on the final post core biopsy image in the area of interest. The
patient tolerated the procedure well. There were no apparent
complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack
in the usual manner. The patient did receive written and verbal post-biopsy
instructions. The patientleft our department in good condition.
IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT BREAST
CALCIFICATIONS.
2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP INTO THE
BIOPSY CAVITY
3. PATIENT LEFT OUR DEPARTMENT IN GOOD CONDITION TODAY WITH POST-
BIOPSY INSTRUCTIONS.
4. PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTERWE
RECEIVE THE PATHOLOGY REPORT. What are the correct CPT codes?
A. 19081
B. 19101, 19081
C. 19100, 19283, 76942-26
D. 19283