MOCK 12

CODING GUIDLINES
1. What statement is true when reporting pregnancy codes :

A. These codes can be used on the maternal and baby records.

B. These codes have sequencing priority over codes from other chapters.
C. Code O80.0 should always be reported with these codes.
D. The fifth digits assigned to these codes indicate the complication during the pregnancy

2. Which of the following is true regarding ICD-10-CM codes with the words “in diseases
classified elsewhere” in their descriptions?

A. They can never be the first listed code.

B. They should always be the first listed code.
C. They are unspecified codes and should be used only when more specific diagnoses cannot be
found.
D. None of the above.

3. Which of the following statements is true regarding sequencing of External cause codes?

A. External cause codes for place of occurrence take priority over all other External cause codes.
B. External cause codes for medical history take priority over all other External cause codes.
C. External cause codes identifying screening exam as the reason for encounter take priority over all
other External cause codes.
D. External cause codes for transport accidents take priority over all other External cause codes
except cataclysmic events and child and adult abuse and terrorism.

4. Which statement is true about Z codes:

A. Z codes are never reported as a primary code

B. Z codes are only reported with injury codes
C. Z codes may be used either as primary code or secondary code
D. Z codes do not have to correspond with procedure codes

5. Which of the following is an example of a case in which a diabetes-related problem exists and the
code for diabetes is never sequenced first?

A. If the patient has an under dose of insulin due to an insulin pump malfunction
B. If the patient is being treated for secondary diabetes
C. If the patient is being treated for Type II diabetes
D. If the patient has hyperglycemia that is not responding to medication
6. If an AMI is documented as nontrans mural or subendocardial, but the site is provided, how is it
reported, according to ICD-10-CM guidelines?

A. As unspecified C. As STEMI
B. As a subendocardial AMI D. As NSTEMI
7. Which place of service code should be reported on the physician’s claim for a surgical procedure
performed in an ASC?

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

INTEGUMENTARY SYSTEM
8. Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area
of skin where the excisions of the tumor will be performed using Mohs micrographic surgery
technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed
in the first stage. Then a second stage had six tissue blocks which were also cut and stained for
microscopic examination. The entire base and margins of the excised pieces of tissue were examined
by the surgeon. No tumor was identified after the final stage of the microscopically controlled
surgery.

What procedure codes should be reported?

A. 17313, 17314 x 2 C. 17260, 17313, 17314

B. 17313, 17315 D. 17313,17314, 17315

9. 45-year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and
have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm
was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary
defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfers of 3 sq cm
was taken from the nasolabial fold and was advanced into the primary defect. Which CPT code(s)
should be used?

A. 14060 C. 11642, 15115

B. 11642, 14060 D. 15574

10. 53-year-old male for removal of 2 lesions located on his nose and lower lip. Lesions were
identified and marked. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area.
The lower lip lesion of 4mm in size was shaved to the level of the superficial dermis. What are the
codes for these procedures?

A. 11104,11310 - 51 C. 17000, 17003

B. 11102,11310 D. 11440, 11310-51

11. 46-year-old female had a previous biopsy that indicated positive margins anteriorly on the right
side of her neck. A 0.5 cm margin was drawn out and a 15-blade scalpel was used for full excision of
an 8cm lesion. Light undermining of all margins was performed along with layered closure. The
specimen was sent for permanent histopathologic examination. What is the code(s) for this
procedure?

A. 11426 B. 11626 C. 11626, 12044-51 D. 11426, 13132, 13133

12. 30-year-old female is having debridement performed on an infected ulcer with eschar on the
right foot. Using sharp dissection, the ulcer and eschar infection was debrided all the way to down to
the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of
the metatarsal. After debriding the area, there was minimal bleeding because of very poor
circulation of the foot. It seems that the toes next to the ulcer may have some involvement and
cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What
CPT code should be reported?

A. 11000 B. 11011 C. 11044 D. 15004

13. 64-year-old female who has multiple sclerosis fell from her walker and landed on a glass table.
She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her
right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot
had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead,
cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with
6-0 Prolene sutures. The arm and leg were repaired by 6-0 Vicryl subcutaneous sutures and prolene
sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate
procedure codes for this visit.

A. 12014, 12034-51, 12002-51, 11041-51 B. 12053, 12034-51, 12002-51

C. 12014, 12034-51, 11041-51 D. 12053, 12034-51

MUSCULOSKELETAL SYSTEM
14. 52-year-old female has a mass growing on her right flank for several years. It has finally gotten
significantly larger and is beginning to bother her. She is brought to the Operating Room for
definitive excision. An incision was made directly overlying the mass. The mass was down into the
subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4
centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery.

What CPT should be reported?

A. 21932, D17.9 B. 21935, D17.1 C. 21931, D17.1 D. 21925, R19.09

15. 42-year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal
in the glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV
changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus.
The biceps were inflamed, not torn at all. The superior labrum was not torn at all, the labrum was
completely intact. The rotator cuff was completely intact. An anterior portal was established high in
the rotator interval. The rotator interval was very thick and contracted and this was released with
electrocautery and the Bovie including the superior glenohumeral ligament. After this was all
released, the middle glenohumeral ligament was released as well as the tendinous portion of the
subscapularis. After this was all done with a shaver and electrocautery, the arthroscope was placed
anteriorly and the shaver and used to debride some of the posterior capsule and the posterior
capsule was released in its posterosuperior and then posteroinferior aspect. After this was done, the
arthroscope was then placed back posteriorly and used to release the anteroinferior capsule down
to 6’oclock. This was done with electrocautery. The arthroscope was then placed anteriorly and used
to release the posteroinferior capsule. The arthroscope was then placed anteriorly and used to
release the posteroinferior capsule. The arthroscope was then placed back posteriorly and used to
confirm that there was still one little strip of capsule around the biceps superiorly and there was one
little strip from 6-7 o’clock posteroinferiorly that was only partially cut. The rest of the capsule was
completely circumferentially released. What CPT code describes this procedure?

A. 23450-LT C. 29805-LT, 29806-51-LT

B. 23466-LT D. 29825-LT

16. PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and
internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought
to the operating room; anesthesia having been administered. The right upper extremity was
prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic
arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist.
Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The
interval between the second and third dorsal compartment tendons was identified and entered. The
respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was
visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045
Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid
distal ward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak drill
bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was
accomplished in this fashion. This was visualized under the OEC imaging device in multiple
projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The
patient tolerated the procedure well and left the operating room in stable condition. What code
should be used for this procedure?

A. 25628-RT B. 25624-RT C. 25645-RT D. 25651-RT

17. An infant with genu valgum is brought to the operating room to have a bilateral medial distal
femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate.
With the growth plate localized, an incision was made medially on both sides. This was taken down
to the fascia, which was opened. The periosteum was not opened. The Orthofix figure-of-eight plate
was placed and checked with x-ray. We then irrigated and closed the medial fascia with 0 Vicryl
suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl. What procedure code should be used?

A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50

18. The patient is a 66-year-old female who presents with Dupuytren's disease in the right palm and
ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar
fasciectomy for Dupuytren's disease right ring digit and palm. An extensible Brunner incision was
then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed
a
large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of
the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the
metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing
toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised.

What procedure code should be used?

A. 26123-RT, 26125 C. 26035-RT

B. 26121-RT D. 26040-RT

19. This is a 32-year-old female who presents today with sacroilitis. On the physical exam there was
pain on palpation of the left sacroiliac joint and imaging confirmation was done for the needle
positioning. Then 80 mg of Depo-Medrol and 1 mL of bupivacaine at 0.5% was injected into the left
sacroiliac joint with a 22-gauge needle. The patient was able to walk from the exam room without
difficulty. Follow up will be as needed. The correct CPT code is:

A. 20610, 77003-26 C. 27096-LT

B. 20551 D. 20555

RESPIRATORY & CARDIOVASCULAR SYSTEM

20. The patient is a 77-year-old white female who has been having right temporal pain and
headaches with some visual changes and has a sed rate of 51. She is scheduled for a temporal artery
biopsy to rule out temporal arteritis. A Doppler probe was used to isolate the temporal artery and
using a marking pen the path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin,
and using a 15-blade scalpel the skin was opened in the preauricular area and dissected down to the
subcutaneous tissue where the temporal artery was identified in its bed. It was a medium size artery
and we dissected it out for a length of approximately 4 cm with some branches. The ends were
ligated with 4-0 Vicryl, and the artery was removed from its bed and sent to Pathology as specimen.

What code should be used for this procedure?

A. 37609 C. 36625
B. 37605 D. 37799

21. The patient is a fifty-eight-year-old white male, one month status post pneumonectomy. He had
a post pneumonectomy empyema treated with a tunneled cuffed pleural catheter which has been
draining the cavity for one month with clear drainage. He has had no evidence of a block or pleural
fistula. Therefore, a planned return to surgery results in the removal of the catheter. The correct
CPT code is:

A. 32440-78 C. 32036-79
B. 32035-58 D. 32552-58

22. 79-year-old male with symptomatic bradycardia and syncope is taken to the Operating Suite
where an insertion of a DDD pacemaker will be performed. A left subclavian venipuncture was
carried out. A guide wire was passed through the needle, and the needle was withdrawn. A second
subclavian venipuncture was performed, a second guide wire was passed and the second needle was
withdrawn. An oblique incision in the deltopectoral area incorporating the wire exit sites. A
subcutaneous pocket was created with the cautery on the pectoralis fascia. An introducer dilator
was passed over the first wire and the wire and dilator were withdrawn. A ventricular lead was
passed through the introducer, and the introducer was broken away in the routine fashion. A second
introducer dilator was passed over the second guide wire and the wire and dilator were withdrawn.
An atrial lead was passed through the introducer and the introducer was broken away in the routine
fashion. Each of the leads were sutured down to the chest wall with two 2-0 silk sutures each,
connected the leads to the generator, curled the leads, and the generator was placed in the pocket.
We assured hemostasis. We assured good position with the fluoroscopy. What code should be used
for this procedure?

A. 33208, 71090-26 C. 33226

B. 33212 D. 33235, 71090-26

23. The patient is a 59-year-old white male who underwent carotid endarterectomy for symptomatic
left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid
artery stenosis extending into the common carotid artery. He is taken to the operating room for
redo left carotid endarterectomy. The left neck was prepped and the previous incision was carefully
reopened. Using sharp dissection, the common carotid artery and its branches were dissected free.
The patient was systematically heparinized and after a few minutes clamps applied to the common
carotid artery and its branches. A longitudinal arteriotomy was carried out with findings of extensive
layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastic balloon-tip
shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima
were removed and the endarterectomized surfaces irrigated with heparinized saline. An oval Dacron
patch was then sewn into place with running 6-0 Prolene. Which CPT code should be used?

A. 35301 B. 35301, 35390

C. 35302 D. 35311, 35390

24. A CT scan identified moderate-sized right pleural effusion in a 50-year-old male. This was
estimated to be 800 cc in size and had an appearance of fluid on the CT scan. A surgical puncture
using an aspirating needle punctured through the chest tissues and entered the pleural cavity. Fluid
was aspirated, draining the effusion under ultrasound guidance using 1% lidocaine as local
anesthetic.

What procedure code should be used?

A. 32555 B. 32554, 76942

C. 32555, 76942 D. 32550, 76942

25. The patient is a 67 -year-old gentleman with metastatic colon cancer recently operated on for a
brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left
subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the
proper position fluoroscopically. A transverse incision was made just inferior to this and a
subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over
the guide wire and the power port line was placed with the introducer and the introducer was
peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the
catheter trimmed to the appropriate length and secured to the power port device. The locking
mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat
very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What
code should be used for this procedure?

A. 36556, 77001-26 B. 36558

C. 36561, 77001-26 D. 36571

DIGESTIVE SYSTEM

26. A 52-year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic
cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting
to the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a
scope was placed into the abdomen. Three other ports were inserted under direct vision. The fundus
of the gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder
were taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was
carried out to the right of this identifying a small cystic duct and artery, was clipped twice proximally,
once distally and transected. The gallbladder was then taken down from the bed using
electrocautery, delivering it into an endo-bag and removing it from the abdominal cavity with the
umbilical port. What CPT and ICD-9 codes should be reported?

A. 47564, K80.18 B. 47562, K81.1

C. 47610, K80.64 D. 47600, K81.9

27. The patient is a 50-year-old gentleman who presented to the emergency room with signs and
symptoms of acute appendicitis with possible rupture. He has been brought to the operating room.
An infraumbilical incision was made which a 5-mm VersaStep trocar was inserted. A 5-mm 0- degree
laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar
in the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no
rupture noted. The base of the appendix was then divided and placed into an Endo-catch bag and
the 12-mm defect was brought out. Select the appropriate code for this visit:

A. 44970 B. 44950 C. 44960 D. 44979

28. An 82-year-old female had a CAT scan which revealed evidence of a proximal small bowel
obstruction. She was taken to the Operating Room where an elliptical abdominal incision was made,
excising the skin and subcutaneous tissue. There were extensive adhesions along the entire length of
the small bowel: the omentum and bowel were stuck up to the anterior abdominal wall. Time-
consuming tedious lysis of adhesions was performed to free up the entire length of the
gastrointestinal tract from the ligament to Treitz to the ileocolic anastomosis. The correct CPT code
is:

A. 44005 C. 44005-22
B. 44180-22 D. 44180-59

29. 55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with
a catheter placement. The endoscope is passed through the cricopharyngeal muscle area without
difficulty. Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted.
Stomach significant distention with what appears to be multiple encapsulated tablets in the stomach
at least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be
engaged due to high-grade narrowing in the pyloric channel. It seems to be a high-grade outlet
obstruction with a superimposed volvulus. What code should be used for this procedure?

A. 43246-52 C. 43235
B. 43241-52 D. 43234

30. The patient is a 78-year-old white female with morbid obesity that presented with small bowel
obstruction. She had surgery approximately one week ago and underwent exploration, which
required a small bowel resection of the terminal ileum and anastomosis leaving her with a large
inferior ventral hernia. Two days ago, she started having drainage from her wound which has
become more serious. She is now being taken back to the operating room. Reopening the original
incision with a scalpel, the intestine was examined and the anastomosis was reopened, excised at
both ends, and further excision of intestine. The fresh ends were created to perform another end-
to-end anastomosis. The correct procedure code is:

A. 44120-78 C. 44120-76
B. 44126-79 D. 44202-58

31. 15-year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied
tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was
digitalized. No significant adenoid tissue was felt. The tonsils were then removed bilaterally by
dissection. The uvula was a huge size because of edema, a part of this was removed and the raw
surface oversewn with 3-0 chromic catgut. Which CPT code(s) should be used?

A. 42821 C. 42826, 42106-51

B. 42825, 42104-51 D. 42842

URINARY, MALE & FEMALE REPRODUCTIVE SYSTEM

32. 25-year-old female in the OR for ectopic pregnancy. Once the trocars were place a
pneumoperitoneum was created and the laparoscope introduced. The left fallopian tube was dilated
and was bleeding. The left ovary was normal. The uterus was of normal size, shape and contour. The
right ovary and tube were normal. Due to the patient’s body habitus the adnexa could not be
visualized to start the surgery. At this point the laparoscopic approach was terminated. The
pneumoperitoneum was deflated, and trocar sites were sutured closed. The trocars and
laparoscopic instruments had been removed. Open surgery was performed incising a previous
transverse scar from a cesarean section. The gestation site was bleeding and all products of
conception and clots were removed. The left tube was grasped, clamped and removed in its entirety
and passed off to pathology. What code(s) should be used for this procedure?

A. 59150, 59120 C. 59121

B. 59151 D. 59120

33. 23-year-old who is pregnant at 39 weeks and 3 days is presenting for a low transverse cesarean
section. An abdominal incision is made and was extended superiorly and inferiorly with good
visualization of the bladder. The bladder blade was then inserted and the lower uterine segment
incised in a transverse fashion with the scalpel. The bladder blade was removed and the infant's
head delivered atraumatically. The nose and mouth were suctioned with the bulb suction trap and
the cord doubly clamped and cut. The placenta was then removed manually. What code should be
reported for this procedure?

A. 59610, O34.211, Z37.0 B. C. 59514, O82, Z37.0

59510, O64.1XX0, Z37.0 D. 59515, O82, Z37.0

34. 45-year-old male is going to donate his kidney to his son. Operating ports were placed in
standard position and the scope was inserted. Dissection of the renal artery and vein was performed
isolating the kidney. The kidney was suspended only by the renal artery and vein as well as the
ureter. A stapler was used to divide the vein just above the aorta and three clips across the ureter,
extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT code is:

A. 50543 B. 50547 C. 50300 D. 50320

35. 67-year-old female having urinary incontinence with intrinsic sphincter deficiency is having a
cystoscopy performed with a placement of a sling. An incision was made over the mid urethra
dissected laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The
edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic
incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What
code should be used for this procedure?

A. 57288 B. 57287 C. 52000, 57288 D. 52000, 51992

36. 16-day-year old male baby is in the OR for a repeat circumcision due to redundant foreskin that
caused circumferential scarring from the original circumcision. Anesthetic was injected and an
incision was made at base of the foreskin. Foreskin was pulled back and the excess foreskin was
taken off and the two raw skin surfaces were sutured together to create a circumferential
anastomosis. Select the appropriate code for this surgery:
 A. 54150 B. 54160 C. 54163 D. 54164

37. 5-year-old female has a history of post void dribbling. She was found to have extensive labial
adhesions, which have been unresponsive to topical medical management. She is brought to the
operating suite in a supine position. Under general anesthesia the labia majora is retracted and the
granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent
granulation tissue was excised on either side. What code should be used for this procedure?

A. 58660 B. 58740 C. 57061 D. 56441

NERVOUS SYSTEM, EYE & EAR

38. The patient is a 73-year-old gentleman who was noted to have progressive gait instability over
the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was
recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt
placement with Codman programmable valve. What is the correct code for this surgery?

A. 62220 B. 62223 C. 62190 D. 62192

39. What is the CPT code for the decompression of the median nerve found in the space in the wrist
on the palmar side?

A. 64704 B. 64713 C. 64721 D. 64719

40. 2-year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was
placed under general anesthesia. With an #11 blade the chalazion was incised and a small curette
was then used to retrieve any granulomatous material on both lids. What code should be used for
this procedure?

A. 67801 B. 67805 C. 67800 D. 67808

41. MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical
laminectomy at C3 through C6 and fusion. The edges of the laminectomy were then cleaned up with
a Kerrison and foraminotomies were done at C4, C5, and,,C6. The stenosis is central: a facetectomy
is performed by using a burr. Nerve root canals were freed by additional resection of the facet, and
compression of the spinal cord was relieved by removal of a tissue overgrowth around the foramen.

Which CPT codes should be used for this procedure?

A. 63045-50, 63048-50 C. 63015-50

B. 63020-50, 63035-50, 63035-50 D. 63045, 63048 x 3
42. An infant who has chronic otitis media was placed under general anesthesia and a radial incision
was made in the posterior quadrant of the left tympanic membrane. A large amount of mucoid
effusion was suctioned and then a ventilating tube was placed in both ears. What CPT and ICD-10-
CM codes should be reported?

A. 69436-50, H65.32 B. C. 69433-50, H65.32

69436-50, H65.22 D. 69421-50, H65.22

43. A craniectomy is being performed on a patient who has Chiari malformation. Once the posterior
inferior scalp was removed a C-1 and a partial C-2 laminectomy was then performed. The right
cerebellar tonsil was dissected free of the dorsal medulla and a gush of cerebrospinal fluid gave good
decompression of the posterior fossa content. Which CPT code should be used?

A. 61322 C. 61343
B. 61345 D. 61458

EVALUATION AND MANAGEMENT

44. Patient is here to follow up on her atrial fibrillation. Her primary care physician is not in the
office. She will be seen by the partner physician that is also in the same practice. No new problems.
Blood pressure is 110/64. Pulse is regular at 72. Temp is 98.6F Chest is clear. Cardiac normal sinus
rhythm. Medical making decision is straightforward. Diagnosis: Atrial fibrillation, currently stable.
What CPT® code is reported for this service?

A. 99201 C. 99212
B. 99202 D. 99213

45. Documentation of a new patient in a doctor’s office setting supports the History in four elements
for an extended history of present illness (HPI), three elements for an extended review of systems
(ROS) and three elements for a complete Past, Family, Social History (PFSH) . There is an extended
examination of six body areas and organ systems. The medical making decision making is of high
complexity. Which E/M service supports this documentation?

A. 99205 C. 99203
B. 99204 D. 99202

46. A patient was admitted yesterday to the hospital for possible gallstones. The following day the
physician who admitted the patient performed a detailed history, a detailed exam and a medical
decision making of low complexity. The physician tells her the test results have come back positive
for gallstones and is recommending having a cholecystectomy. What code should be reported for
this evaluation and management service?

A. 99253 C. 99233
B. 99221 D. 99234
47. A patient came in to the ER with wheezing and a rapid heart rate. The ER physician documents a
comprehensive history, comprehensive exam and medical decision of moderate complexity. The
patient has been given three nebulizer treatments. The ER physician has decided to place him in
observation care for the acute asthma exacerbation. The ER physician will continue examining the
patient and will order additional treatments until the wheezing subsides. Select the appropriate
code(s) for this visit.

A. 99284, 99219 C. 99284

B. 99219 D. 99235

48. Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax
for his herpes zoster and Percocet for pain. His primary care physician came to the ER and admitted
him to the hospital for intravenous therapy and management of this problem. His physician
documented a detailed history, comprehensive examination and a medical decision making of
moderate complexity. Which E/M service is reported?

A. 99285 B. 99284 C. 99221 D. 99222

49. 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for
cyanosis and rapid breathing. The neonatologist performed intubation, ventilation management and
a complete echocardiogram in the NICU and provided a report for the echocardiography which did
indicate congenital heart disease. Select the correct code(s) for the physician service.

A. 99468-25, 93303-26 B. 99471-25, 31500, 94002, 93303

C. 99460-25, 31500, 94002, 93303 D. 99291-25, 93303

ANESTHESIA
50. 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

51. A 6-month-old patient is administered general anesthesia to repair a cleft palate. What
anesthesia code(s) should be used for this procedure?

A. 00170, 99100 C. 00172, 99100

B. 00172 D. 00176
52. A 50-year-old female had a left subcutaneous mastectomy for cancer. She now returns for
reconstruction which is done with a single TRAM flap. Right mastopexy is done for asymmetry. Code
the anesthesia for this procedure.

A. 00404 C. 00406
B. 00402 D. 00400

53. 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

RADIOLOGY
54. A CT density study is performed on a post-menopausal female to screen for osteoporosis.
Today’s visit the bone density study will be performed on the spine. Which CPT code should be
used?

A. 77075 C. 77078
B. 77080 D. 72010

55. The patient is 15 weeks pregnant with twins coming back to her obstetrician to have a
transabdominal ultrasound performed to reassess anatomic abnormalities of both fetuses that were
previously demonstrated in the last ultrasound. What code(s) should be used for this procedure?

A. 76815 C. 76801, 76802

B. 76816, 76816-59 D. 76805, 76810

56. 76-year-old female had a ground level fall when she tripped over her dog earlier this evening in
her apartment. The Emergency Department took x-rays of the wrist in oblique and lateral views
which revealed a displaced distal radius fracture, grade I open right wrist. What radiological service
and ICD-10 codes should be reported?

A. 73100-26, S52.501A, W01.0XXA, Y92.039

B. 73110-26, S52.509A, X58.XXXA, Y92.039
C. 73115-26, S52.513A, X58.XXXA, Y92.038
D. 73100-26, S52.511A, W01.0XXA, X58.XXXA, Y92.038
57. 56-year-old female is having a bilateral mammogram with computer aid detection conducted as
a screening since the patient has had a previous cyst in the right breast. What radiological services
are reported?

A. 77065 B. 77059 C. 77067 D. 77066

58. .A patient presents to the ER with intractable nausea and vomiting, and abdominal pain
that radiates into her pelvis. The physician orders a CT scan of the abdomen, first without
contrast and then followed by contrast, and a CT of the pelvis, without contrast.

a. 74178 c. 74178 x2, 74177 b. 74178, 74176-51 d. 74176, 74178-51

59. .A 35 year old mother carrying twin gestations, who has a three year old child with Down
syndrome, comes in for a prenatal screening. She is in her 12th week of pregnancy and the
physician requests that the amount of fluid behind the necks of the fetuses be measured. A
transabdominal approach was used.

a. 76801, 76802 b. 76811, 76812 c. 76813, 76814 d. 76816, 76816-59

PATHOLOGY
60. Sperm is being prepared through a washing method to get it ready for the insemination of five
oocytes for fertilization by directly injecting the sperm into each oocyte. Choose the CPT® codes to
report this service.

A. 89257, 89280 B. C. 89261, 89280

89260, 89280 D. 89260, 89268

A 61. patient uses Topiramate to control his seizures. He comes in every two months to have a
therapeutic drug testing performed to assess serum plasma levels of this medication. What lab code
is reported for this testing?
A.80305 C.80201

B.80307 D.80201, 80305

62. Patient that is a borderline diabetic has been sent to the laboratory to have an oral glucose
tolerance test. Patient drank the glucose and five blood specimens were taken every 30 to 60
minutes up to three hours to determine how quickly the glucose is cleared from the blood. What
code(s) should be reported for this test?

A. 82947 x 5
B. 82946
C. 80422
D. 82951, 82952 x 2
63. A patient with severe asthma exacerbation has been admitted. The admitting physician orders a
blood glass for oxygen saturation only. The admitting physician performs the arterial puncture
drawing blood for a blood gas reading on oxygen saturation only. The physician draws it again in an
hour to measure how much oxygen the blood is carrying. Select the codes for reporting this service.

A. 82805, 82805-51 C. 82803, 82803-51

B. 82810, 82810-91 D. 82805, 82805-90

64. Patient is coming in for a pathological examination for ischemia in the left leg. The first specimen
is 1.5 cm of a single portion of arterial plaque taken from the left common femoral artery. The
second specimen is 8.5 x 2.7 cm across x 1.5 cm in thickness of a cutaneous ulceration with
fibropurulent material on the left leg. What surgical pathology codes should be reported for the
pathologist?

A. 88302, 88304 B. 88304, 88305

C. 88305, 88307 D. 88307, 88309

65. Physician orders a comprehensive metabolic panel but also wants blood work on calcium ions
and also orders a basic metabolic panel. Select the code(s) on how this is reported.

A. 80053, 80047 B. 80053

C. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 D. 80053, 82330

MEDICINE

66. A patient with chronic renal failure is in the hospital being evaluated by his endocrinologist after
just placing a catheter into the peritoneal cavity for dialysis. The physician is evaluating the dwell
time and running fluid out of the cavity to make sure the volume of dialysate and the concentration
of electrolytes and glucose are correctly prescribed for this patient. What code should be reported
for this service?

A. 90935 B. 90937 C. 90947 D. 90945

67. An established patient had a comprehensive exam in which she has been diagnosed with dry eye
syndrome in both eyes. The ophthalmologist measures the cornea for placement of the soft contact
lens for treatment of this syndrome. What codes are reported by the ophthalmologist?

A. 92014-25, 92071 B. 99214-25, 92325-50

C. 92014-25, 92325-50 D. 92014-25, 92310

68. A patient who is a singer has been hoarse for a few months following an upper respiratory
infection. She is in a voice laboratory to have a laryngeal function study performed by an
otolaryngologist. She starts off with the acoustic testing first. Before she moves on to the
aerodynamic testing she complains of throat pain and is rescheduled to come back to have the other
test performed. What CPT® code(s) should be reported?

A. 99211, 92520 B. 92700 C. 92520-52 D. 99211, 92700-52

69. A new patient is having a cardiovascular stress test done in his cardiologist’s office. Before the
test is started the physician documents a comprehensive history and exam and moderate complexity
medical decision making. The physician will be supervising and interpreting the stress on the
patient’s heart during the test. What procedure code should be documented for this encounter?

A. 93015-26, 99204-25 C. 93015, 99204-25

B. 93016, 93018, 99204-25 D. 93018-26, 99204-25

70. A cancer patient is coming in to have a chemotherapy infusion. The physician notes the patient is
dehydrated and will first administer a hydration infusion. The infusion time was 1 hour and 30
minutes. Select the code(s) that should be reported for this encounter?

A. 96360 C. 96365, 96366

B. 96360, 96361 D. 96422

71. 10-year-old patient had a recent placement of a chochlear implant. She and her family see an
audiologist to check the pressure and determine the strength of the magnet. The transmitter,
microphone and cable are connected to the external speech processor and maximum loudness
levels are determined under programming computer control. Which CPT® code should be used?

A. 92601 C. 92562
B. 92603 D. 92626

ANATOMY AND MEDICAL TERMINOLOGY

72. Glomerulonephritis is an inflammation affecting which system?

A. Digestive C. Urinary
B. Nervous D. Cardiovascular

73. What is the term used for inflammation of the bone and bone marrow?

A. Chondromatosis C. Costochondritis
B. Osteochondritis D. Osteomyelitis

74. The root word trich/o means:

A. Hair C. Eyelid
 B. Sebum D. Trachea

75. Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, .

A. Medulla lobe C. Middle lobe

B. Occipital lobe D. Inferior lobe

76. A patient is having pyeloplasty performed to treat a uretero-pelvic junction obstruction. What is
being performed?

A. Surgical repair of the bladder D. Surgical reconstruction of the renal

B. Removal of the kidney pelvis
C. Cutting into the ureter

77. What type of graft is used when pigskin is applied to a burn wound?

A. Xenograft B. Allograft C. Autograft D. Pinch graft

78. Ventral, umbilical, spigelian and incisional are types of:

A. Surgical approaches B. Hernias

C. Organs found in the digestive system D. Cardiac catheterizations

79. Fracturing the acetabulum involves what area?

A. Skull B. Shoulder C. Pelvis D. Leg

ICD-10-CM
80. Patient comes into see her primary care physician for a productive cough and shortness of
breath. The physician takes a chest x-ray which indicates the patient has congestive pneumonia.
Select the ICD-10-CM code(s) for this visit.

A. J18.8, R05, R06.02 B. R05, R06.02, J18.8 C. J18.8 D. J18.9

81. What is the correct way to code a patient having bradycardia due to Demerol that was correctly
prescribed and properly administered?

A. T40.2X1A, R00.1 B. T40.2X5A, R00.1

C. R00.1, T40.2X5A D. R00.1, T40.2X1A

82. 55 year-old-patient had a fracture of his left knee cap six months ago. The fracture has healed
but he still has staggering gait in which he will be going to physical therapy. What ICD-10-CM codes
should be reported?

A. R26.0, S82.092A B. C. S82.002S, R26.0

R26.0, S82.009S D. R26.0, S82.002S

83. Patient is going back to the OR for a re-exploration L5-S1 laminectomy for a presumed
cerebrospinal fluid leak. A small partial laminectomy was slightly extended, however revealed no
real evidence of leak. Valsalva maneuver was performed several times, no evidence of leak. There
was a pocket of clear serous fluid oozing, which was drained. What ICD-10-CM code(s) should be
reported?

A. M96.1 C. G97.82
B. M96.89 D. G96.0

84. A patient that has benign hypertension with congestive heart failure is coded:

A. I11.0, I50.9 C. I11.0

B. I50.9 D. I50.9, I11.0

HCPCS
85. 10 year-old-male sustained a Colles’ fracture in which the pediatrician performs an application of
short arm fiberglass cast. Identify the HCPCS Level II code that would be reported.

A. Q4012 C. A4570
B. A4580 D. Q4024

86. 35-year-old-female is having an IUD insertion. The IUD type: Mirena. The HCPCS Level II code is:

A. S4989 C. A4264
B. J7298 D. J7300

87. 66-year-old Medicare patient, who has a history of ulcerative colitis, presents for a colorectal
cancer screening. The screening is performed via barium enema. What HCPCS Level II code is
reported for this procedure?

A. G0106 B. G0105 C. G0120 D. G0121

COMPLIANCE AND REGULATORY

88. What is PHI?
 A. Physician-health care interchange B. Private health insurance

C. P health information D. Provider identified incident-to

89. Which of the following is an example of electronic data?

A. A digital X-ray C. An advance beneficiary notice

B. An explanation of benefits D. A written prescription

90. Which of the following health plans does not fall under HIPAA?

A. Medicaid C. Workers’ compensation

B. Medicare D. Private plans

CASE 1
91. PRE-OPERATIVE DIAGNOSIS: Left Breast Abnormal MMX or Palpable Mass; Other Disorders Of
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 procedure with 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 was
injected 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 SteriStrips,
bandage and ice pack in the usual manner. The patient did receive written and verbal postbiopsy
instructions. The patient left 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 AFTER WE RECEIVE THE PATHOLOGY REPORT. What are the codes for
the procedures?

A.19081
 B.19081

C.19081,76942-26

D.191081,77012-26

CASE 2
92. PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and

ulna. POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and

ulna.

OPERATIVE PROCEDURE: Reduction with application external fixator, left wrist fracture FINDINGS:
The patient is a 46-year-old right-hand-dominant female who fell off stairs 4 to 5 days ago sustaining
an impacted distal radius fracture with possible intraarticular component and an associated ulnar
styloid fracture. Today in surgery, fracture was reduced anatomically and an external fixator was
applied. PROCEDURE: Under satisfactory general anesthesia, the fracture was manipulated and Carm
images were checked. The left upper extremity was prepped and draped in the usual sterile
orthopedic fashion. Two small incisions were made over the second metacarpal and after removing
soft tissues including tendinous structures out of the way, drawing was carried out and blunt-tipped
pins were placed for the EBI external fixator. The frame was next placed and the site for the proximal
pins was chosen. Small incision was made. Subcutaneous tissues were carried out of the way. The
pin guide was placed and 2 holes were drilled and blunt-tipped pins placed. Fixator was assembled.
C-arm images were checked. Fracture reduction appeared to be anatomic. Suturing was carried out
where needed with 4-0 Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile
dressings were applied. Vascular supply was noted to be satisfactory. Final frame tightening was
carried out. What CPT and ICD-9-CM codes should be reported?

A. 25600-LT, 20692-51 C. 25606-LT

B. 25605- LT, 20690-51 D. 25607-LT

CASE 3
93. PREOPERATIVE DIAGNOSIS: Left breast carcinoma. POSTOPERATIVE DIAGNOSIS: Left breast
carcinoma. NAME OF PROCEDURE: Left lumpectomy and sentinel node biopsy. DESCRIPTION OF
PROCEDURE: The patient is a 65-year female admitted with a diagnosis of left breast carcinoma.
Risks and benefits of the procedure had been discussed preoperatively including risks of bleeding,
infection, deformity in the breast, chronic pain, numbness, chronic lymph edema associated with the
lymph node biopsy as well as other possible complications. The patient agreed to proceed. Because
the wire was located in the upper outer quadrant of the breast over the lesion and the length of the
wire was 10 cm, it was felt that it would be best to approach the node biopsy as well as the
lumpectomy through the same incision in the upper outer quadrant of the left breast. Incision was
made with a 15-blade through skin and subcutaneous. Homeostasis achieved with Bovie
electrocautery. Flaps were formed in the usual manner. A wire was brought out through the incision.
We then circumferentially removed all the tissue around the wire down to the tip. We marked the
specimen with a long lateral stitch, short superior stitch, 2 lateral clips, and 1 superior clip. We were
able to identify a hot node in the axilla and at least 2 lymph nodes that were blue-dyed within the
sentinel nodes. We did perform lymphoscintigraphy and injected 2 cc of methylene blue dye in the
periareolar area preoperatively and massaged the breast for 5 minutes. The lymph nodes were
excised and a biopsy was performed on the axillary node. At this point, we copiously irrigated the
area to assure good homeostasis. We placed clips throughout the entire cavity. We then closed the
deep dermal tissue with interrupted 3-0 Vicryl sutures and then closed the skin with a fine 5-0 nylon.
The patient tolerated the procedure well. Sponge count was correct. Blood loss was minimal. The
patient was sent to the recovery room in stable condition. What are the codes for these procedures?

A. 19120, 38530-51-LT C. 19302, 38520-51-LT

B. 19301, 38525-52-51-LT, 38792-51- D. 19120, 38510-51-LT, 38792-51-LT
LT

CASE 4
94. PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula POST OPERATIVE DIAGNOSIS:
Diverticulitis, perforated diverticula PROCEDURE: Hartman procedure, which is a sigmoid resection
with Hartman pouch and colostomy. DESCRIPTION OF THE PROCEDURE: Patient was prepped and
draped in the supine position under general anesthesia. Prior to surgery patient was given 4.5 grams
of Zosyn and Rocephin IV piggyback. A lower midline incision was made, abdomen was entered.
Upon entry into the abdomen, there was an inflammatory mass in the pelvis and there was a large
abscessed cavity, but no feces. The abscess cavity was drained and irrigated out. The left colon was
immobilized, taken down the lateral perineal attachments. The sigmoid colon was mobilized. There
was an inflammatory mass right at the area of the sigmoid colon consistent with a divertiliculitis or
perforation with infection. Proximal to this in the distal left colon, the colon was divided using a GIA
stapler with 3.5 mm staples. The sigmoid colon was then mobilized using blunt dissection. The
proximal rectum just distal to the inflammatory mass was divided using a GIA stapler with 3.5 mm
staples. The mesentary of the sigmoid colon was then taken down and tied using two 0 Vicryl ties.
Irrigation was again performed and the sigmoid colon was removed with inflammatory mass. The
wall of the abscessed cavity that was next to the sigmoid colon where the inflammatory mass was,
showed no leakage of stool, no gross perforation, most likely there is a small perforation in one of
the diverticula in this region. Irrigation was again performed throughout the abdomen until totally
clear. All excess fluid was removed. The distal descending colon was then brought out through a
separate incision in the lower left quadrant area and a large 10 mm 10 French JP drain was placed
into the abscessed cavity. The sigmoid colon or the colostomy site was sutured on the inside using
interrupted 3-0 Vicryl to the peritoneum and then two sheets of film were placed into the intra-
abdominal cavity. The fascia was closed using a running #1 double loop PDS suture and
intermittently a #2 nylon retention suture was placed. The colostomy was matured using interrupted
3-0 chromic sutures. I palpated the colostomy; it was completely patent with no obstructions.

Dressings were applied. Colostomy bag was applied. Which CPT code should be used?

A. 44140 C. 44160
B. 44143 D. 44208

CASE 5
95. 76-year-old female had a recent mammographic and ultrasound abnormality in the 6 o’clock
position of the left breast. She underwent core biopsies which showed the presence of a papilloma.
The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After
undergoing preoperative needle localization with hookwire needle injection with methylene blue,
the patient was brought to the operating room and was placed on the operating room table in the
supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was
prepped and draped in a sterile fashion. A radial incision was then made in the 6 o'clock position of
the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp
dissection, we performed a generous excisional biopsy around the needle localizing wire including all
of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation
followed by permanent section pathology. Once hemostasis was assured, digital palpation of the
depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound
was closed in 2 layers with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local anesthetic
was infiltrated for postoperative analgesia. What CPT and ICD-9-CM codes describe this procedure?

A. 19100, N63 C. 19120, R92.8

B. 19102, C50.919 D. 19125, D24.1

CASE 6
96. PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS:
Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee
TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and
synovectomy, right knee The patent was brought to the operating room, placed in the supine
position after which he underwent general anesthesia. The right knee was then prepped and draped
in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim
portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella
and the femoral groove were as noted above. An intra-articular shaver was introduced to debride
the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial
scarring between the patella and the femoral groove was debrided. The hypertrophic impinging
medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar
notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting
basket was introduced to transect the base of the degenerative posterior horn flap tear. This was
removed with a grasper. The meniscus was then further contoured and balanced with an
intraarticular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated
and found to be intact. The lateral compartment was then inspected. The lateral meniscus was
probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau
was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the
arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A
sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable
condition.

What CPT and ICD-9-CM codes should be reported?

A. 29880-RT C. 29881-RT, 29822-59-RT

B. 29881-RT D. 29880-RT, 29822-59-RT

CASE 7
97. Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower
quadrant transverse incision was made upon entry to the abdomen. In the right lower quadrant
there was a large amount of pus consistent with a right lower quadrant abscess. Intraoperative
cultures anaerobic and aerobic were taken and sent to microbiology for evaluation. Irrigation of the
pus was performed until clear. The base of the appendix right at the margin of the cecum was
perforated. The mesoappendix was taken down and tied using 0-Vicryl ties and the appendix fell off
completely since it was already ruptured with tissue paper thin membrane at the base. There was no
appendiceal stump to close or to tie, just an opening into the cecum; therefore, the appendiceal
opening area into the cecum was tied twice using figure of 8 vicryl sutures. Omentum was tacked
over this area and anchored in place using interrupted 3-0 Vicryl sutures to secure the repair. What
CPT and ICD-10-CM codes should be reported?

A. 44950, K37 C. 44950, 49905, K35.3

B. 44960, 49905, K35.3 D. 44970, K37

CASE 8
98. The patient is a 51 year old gentleman who has end-stage renal disease. He was in the OR
yesterday for a revision of his AV graft. The next day the patient had complications of the graft
failing. The patient was back to the operating room where an open thrombectomy was performed
on both sides getting good back bleeding, good inflow. An arteriogram was shot. There was a small
amount of what looked like pseudo-intima in the distal anastomosis of the venous tract that was
causing a flow defect which was taken out with a Fogarty catheter. A Conquest balloon was
ballooned up again with a 6 millimeter and a 7 millimeter. An arteriogram was reshot in both
directions. The arterial anastomosis looked fine as did the venous anastomosis. Select the
appropriate codes for this visit:

A.36831-76, 36902-76 C.36831-78, 36902-78

B.36831, 36907 D.36831-58, 36902-58

CASE 9
99. A 61 year-old gentleman with a history of a fall while intoxicated suffered a blow to the forehead
and imaging revealed a posteriorly displaced odontoid fracture. The patient was taken into the
Operating Room, and placed supine on the operating room table. Under mild sedation, the patient
was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy was performed to
gently try to reduce the fracture. It did reduce partially without any change in the neurologic
examination. More manipulation would be necessary and it was decided to intubate and use
fiberoptic technique. The anterior neck was prepped and draped and an incision was made in a skin
crease overlying the C 4-C5 area. Using hand-held retractors, the ventral aspect of the spine was
identified and the C2-C3 disk space was identified using lateral fluoroscopy. Using some pressure
upon the ventral aspect of the C2 body, we were able to achieve a satisfactory reduction of the
fracture. Under direct AP and lateral fluoroscopic guidance, a Kirschner wire was advanced into the
C2 body through the fracture line and into the odontoid process. This was then drilled, and a 42
millimeter cannulated lag screw was advanced through the C2 body into the odontoid process. What
procedure code should be used?

A. 22505 C. 22315
B. 22319 D. 22318
CASE 10
100. The patient is a 22-year-old who was found to be 7-1/2 weeks pregnant. She has consented for
a D&E .She was brought to the operating room where MAC anesthesia was given. She was then
placed in the dorsal lithotomy position and a weighted speculum was placed into her posterior
vaginal vault. Cervix was identified and dilated. A 6.5-cm suction catheter hooked up to a suction
evacuator was placed and products of conception were evacuated. A medium size curette was then
used to curette her endometrium. There was noted to be a small amount of remaining products of
conception in her left cornua. Once again the suction evacuator was placed and the remaining
products of conception were evacuated. At this point she had a good endometrial curetting with no
further products of conception noted. Which CPT code should be used?

A. 59840 C. 59812
B. 59841 D. 59851