Maharlika Academy

Mock Exam
1. Mohs surgery will be performed on a 56-year-old that has basal cell carcinoma on the neck. The
gross tumor was completely excised. Tissue was divided into two tissue blocks which were mapped
and color coded at their margins; frozen sectioning was performed. A full thickness graft was used to
harvest skin from the patient’s left axilla for an area of 5 sq cm. The appropriate CPT codes are:
A. 26115, 15260 C. 17311, 15240
B. 11600, 15240 D. 17313, 15260

2. A patient has a 4.3 cm x 2 cm lesion on the left thigh that was excised. Due to the size and location
of the lesion, the decision was made to harvest a full thickness skin graft from his left lower leg. An
excision of 5 cm x 5 cm full thickness graft was obtained and grafted onto the defect and sewn. The
pathology finding confirmed that the lesion was basal cell carcinoma. The CPT code(s) to report is
(are):
A. 14021 C. 11606, 15220-51, 15221
B. 11406, 15100-51 D. 11606, 15150-51

3. A 10-year-old who fell off her bike sustained a 7 cm laceration to her brow and an 8.5 cm
laceration to her upper arm. Her parents requested the suturing to be done by a plastic surgeon. The
left arm was irrigated and devitalized skin was sharply debrided. The subcutaneous fat, which had
been avulsed, was sharply debrided, as well. Fascial defects in the arm were reapproximated with 2-0
Vicryl sutures. A large good flap was tacked down with Vicryl sutures. A large portion of this wound
was unable to be covered. A wet-to-dry dressing was then placed over the wound and wrapped. The
facial laceration was then closed in multiple layers with 5-0 PDS and 5-0 fast-absorbing gut suture
with extensive undermining. The eyebrow was reapproximated. The wound was closed in layers to
achieve a good reapproximation. The CPT codes for this service are:
A. 12053, 12034-59 C. 13121, 12053-59, 13122
B. 12014, 12004-59 D. 13132, 13121-59, 13122

4. The patient has a torn medial meniscus. An arthroscope was placed through the anterolateral
portal for the diagnostic procedure. The patellofemoral joint showed some grade 2 chondromalacia
on the patella side of the joint only, and this was debrided with the 4.0-mm shaver. The medial
compartment was also entered and a complex posterior horn tear of the medial meniscus was noted.
It was probed to define its borders. A meniscectomy was carried out back to a stable rim. CPT codes
for this service are:
A. 29882 C. 29870, 29879-59
B. 29880, 29877-59 D. 29881

5. A 63-year-old man sustained a gunshot wound through the right maxillary sinus that penetrated
through the right neck. CT scan revealed no hard evidence of arterial injury but a bullet was directly
in line with the internal jugular vein. He was sent to the operating room for neck exploration to rule
out vascular injury and injury to the aero digestive tract. A sternocleidomastoid incision was
performed and carried down through the platysma muscle. There was no penetration of the internal
jugular vein, but a foreign body was identified resting on the internal jugular vein at approximately
the level of the angle of the mandible and removed. The parotid gland was noted to have a blast
injury near the tail. This was not surgically repaired or resected. Once all bleeding was controlled, a
10 French round drain was placed in the wound. The wound was copiously irrigated. The platysma
muscle was closed and the skin was closed with subcuticular closure. Select the appropriate CPT code
for this procedure:
A. 20525 C. 35201
B. 20100 D. 21899

6. A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture
while on vacation. The patient was put under general anesthesia and the elbow was reduced and was
stable. The medial elbow was held in the appropriate position and was reduced in acceptable position
and elevated to treat non-surgically. A long arm splint was applied. The patient is referred to an
orthopedist when she returns to her home state in a few days. What procedure codes should be
used?
A. 24575-54, 24615-54-51 C. 24577-54, 24600-54-51
B. 24576-54, 24620-54-51 D. 24565-54, 24605-54-51

7. A 77-year-old patient who was found to have a huge aneurysm underwent a coronary artery
bypass graft. A median sternotomy was made and the left internal mammary artery was harvested
from the left chest wall. The saphenous vein was harvested from the left leg and bypassed distally as
it ran in the left ventricular muscle. Next, a second saphenous vein segment was placed to the
diagonal vessel and then the left internal mammary artery was placed to the mid LAD. The LAD was
bypassed in the mid aspect of the LAD and good flow was measured in the graft. What CPT codes
describe this procedure?
A. 33533, 33518 C. 33534, 33518
B. 33510, 33517 D. 33511, 33517

8. The patient is an 83-year-old female with a new onset of atrial fibrillation that has developed into a
tachy-brady syndrome. Her cardiologist decided to insert a pacemaker. The left chest was incised and
a subcutaneous pocket was formed above the fascia. The left subclavian vein was accessed with an
18 gauge needle times two. The atrial and ventricular leads were then placed through the sheaths,
positioned and secured to the pectoral fascia. The pacemaker leads were then connected to the
pacemaker coiled and placed in the previously made pocket. What CPT code describes this
procedure?
A. 33213 C. 33208
B. 33217 D. 33206

9. A 45-year-old’s blood pressure was progressively trending downward, and it was determined that
an emergent central venous access was needed for fluid resuscitation. A non-tunneled catheter was
used to access the subclavian vein and secured into place to infuse medication. Due to the patient's
low blood pressure and anticipated need for vasopressor agents, a radial arterial line was also
desired. The left radial artery pulse was easily palpable, and the skin was punctured by a needle and
the Angiocatheter was placed in the left wrist. What are the codes for these procedures?
A. 36555, 36625-51 C. 36558, 36640-51
B. 36556, 36620 D. 36569, 36620

10. 55-year-old patient underwent a repair of an initial left inguinal hernia. An incision was made at
the groin and a hernia sac was readily identified and cleared from the surrounding tissue and inverted
into the preperitoneal space and plugged. Mesh was tacked to the surrounding muscle layers then
placed over the entire floor. The correct CPT code(s) is (are):
A. 49500 C. 49505, 49568
B. 49505 D. 49650, 49658

11. A 79-year-old male has acute cholecystitis and abnormal liver function test. He has elected to go
in for surgery. A laparoscope was placed through an epigastric incision with the insertion of two
lateral 5 mm ports. The gallbladder was elevated and the cystic duct was located and dissected out.
In the process of transecting the duct the gallbladder tore and several gallstones were released and
these were removed with a gallstone retriever along with the removal of the gallbladder. The cystic
duct stump was tied off and the common bile duct was incised and a large stone was seen and
removed. The common bile duct is closed connected to a drainage tube placed outside of the
abdomen wall into a bowel bag. What are the codes for this procedure?
A. 47420, 47562-51 C. 47420, 47564-51
B. 47480, 47564-51 D. 47480, 47562-51

12. An elderly gentleman presented with a high-grade small bowel obstruction. A midline abdominal
incision was done encountering fairly dense adhesions. Using a combination of sharp dissection and
electrocautery, a full adhesiolysis was done on several of adhesions up to the anterior abdominal
wall, which appeared to be the culprit for this patient’s small bowel obstruction. In dissecting out this
mat of adhesions, an enterotomy was made performing a limited small bowel resection, dividing the
intervening mesentery and a double-stapled anastomosis. What CPT code(s) describe(s) the
procedure?
A. 44120, 44005-51 C. 44120
B. 44125 D. 44130, 44005-51

13. A 55-year-old female presents with right hydronephrosis. A 23 French cystoscope is introduced
into the urethra and passed into the bladder. The bladder was carefully inspected no tumors or
stones were visualized. The first effluxed urine from the bladder was sent for urine cytology. Then a 6
French access catheter was passed into the right ureteral orifice requiring a 0.35 guide wire to help
cannulate the right ureteral orifice because of the angulation. There was some stiffness in the
intramural portion of the ureter, and then the catheter popped through into a more dilated ureter.
Contrast was injected and there were no filling defects, fixed tumors, or stones noted. There was mild
hydroureteral nephrosis against the bladder. The renal pelvis was barbotaged with saline and the
renal pelvis urine was drained and sent to pathology for urine cytology. After the retrograde
pyelogram was performed the access catheter was removed and there was brisk efflux of the
contrast and drained very well. The bladder was then drained and the patient was awakened and
transferred in stable condition to the recovery room. What CPT code should be reported?
A. 52005 C. 52010
B. 52327 D. 52281

14. A 65-year-old male presents with a medium size bladder tumor on the posterior wall of the
bladder behind the trigone and has an elevated PSA. Six needle biopsies of the right and left lobe of
the prostate were performed. Each biopsy core was performed under transrectal ultrasound
guidance and sent for pathologic review. Then using the cutting mode of the Bovie through the loop a
resection was performed on 2.2 cm bladder tumor. The procedure is performed in an ASC. Which CPT
codes should be used for the physician’s services?
A. 55700, 52234-51, 76942-26 C. 55706, 52315-51
B. 55706, 52310-51 D. 55700, 52235-51, 76942-26

15. A pregnant patient delivers twins at 30 weeks gestation. The first baby is delivered vaginally, but
during this delivery, the second baby has turned into the transverse position during labor. The
decision is made to perform a cesarean to deliver the second baby. Both babies are healthy. The
physician performing the deliveries also performed the prenatal and postpartum care. Code the
procedure and diagnosis codes.
A. 59400, 59514, O30.003, O32.0XX2, Z37.2
B. 59510, 59409-51, O30.003, O32.0XX2, Z37.2
C. 59510-22, O30.003, O64.9XX0, O32.0XX2, Z37.2
D. 59510, 59409-51, O30.003, O64.0XX0, Z37.2
16. A 30-year-old male has displacement of the lumbar intervertebral disc. Under fluoroscopic
guidance, the affected nerve in the facet joints of the lumbar region was destroyed by a neurolytic
agent in the right segmental medial branches of L3, L4, and L5. Select the procedure codes.
A. 64493, 64494, 64495 C. 64483, 64484-51 x 2
B. 64635, 64636 x 2 D. 64633, 64634 x 2

17. A patient has spinal stenosis and disk displacement in the L3-L4 and L4-L5 and underwent a
removal of the posterior arch of a vertebra to provide additional space for the nerves and widen the
spinal canal. The back was prepped and an incision was made down to the deep fascia and the
spinous processes of L5, L4 and L3 were identified performing the laminectomy of L4 up to L3 and a
resection of the flavum ligament. There was resection of the facet and decompression was carried
out laterally to the level of the medial border of the pedicle. Foraminotomies of L3-4 and L4-5 were
performed with the Kerrison punch and there was plenty of room for the nerve roots to exit in these
regions with no further stenosis above or below this area. What procedure code(s) should be used?
A. 63047, 63048 C. 63017
B. 63042, 63044 D. 63005

18. Parents of a three-year-old male who has been having chronic serous otitis media in the right ear
have consented to surgery. Patient is placed under general anesthesia and the physician makes an
incision in the tympanic membrane. Fluid is suctioned out from the middle ear and a ventilating tube
is placed in the ear to provide a drainage route to help reduce middle ear infections. What CPT and
ICD-10-CM codes should be reported?
A. 69420-RT, 69433-51-RT, H65.20 C. 69421-RT, 69436-51-RT, H65.20
B. 69421-RT, 69436-50, H65.90 D. 69420-RT, 69433-RT, H65.00

19. A 33-year-old white male was admitted to the hospital on 12/17/XX from the ER, following a
motor vehicle accident, to have a splenectomy done. Patient is being discharged from the hospital on
12/20/XX. During his hospitalization he was experiencing pain and shortness of breath, but with an
antibiotic regimen of Levaquin, he improved. Physician performed final examination and reviewed
chest X-ray that revealed possible infiltrates and a CT of the abdomen that ruled out any abscess. He
was given a prescription of Zosyn. Patient told to follow up care with PCP or return back to the
hospital for any pain or bleeding. Physician spent 20 minutes. Select the appropriate CPT code for
12/20 visit:
A. 99283 C. 99231
B. 99221 D. 99238

20. The physician was notified to go to the hospital floor for medical management of a 56-year-old
patient admitted one day ago for aspiration pneumonia and COPD. An expanded problem focused
history was documented indicating no chest pain at present, but still SOB and some swelling in his
lower extremities. Was tachypenic yesterday; lungs reveal course crackles in both bases, right worse
than left. MDM was moderate with the continuation of intravenous antibiotic treatment and
respiratory support, reviewed chest X-ray and labs. Patient is improving and a pulmonary
consultation has been requested. What CPT code should be reported?
A. 99221 C. 99218
B. 99231 D. 99232

21. Established patient presents to the office with a recurrence of bursitis in both shoulders.
Examination is only limited to the shoulder in which range of motion is good and full, but he has
tenderness in the subdeltoid bursa. Both shoulders were injected in the deltoid bursa with 120mg
Depo-Medrol. Select the appropriate CPT code for this visit:
A. 99212-25, 20610-50 C. 99211-25, 20610 x 2
B. 20610-50 D. 20550-50
22. A 75-year-old established patient is brought in by his son to have a physical screening done to be
enrolled in a group home. No new complaints. The patient has an established diagnosis of Cerebral
Palsy and Type II Diabetes and is currently on his meds. A comprehensive history and examination is
performed along with a moderate MDM. Blood work was ordered. PPD was done and flu vaccine
given. Patient already had a vision exam. No abnormal historical facts or finding are noted. What CPT
code should be reported?
A. 99397 C. 99214
B. 99387 D. 99215

23. A 90- year-old was admitted in the observation unit yesterday with chest pressure and difficulty
breathing. The next day the ER physician, now on call, reviews the last set of lab orders and
echocardiogram that was ordered. The tests come back normal. MI protocol was ruled out. Patient is
pain free and vitals are normal. Patient is being discharged, is already on Lasix and Coumadin and was
told to follow up with her cardiologist. Select the appropriate CPT code for the next day visit:
A. 99283 C. 99233
B. 99217 D. 99238

24. A 10-month-old child is taken to the operating room for removal of a laryngeal mass. What is the
appropriate anesthesia code?
A. 00320
B. 00326
C. 00320, 99100
D. 00326, 99100

25. A patient is having knee replacement surgery. The surgeon requests that in addition to the
general anesthesia for the procedure, the anesthesiologist also insert a lumbar epidural for
continuous infusion postoperative pain management. The anesthesiologist performs postoperative
management for two postoperative days.
A. 01400-AA, 62326 C. 01402-AA, 62326, 01996 x 2
B. 01402-AA, 01996 x 2 D. 01400-AA, 62311

26. PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE DIAGNOSIS:

Multivessel coronary artery disease.
NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the LAD,
saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal. The patient is
placed on heart and lung bypass during the procedure. Anesthesia time: 6:00 PM to 12:00 AM
Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and anesthesia time?
A. 00567, 6 hours C. 00567, 5 hours and 30 minutes
B. 00566, 6 hours D. 00566, 5 hours and 30 minutes

27. A physician manages radiation therapy treatments for a patient with small cell lung cancer, who is
receiving 18 MeV external beam applications with one port and two blocks. Which CPT code should
be used to report the radiation therapy services?
A. 77402 C. 77385
B. 77412 D. 77401
28. A complete B-scan ultrasound without duplex Doppler of the kidney is performed on a patient
following a kidney transplant. The service is performed in the physician’s office. Which CPT code is
reported for this procedure?
A. 76776 C. 76775
B. 76775-26 D. 76856-26

29. A 6-year-old patient who has been admitted requires a tunneled PICC insertion. The physician
uses ultrasound guidance to perform the insertion. Select the codes for the physician’s services.
A. 36569, 76937-26 C. 36569, 76942-26
B. 36568, 77001-26 D. 36558, 77001-26

30. A 32-year-old patient with a history of illegal drug use arrives at the ER in a coma. The treating
physician orders a presumptive multiple class drug using thin layer chromatography to screen and
detect the presence of drugs. The report comes back positive for opiates. The physician orders a drug
confirmatory test. The correct CPT codes for the laboratory tests are:
A. 80305, 80362 C. 80300, 80361
B. 80306, 80362 D. 80307, 80361

31. A surgical removal of two skin lesions, one being a pigmented nodule measuring 2 cm x 2.5 cm on
the left upper back and the second lesion an inclusion cyst measuring 2.5 cm x 3 cm in the middle of
the back. Both specimens were placed in individual containers to surgical pathology for gross and
microscopic examination.
A. 88304 x 2 C. 88304, 88305
B. 88305 x 2 D. 88304 x 2, 88329

32. An established patient comes in complaining of nausea and vomiting and states she has not
gotten her menstrual period. A complete CBC and automated differential WBC was ordered. Also
Hepatitis B antigen, Rubella, RPR, Antibody Screen, Blood Typing for Rh and ABO along with a urine
pregnancy test. The correct CPT code(s) for the laboratory service(s) is (are):
A. 80055
B. 85004, 87340, 86762, 86592, 86850, 86900, 86901, 81025
C. 80055, 81025
D. 85025, 87340, 86762, 86592, 86850, 86900, 86901

33. A 65-year-old stumbled and tripped in her home landing on her side, injuring her left hip. The ER
physician gets the X-ray back showing there is anterior dislocation of the left hip. Consent has been
given for sedation for the reduction of the hip. The ER physician administered Ketamine (IV) and a
nurse was there to assist in the monitoring of the patient for duration of 30 minutes. Abduction was
performed on the right hip and reduction was successful by the ER physician. Upon recovery from
sedation, the patient states she feels better. The CPT codes the ER physician reports are:
A. 27252-54, 99149
B. 27266-54
C. 27250-54, 99152
D. 27257-54

34. A 65-year-old male went into atrial fibrillation in the ER. Anti-arrhythmic drugs fail to convert the
heart back to normal sinus rhythm. A single 150 joule synchronized biphasic shock using AP paddles
did restore him to sinus rhythm in the 80s. He tolerated it well. He will be observed for a couple
hours and discharged home later today.
A. 92971
B. 92960
C. 92953
D. 92950

35. A patient with advanced gastric cancer receives palliative chemotherapy using Adriamycin for 1
hour and 35 minutes. The patient first receives IV infusion of 1000 cc of D-5-W for hydration for 40
minutes before the chemo.
A. 96401, 96360, 96361
B. 96413, 96415, 96361
C. 96422, 96423, 96361
D. 96409, 96411, 96361

36. A 45-year-old construction worker requires a physical performance evaluation to determine if he

can tolerate the demands of returning to work after a wrist and knee injury. The physical therapist
evaluated all records he had on the patient. He had the patient participate in a functional capacity
evaluation for a two hour period in one day. The data during the test was collected and prepared in a
written report. The CPT code for this service is:
A. 97750 x 8
B. 97755 x 8
C. 97760 x 8
D. 97799

37. Sebaceous glands are a part of which anatomical system?

A. Circulatory
B. Endocrine
C. Genitourinary
D. Integumentary

38. Complete this series: Incus, stapes, __________.

A. Radius
B. Isthmus
C. Meatus
D. Malleus

39. The patient is reported to have hives in his epigastric region. Where are the hives?
A. Between ribs and buttocks
B. Between inguinal region and umbilicus
C. Between neck and axilla
D. Between umbilicus and sternum

40. Which of the following is a renal calculus?

A. Pyelectasia
B. Hydroureter
C. Nephrolithiasis
D. Pyonephrosis

41. The patient has a significant visual impairment due to astigmatism in the left eye. It is corrected
with glasses. The right eye has normal vision. Code the patient’s condition based on this information.
A. H52.209, H54.52A1
B. H52.209
C. H52.229 , H54.52A1
D. H54.50 , H52.209

42. The site of the patient’s cellulitis is within the fold of redundant skin in his apron of fat. It covers
approximately 20 cm of skin. A swab from the site was cultured and found to be methicillin resistant
staphylococcus aureus.
A. B95.61
B. L03.90, B95.61
C. L03.319 , B95.62
D. L02.221, B95.62

43. Patient with thyroid cancer has fever and found to have chemo drug induced agranulocytosis
A. D72.0, T36.91XA, C73, R50.81
B. D70.1, T45.1X1A, C73
C. R50.81, J34.81, K92.81
D. D70.1, T45.1X5A, C73, R50.81

44. The patient just turned 50 and is here today for a screening colonoscopy. During the procedure,
two polyps are found and removed with a snare technique. How would this be reported?
A. Z12.11, K63.5
B. K63.5
C. Z12.11
D. K63.5, Z12.11

45. Type 1 diabetic patient is brought to the ER by ambulance in a coma. Patient is pale, rapid
heartbeat, and their face is covered in sweat. Physician finds the insulin pump not delivering insulin
and after reviewing the lab's diagnosis the patient with diabetic ketoacidosis with diabetic coma.
______
A. T85.614A, T38.3X1A, E10.641
B. T85.614A, T38.3X6A, E10.11
C. E10.11, T85.614A, T38.3X6A
D. T85.614A, T38.3X6A, E11.641

46. A 35 year old woman is brought by ambulance to the ED. She was a passenger in a motor vehicle
accident that involved another car and occurred on the exit ramp of the Palisades Parkway. The
diagnosis is diffuse traumatic brain injury due to fracture of frontal bone. She was unconscious for 45
minutes. What ICD-10-CM code(s) are reported?
A. S06.2X2, S02.0XXA, V43.01XA, Y92.412
B. S06.2X2A, S02.0XXA, V43.62XA, Y92.412
C. S06.2X2A, S02.0XXA, V43.62XA, Y92.415
D. S06.2X2, S02.0XXA, V43.12XA, Y92.411

47. A 55 y/o patient underwent a repair of an initial left inguinal hernia. An incision was made at the
groin and a hernia sac was readily identified and cleared from the surrounding tissue, and inverted
into the peritoneal space and plugged. Mesh was tacked to the surrounding muscle layers, and then
placed over the entire floor.The correct CPT code(s) is (are):
A. 49500 – LT
B. 49505 – LT
C. 49505 – LT, 49568
D. 49650 – LT, 49568

48. Dr. Howitzer sees Mrs. Jones in Clinic Eight for sudden loss of consciousness while watching the
Olympic Torch go by. He is a new provider to the neurology department. Dr. Drake Rinaldi, a
prominent member of the neurology faculty at the university saw Mrs. Jones last month. Dr. Howitzer
performs a history including 3 HPI elements and 2 ROS, a detailed exam and has medical decision
making of high complexity. The final diagnosis given is transient loss of consciousness. The patient
makes a follow-up appointment to see Dr. Rinaldi in one week. What is the appropriate E/M code for
this visit?
A.99214
B.99213
C.99203
D.99204

49. A patient with adenocarcinoma of the larynx has developed cervical adenopathy and is
undergoing an excisional biopsy of the right cervical node.An excision is made above the clavicle and
dissection taken down into the muscle. Blunt dissection was used to work the way down to the node
which was firm and white. The entire node was taken and the wound was closed.
A. 38500
B. 38510
C. 38520
D. 38542

50. If an AMI is documented as nontransmural or subendocardial, but the site is provided, how is it
reported, according to ICD-10-CM guidelines?
A. As unspecified
B. As a subendocardial AMI
C. As STEMI
D. As NSTEMI