Mock 2

1. Patient’s abdominal cavity and organs were bound with fibrous tissue bands,
which had to belysed during surgery. These bands are called
________________________.
1 point

a. prodromes
b. sequelae
c. adhesions
d. ascites

2.  CABG
1 point

a. disease of the heart’s vessels

b. defibrillation device
c. study of the electrical activity of the heart
d. surgery to create a shunt around a blocked vessel

3. cardiac tamponade
1 point

a. accumulation of fluid in the pericardial sac

b. drug that lowers serum cholesterol
c. anterior region over the heart
d. muscular pain during exercise

4. The common name for epinephrine is:

1 point

a. heparin
b. adrenaline
c. cortisone
d. apheresis

5. Autotransfusion is transfusion of autologous blood, that is, the patient’s own

blood.Homologous blood is taken from:
1 point

a. another human
b. synthetic chemicals
c. plasma with clotting factors
d. an animal with similar antibodies as humans

6. A.E. takes several drugs to prevent or act against his inflammatory response.
These agentsare called ________________________ drugs.
1 point

a. contrainflammatory
b. counterinflammatory
c. anti-inflammatory
d. corticosteroids

7. The root spir/o, as in spirometry, means:

1 point

a. turbulence
b. breathing
c. twisted
d. air quality

8.Flatulence and eructation represent:

1 point

a. regurgitation of chyme
b. distention of the esophagus
c. passage of gas or air from the GI tract
d. muscular movement of the alimentary tract

9.The term perfusion means:

1 point

a. size
b. shape
c. passage of fluid
d. surrounding tissue

10.The term for male sterilization surgery is:

1 point

a. herniorrhaphy
b. circumcision
c. vagotomy
d. vasectomy

11. The incidental (accidental) puncture of the intestines and nerve injury to C.F.’s
arm are notexpected outcomes of surgery. They are critical incidents and occurred
despite attempts toprotect her from harm. The term for this type of disorder is
________________________(see Chapter 6).
1 point

a. iatrogenic
b. nosocomial
c. idiopathic
d. etiologic
12. An oblique surgical incision follows what direction?
1 point

a. slanted or angled
b. superior to inferior
c. lateral
d. circumferential

13. 3. When the ends of the vas were coagulated with electrosurgery, they were:
1 point

a. probed
b. dilated
c. sealed
d. sutured

14.A.E. presented with several untoward results or risks from the corticosteroid
therapy. Thesesequelae are called:
1 point

a. contraindications
b. side effects
c. antagonistic effects
d. exacerbations

15. Necrotizing hemorrhagic pancreatitis can be described as:

1 point

a. enlargement of the pancreas with anemia

b. inflammation of the pancreas with tissue death and bleeding
c. inflammation of the pancreas with overgrowth of tissue
d. marsupialization of a pancreatic pseudocyst

16. The ileocecal valve is:

1 point

a. part of a colonoscope
b. at the distal ileum
c. near the appendix
d. b and c

17. R.B.’s midepigastric pain was located:

1 point

a. inferior to the sternum

b. periumbilical
c. cephalad to the clavicle
d. lateral to the anterior costal margins
18. Using the SOAP style of documenting progress notes,choose the "subjective"
statement from the following:
1 point

A. The patient suffered lower fight quadrant stomach pain.

B. Microscopic examination revealed bacteria in the urine.
C. Upon palpation the patient was "guarded" on the lower fight quadrant of the stomach.
D. The patient’s temperature was 102.4 and his respirations were at 26

19. Abbreviation and symbols are to be used in the patient record only when:
1 point

A. They should never be used.

B. They can be found in the CPT-4 code book.
C. They are approved by the AMA.
D. They are part of published criteria for the medical facility. --Rationale: All abbreviations
must first be approved by medical staffand then published in a proper manner.

20. Fraud includes all of the following except:

1 point

A. Coding to a higher level of service than is justifiable on the patient record.

B. Abuse of a child or the elderly.
C. Billing services that were never provided.
D. Listing diagnoses that are not valid.

21. A new patient is:

1 point

A. One who has not visited the physician is more than 6 months.
B. One who has not visited the physician in more than 3 years.
C. Determined by the physician and staff.
D. Determined by a third-party payer.

22. A covered entity may disclose PHI to facilitate treatment, payment, or health care
operations or:
1 point

A. If the covered entity has obtained authorization from the individual.

B. If the covered entity is entered into an accession registry.
C. If the covered entity is located in a specific geographical location.
D. If the covered entity is registered in the Physician Index

23. A 74-year-old male afflicted with Alzheimer’s disease wandered off from his
daughter’s home where he resides. The daughter stated that his dementia had
gotten worse over the last several months, and she was afraid for his safety. A
search was conducted by neighbors and local authorities and the elderly man was
found. Upon admission to the hospital, he was disoriented and suffered a laceration
on his rightforearm, which required ten stitches. What codes would be reported in
this case?
1 point

A. G31.83, F02.80, S41.109A

B. G30.9,F02.80, ,S51.811A
C. G30.9,F02.80, S51.809A
D. G31.83, F02.80, S51.809A

24. A 10-month old infant was admitted for surgery for a right-sided, incomplete cleft
lip and palate. The infant underwent surgery for both deformities. What codes would
be reported in this case?
1 point

A. Q35.9, Q36.9
B. Q37.8
C. Q37.1, Q38.1
D. Q37.9

25. What is the correct ICD-10-CM code(s) for malignant hypertension with stage III
kidney disease?
1 point

a) I10 , N18.3
b) I12.9
c) I10
d) I12.9 , N18.3

26. What is the five-digit code for diabetes with neurological manifestations for a
patient with type II uncontrolled diabetes?
1 point

A. E11.001
B. There is no fifth digit
C. E11.49
D. E11.44

27. In what volume of the ICD-10-CM manual will you find procedures?
1 point

A. Volume I
B. Volume II
C. Volume III
D. You will not find procedures in the ICD-10-CM manual
28. What code would you assign, specifically the fourth digit, for chest pain caused
by acute myocardial infarction of the inferior  wall 2 weeks after the initial diagnosis
of same area?
1 point

A. I21.19
B. I22.1
C. I21.18
D. I21.11

29. A 56-year-old female was admitted to the hospital for a large pelvic mass located
on the lower right quadrant in the pelvic region. After an exploratory laparotomy,
pathology confirmed carcinoma of the right ovary with metastasis to the omentum. A
total, radical abdominal hysterectomy and total omenectomy was performed with a
bilateral salpingo-oopherectomy. What codes would be reported in this case?
1 point

A. C48.1, C79.60
B. 183.8, C79.60
C. D07, C48.1
D. C56.1, C78.6

30. A 27-year-old male patient with AIDS and Kaposi’s sarcoma of the skin was
dmitted to the hospital for the closed fracture of four ribs. The patient received an
application of pressure dressing and was referred to an infectious disease specialist.
What codes would be reported in this case?
1 point

A. S22.43XB, C46.0
B. S22.49XA, B20, C46.0
C. S22.43XB, B20, M24.176
D. S22.5XXA, C46.1,B20

31. A 41-year-old obese female was diagnosed with chronic kidney disease, stage
III, resulting from malignant hypertension and type II diabetes mellitus. What codes
would be reported in this case?
1 point

A. I12.8, E10.29, N18.9

B. I12.9, E11.22, N18.3
C. I12.9, E11.29
D. I12.8, I10, E11.29, N18.3

32. Code the following statement: A 30-year-old female with moderate mental
retardation as a result of Edward’s disease is being evaluated today for her
paraplegia, which was caused by a cervical level spinal cord injury she suffered 4
years ago.
1 point

A. G82.50, S14.109S, F71

B. G81.90, S14.109S, F72, Q90.9
C. G82.20, S14.109S, F71, Q91.3
D. G82.20,905.9, F72, Q90.9

33. What code would you assign for the topical anesthetic for dialysis?
1 point

A. A4737
B. A4740
C. A4736
D. A4725

34. What code would you assign for a sterile syringe with needle, 5 ec?
1 point

A. A4206
B. A4210
C. A4209
D. A4208

35. CPT codes are considered HCPCS codes.

1 point

A. Level II
B. Level III
C. Level I
D. They are not considered HCPCS codes

36. What HCPCS modifier would you assign for items furnished in conjunction with a
urological, ostomy, or tracheostomy supply?
1 point

A. AU
B. AW
C. BA
D. AV

37. A 25-year-old male was fitted for a short-arm fiberglass cast after the physician
diagnosed him with a fracture. The casting was performed in part by a resident under
the direction of the physician. What code would be reported in this case?
1 point

A. Q4013 -GE
B. Q4009 -GC
C. Q4010 -GC
D. Q4006 -GC

38. A gel-like pressure pad was provided to a patient whose mattress was standard
length and width. What code would be reported in this ease?
1 point

A. E0182
B. E0185
C. E0188
D. E0196

39. A physician provided an 81-year-old male an oxygen concentrator, dual delivery

ort, capable of delivering 85% or greater oxygen concentration at the prescribed
level in an area of the country where physicians are scarce or not present at all.
What code would be reported in this case?
1 point

A. E1390 -AQ
B. EI390- AR
C. E1391-AR
D. E1392 -AT

40. An 89-year-old female high-risk patient underwent a glaneoma screening by an

optometrist. What code would be reported in this ease?
1 point

A. GO117
B. G0118
C. G0123
D. G0122

41. A physician documented that a 41-year-old male patient was not an eligible
candidate for screening. What code would be reported in this case?
1 point

A. G8400
B. G8405
C. G8401
D. G8040

42. A physician fitted a semirigid cervical plastic collar on a 59-year-old male who
suffered whiplash during a car accident. What code would be reported in this case?
1 point

A. L0130
B. L0120
C. L0140
D. L0170

43. What are the three key components of an E&M code?

1 point

A. Examination, coordination of care, medical decision making

B. History, examination, medical decision making
C. History, nature of presenting problem, coordination of care
D. Nature of presenting problem, examination, coordination of care

44. An expanded problem-focused examination is:

1 point

A. A general multisystem examination or a complete examination of a single organ system.

B. A limited examination of the affected body area or organ system and other symptomatic
or related organ system(s).
C. An extended examination of the affected body area(s) and other symptomatic or related
organ system(s).
D. A limited examination of the affected body area or organ system.

45. The following is a history and physical examination for a 91-year-old male
established patient. Choose the correct E&M code based on the information
provided.PATIENT: xxx xxxxCHART NUMBER: xxx-xxHISTORY OF PRESENT
ILLNESS: A pleasant, 91-year-old male who lives independently presents with
symptoms of shortness of breath, confusion and congestion. Patient denies fever or
cough. Patient has a recent history of COPD. Current medications include
prednisone and Colace.PAST HISTORY: The patient’s past medical history includes
cholecystectomy × 30 years ago. Patient denies any other hospitalization. Patient
says that he has been in relatively good health all of his life, with the exception of a
recent diagnosis of COPD.SOCIAL HISTORY: He is retired 30 years ago, widowed
for 15 years. No smoking, no ETOH, no known allergies. Denies caffeine and any
illicit drug use.FAMILY HISTORY: Urtremarkable.PHYSICAL EXAMINATION: Vital
Signs: Temp: 99.2,Pulse: 64, Respirations: 26, Blood Pressure: 92/50.HEENT:
Normocephalic, with post surgical eyes.Neck: No jugular venous distention. No
carotid bruits.Skin: Poor turgor and texture. Lungs: Bilateral bibasilar crackles. Liver:
Not palpably enlarged. Heart: S 1 and $2 present, no $3. Abdomen: Soft and non-
tender.Extremities: Bilateral leg edema. Neurological: No deficits, alert X 3, alert to
orientation, place and time.INTERPRETATION: Laboratory data was negative with
the exception of elevation white blood cell count. A chest x-ray revealed congestive
heart failure and pneumonia.TREATMENT: The patient was admitted to the hospital
as a result of this service and prescribed tobramycin for the pneumonia and Lasix for
the congestive heart failure.
1 point

A. 99214-57
B. 99214
C. 99215-25
D. 99215

46. Physician # 1 sent a 72-year-old female cancer patient to observation at the local
hospital following his visit to the patient’s nursing care facility. The patient was
admitted to observation to rule out CVA (cardiovascular accident) and multisystem
organ failure due to a change in her physical status. The next day, Physician #1
became ill, and Physician #2 took over the patient’s care. Physician # 2 admitted the
patient to the hospital because of a dramatic worsening of symptoms. Later that day
the patient expired. Assuming the patient’s status was of high severity, how would
the E&M services for the two physicians be coded?
1 point

A. Physician #1: 99223; Physician #2:99219

B. Physician #1: 99223, 99219; no codes would be assigned for Physician #2
C. Physician #1: 99220; Physician #2:99236
D. Physician #1: 99220; Physician #2:99217

47.Documentation in history of the use of caffeine, smoking, illicit drug use, sexual
preference, and alcohol use is considered part of:
1 point

A. Nature of presenting illness

B. Past medical history
C. Social history
D. Occupational history

48. The physician on the following case provided care during and after the helicopter
transport of a 29-year-old male who was critically injured during a car crash in an
isolated area. The patient was also exposed to the outside elements for more than
24 hours. Choose the correct code(s) based on the information provided. A 29-year-
old male patient was admitted to the critical care unit after his car crashed on an icy,
mountainous road and was exposed to freezing temperatures for over 2 days. The
patient was wearing a seatbelt, however sustained a skull fracture, subdural
hematoma, and frostbite on portion of his feet and hands. The patient was
unconscious at the scene and upon examination had respirations of 6, pulse 50,
temperature of 97.2, and blood pressure of 82/40. The fight pupil was blown, fLxed,
and dilated, indicating the intracranial injury. Hypoxemia and brain swelling were
noted. The patient experienced increasing periods of apnea and dyspnea and was
placed on a ventilator 3 hours later after endotracheal intubation. The patient had
open fractures of the left tibia and fight femur, a closed fracture of the left wrist, and
four fractured fibs. Brain wave monitoringshowed little functioning, and his family was
called. The care provided by the physician included the interpretation of cardiac
output measurements, pulse oximetry, blood gases, endotracheal intubation,
ventilatory management, and brain wave functions. The total time the physician
spent with the patient was about 3 hours.
1 point

A. 99289 × 1, 99290 × 4
B. 99291 × I, 99292 × 5
C. 99292
D. 99291 × 1, 99292 × 4

49. A 37-year-old female presented in the emergency department with shortness of

breath, lethargy, and cough with blood in the sputum for 3 days; an expanded
problem-focused history was taken.BRIEF HISTORY: On examination, her skin was
warm, moist, and pale. She stated she had been coughing up blood and had been
short of breath with fever for more than 3 days. Upon admission, her temperature
was 102.6, respirations were 28, pulse 130, and blood pressure 162/92. She
appeared very lethargic. PHYSICAL FINDINGS: The patient’s heart was
tachyeardiac. The patient had  decreased breath sounds in the left lower lobe with a
line of consolidation about halfway up. No friction rub was heard. PMI was at the
mid-clavicular line, and a regular rhythm was noted.No significant murmur or gallop.
Abdomen was soft and tender, with no organomegaly, bowel sounds active.
Extremities showed no edema, clubbing, orcyanosis.LABORATORY FINDINGS:
Gram stain of sputum showed Gram-positive cocci in clusters and
polymorphonuclear cells. Blood and urine cultures showed no growth. Chest x-ray
revealed consolidation of the basal segments of the left lower lobe. Hematocdt was
40. Sed rate was 98 mm per hour. WBC was 14,000. PT and PTT were negative.
Blood sugar was 150, BUN 20.IMPRESSION:Lobar pneumonia caused by
pneumococcus.What code would be reported in this case?
1 point

A. 99234
B. 99283
C. 99284
D. 99221

50. An elderly 82-year-old deaf male, new patient, presented in the office with
dehydration, lethargy, bluish discoloration around the eyes, confusion, and shortness
of breath. The patient’s caregiver stated that he had not seen a physician in more
than 15 years. It was very difficult for the physician to communicate with the patient
because of his deafness and confusion, and the caregiver did not speak fluent
English. The physician was able to complete medical decision making was of
moderate complexity. The physician took an extra hour to write down and provide
instructions to the caregiver and to coordinate the care of this patient.What codes
would be reported in this case.
1 point

A. 99203-21, 99354
B. 99204, 99354
C. 99205
D. 99203-21, 99354

51. An established 61-year-old female patient came into the office for a follow-up
visit after the removal of pituitary tumor as a result of being diagnosed with non-small
adenocarcinoma of the lung.HISTORY: The patient is a 61-year female with a large
pituitary tumor found after lymph node biopsy that demonstrated lung cancer. The
patient has a long history of asthma and chronic obstructive pulmonary disease. The
patient’s social and family history is on record.PHYSICAL EXAM: Vital Signs: Temp:
98.2.Pulse: 66. Respirations: 12. BP: 98/46.HEENT: Normocephalic. Skin:
Carbuncle was noted on left shoulder. PERRLA. Throat unremarkable. Neck:
Supple. Heart: Irregular in rate without any murmurs heard. Abdomen: soft and
benign without any gross organomegaly; positive bowel sounds. Extremities:
Negative, no edema. Neurological: Oriented × 3. LAB DATA: Not on
hand.ASSESSMENT AND PLAN: Status post resection of the pituitary gland: Patient
is to continue on current medications. Patient is to follow up with oncologist for
chemotherapy regime. Follow-up appointment × 4 weeks. Total time spent with
patient was about 15 minutes. Later, that same day, the patient returned for a
complaint of the boil on her shoulder. The physician lanced and drained the
carbuncle and applied a topical antibiotic on the left shoulder area.What code(s)
would be reported in this case?
1 point

A. 99214-21
B. 99213, 99212-25
C. 99213-24
D. 99214-25

52. The following case involves a 52-year-old male who is encountering subsequent
hospital care. Choose the correct code based on the information provided.
HISTORY: A pleasant 52-year-old male patient has returned to the hospital for the
E&M of malignant hypertension, diabetes  mellitus type II, and congestive heart
failure. The patient’s new complaints consist of headache, dizziness, shortness of
breath, andnumbness of the extremities. The patient denies chest pain. The patient
has complied with medication regime and monitors his BP daily by visiting a "minute
clinic" at the local pharmacy.EXAMINATION: The patient is not in acute distress;
however he suffers shormess of breath because of the congestive heart failure.
PERRLA. Neck: Distended neck veins. Skin: Turgor fair. Heart: A hyperactive carotid
pulse is present. The heart has an atrial regular rhythm with some periods of
irregularity. Chest: Slight congestion is noted along with atelectasis on the right base.
VITAL SIGNS: Temp: 99.2. Pulse: 94. Respirations: 18. BP: 168/98. Abdomen: Soft
and nontender. Bowels: Positive bowel sounds are noted. Extremities: Edema is
noted in both calves. ASSESSMENT: Patient not responding to BP reeds, and a
medication change is ordered; congestive heart failure, malignant hypertension,
possible pneumonia.PLAN: The physician orders a chest radiograph and begins
Proeardia 20 mm b.i.d.
1 point

A. 99233
B. 99232
C. 99234
D. 99213

53. Physical status modifier P3 is documented for:

1 point

A. A normal healthy patient

B. A patient with severe systemic disease that is a constant threat to life
C. A moribund patient who is not expected to survive without the operation
D. A patient with severe systemic disease

54. A 78-year-old male patient underwent a popliteal thromboendarterectomy with

patch graft for severe carotid artery stenosis. The patient, afflicted with atrial
fibrillation, recently had a pacemaker implantation.What codes would be reported in
this case?
1 point

A. 01444, P2, 99100

B. 01442, P3, 99100
C. 01274, P3
D. 01430, P4, 99140

55. A 2-day-old infant is brought to the operating room for a repair of an

interventricular septal defect with pump oxygenator and hypothermic circulatory
arrest. The infant is in critical condition and will not survive without the operation.
What codes would be reported in this case?
1 point

A. Q21.0 , 00563, P5, 99100

B. I51.0, 00563, P5, 99100
C. Q21.1, 00561, P5, 99100
D. I51.0, 00561, P5

56. OPERATIVE REPORTPREOPERATIVE DIAGNOSIS: Carcinoma of the skin:

scrotum, left sidePROCEDURE: Excision ofa 3-cm lesion on
skin:scrotumANESTHETIC: GeneralCLINICAL HISTORY: The 61-year-old male had
a biopsy of the lesion on the left side of the scrotum to confirm f’mdings of squamous
cell carcinoma of the scrotum.PROCEDURE: The patient was taken to the operating
room and put in the lithotomy position, prepped and draped in the usual manner. The
anesthesiologist administered a general anesthetic and monitored for the duration of
the procedure. An ellipse was taken around the primary lesion with 7-mm margins for
excision around the lesion. The lesion was elliptically  excised and closed in layers
with 4-vicryl. The patient  tolerated he procedure well and was given instructions to
follow up in the office in 10 days for suture removal.What codes would be reported in
this case?
1 point

A. C60.2, 11423, 00926

B. C60.2, 11603, 00920
C. C63.2, 11423, 00928
Option 4

57. In accordance with CPT Guidelines, anesthesia time begins when the
anesthesiologist begins to prepare the patient for administration and ends:
1 point

A. when the anesthesiologist is no longer in attendance

B. when the patient has been released from recovery
C. when the patient leaves the OR
D. It depends on the OR protocol

58. Code the anesthesia only for the following: Anesthesia for a lumbar laminectomy
with fusion and insertion of rods and hooks.
1 point

A. 00640
B. 00670
C. 00630
D. 00600
59. OPERATIVE REPORTPROCEDURE: SigmoidoscopyINDICATIONS: The patient
was a 43-year-old female with significant changes in bowel patterns and occult
blood in stool who was evaluated with a sigmoidoscopy. ANESTHESIA: Conscious
sedation.PROCEDURE: The patient was given Versed, which was well tolerated. A
fleet enema was given 2 hours  before the procedure. The video colonoscope was
inserted and passed without difficulty to 60 cm. The mucosa were normal.
Diverticulosis was noted, as well as several polyps. A biopsy sample was taken and
sent to pathology. The patient tolerated the procedure well and was sent to
recovery.What code(s) would be reported in this case?
1 point

A. 00904
B. No code is required for conscious sedation
C. 00902
D. 00902, 99156

60. A physician performed a partial hepatectomy and administered the anesthesia

for a 37-year-old male prison inmate infected with hepatitis C.
1 point

A. 47120-47
B. 00792-47
C. 47010-47
D. 47120-47, 00792

61. What anesthesia code would be assigned for physiological support for harvesting
organs(s) from a brain-dead patient?
1 point

A. 00580-P6
B. 01990-P6
C. 01999
D. 01990

62. Anesthesia was administered to an 18-year-old male for second- and third-
degree bum debridement with skin grafting on the lower right and left legs for a19%
total body surface area bum. What codes would be reported in this case?
1 point

A. 01953 x 5
B. 01952, 01953 × 5
C. 01952, 01953 × 2
D. 01953 × 2
63. Code for a free, full-thickness skin graft including direct closure of donor site,
neck 11 cm. The surgical preparation of recipient site, 11 cm, was also performed
during the same operative session.
1 point

A. 15320, 14041-51
B. 15004, 13131, 13133 × 2-80
C. 15240, 13131, 13133 × 2-66
D. 15240, 15004-51

64. A 22-year-old female presented in the ER with multiple lacerations on her body
caused by glass breaking in her apartment building. The emergency physician
performed the following repairs:                                        1-cm simple repair of the
nose                                                                 2.5-cm simple repair of the left ear      
7-cm intermediate repair of the scalp                               5-era intermediate repair of
the left lower leg            4.2-cm intermediate repair of the left foot                                
3.7-cm complex repair of the lip                                   What codes would be reported
in this case?
1 point

A. 13152, 12035, 12013-51

B. 13131, 12035, 12001, 12011-51
C. 13152, 12042, 12034, 12013-51
D. 13132, 12035, 12001, 12013-51

65. Three cysts are excised from one breast through two separate incision sites.
Correct reporting would be:
1 point

A. 19120
B. 19120, 19120-59
C. 19120, 19120-59 x 2
D. 19301

66. A patient presents to a dermatologist with a 0.6 cm lesion on her right cheek. The
patient is concerned about the looks of it, but indicates that other than its location on
her cheek she has had no symptoms. The lesion has been there for an extended
period, but she was not concerned until a friend asked her about it. The provider
excises the benign lesion with 0.5 cm margins and generously applies bacitracin and
an adhesive bandage. The total size is 1.1 cm, including margins. Although the
provider assures the patient the lesion is benign, he sends the specimen to
pathology for confirmation. Which is the correct coding combination?
1 point
A. 11442-GZ
B. 11442, 11100-59, 12011-59
C. 11441
D. 11442

67. A 16-year-old boy is brought in because of a skateboarding accident. He

sustained open wounds on both lower legs. The surgeon takes the patient to the OR
for debridement. The wound on the left leg is 4 cm x 6 cm. The surgeon irrigates the
wound and debrides the subcutaneous tissue and skin. When all of the debris is
removed, he applies a dressing and then addresses the right leg, which has a wound
measuring 3 cm x 5 cm. This wound is deeper than the last, and requires
debridement of nonviable muscle, subcutaneous tissue, and skin. What is the proper
code selection?
1 point

A. 11043, 11042
B. 11043, 11046
C. 11042, 11045, 11043
D. 11042, 11045, 11043, 11046

68. The provider debrides 25 sq cm of subcutaneous tissue from the right leg, and
20 sq cm of subcutaneous tissue from the left leg. Proper coding is:
1 point

A. 11042 x 3
B. 11042, 11045
C. 11042, 11045-59, 11045-59
D. 11042, 11045 x 2

69. Which of the following codes properly describes a separate encounter for simple
suture removal for a Medicare patient?
1 point

A. 15850
B. 15851
C. S0630
D. Medicare does not designate a separate code for simple suture removal

70. A male patient with gynecomastia undergoes extensive resection of right breast
tissue. Correct reporting of this procedure would be:
1 point

A. 19120-RT
B. 19300-RT
C. 19301-RT
D. 19303-RT
71. A patient has a pressure ulcer requiring the surgeon to debride all the necrotic
muscle, subcutaneous tissue, and skin. The size of the ulcer before the debridement
was 3 cm x 5 cm. When the debridement was complete, the size of the ulcer was 4
cm x 6 cm. Which is the proper coding?
1 point

A. 11043, 11046
B. 11043
C. 11046
D. 11042, 11043

72. A 36-year-old male weightlifter recently ruptured his intervertebral disks at L1-L3.
A laminectomy without decompression and disk removal with pedicle fixation anterior
instrumentation were performed. What codes would be reported in this case?
1 point

A. 22630, 22632 × 2, 22845

B. 22630, 22632, 22842
C. 63017, 22632 × 2, 22845
D. 63047, 63048 × 3, 22842

73. A 52-year-old man presents to the ER with severe abdominal pain. He has had
abdominal pain for about six months, which has been coming and going. The pain
increased one week ago, and today the patient was unable to bend without
becoming short of breath due to the pain. A CT scan was performed and patient was
noted to have a large, 7.5 cm soft tissue tumor attached to his abdominal wall. The
patient underwent surgery to have it removed and it was found to be a sarcoma.
During surgery, the patient also had a large margin removed from around the tumor
site. What is the correct code for this procedure?
1 point

A. 22902
B. 22903
C. 22904
D. 22905

74. A 12-year-old boy arrives to his pediatrician’s office complaining of right arm pain
around the elbow. Two days prior, he fell during football practice. An x-ray was
obtained and it was noted that he had a displaced fracture of the capitellum at the
radial head. This was a closed fracture requiring manipulation. Which CPT code is
correct?
1 point

A. 24600
B. 24620
C. 24640
D. 24655

75. A 25-year-old construction worker has been diagnosed with trigger finger of his
right 2nd digit. He has received three steroid injections over the last year, but it
continues to flare. He is referred to surgery for further evaluation. The surgeon
recommends a tendon sheath incision and this is scheduled as an outpatient. What
is the correct CPT code for this procedure?
1 point

A. 26055
B. 26060
C. 26160
D. 26170

76. A 3-year-old girl was born with two polydactylous digits on her right hand. One
digit was soft tissue only and was able to be tied off at birth. The second digit
included bone and skin and was unable to be treated at birth. Because she is now
three years old, this extra digit will be removed, leaving her with five digits total. What
is the correct code for this procedure?
1 point

A. 26560
B. 26561
C. 26587
D. 26590

77. A neurosurgeon performs craniocervical posterior arthrodesis (22590), applies

non-segmental instrumentation (22840), and a bone graft (20900). What reductions,
if any, will apply to her reimbursement?
1 point

A. No reductions apply
B. 22590 is the primary code reimbursed at 100 percent; 22840 and 20900 are each reduced
50 percent
C. 22590 is the primary code reimbursed at 100 percent; 22840 is reduced 50 percent and
20900 is not reduced
D. 22590 is the primary code reimbursed at 100 percent; 20900 is reduced 50 percent and
22840 is not reduced

78. A 17-year-old boy slipped and fell and severely injured his left knee in a high
school football game. He is diagnosed with a left ACL and lateral meniscus tear. He
undergoes an arthroscopically-aided ACL repair, plus a lateral meniscus repair.
Proper coding is:
1 point
A. 29888-LT, 29881-LT
B. 29889-LT, 29881-LT
C. 29888-LT, 29882-LT
D. 29889-LT, 29882-LT

79. Mr. Smith had an arthroscopic right shoulder rotator cuff repair done by his
orthopedic surgeon. This was done as an outpatient procedure at 10:00 a.m., and he
was discharged home at 1:00 p.m. That afternoon, while using the bathroom, Smith
slipped and fell, injuring his left wrist. He is rushed to the hospital, where X-rays
confirm a Colles fracture of his left wrist. The same orthopedic surgeon performs a
closed reduction on his left wrist at 4:00 p.m. Proper coding is:
1 point

A. 25520, 23410
B. 29827, 25605-59
C. 29827, 25600
D. 25600, 29827-59

A 32-year-old woman fractured her left patella in a skiing accident. The clinical
diagnosis indicated fracture into three fragments. She had an ORIF of the fracture
performed, with partial patellectomy and underlying soft tissue repair. Proper coding
for this scenario isz
1 point

A. 27524-LT, S82.045A, V00.321A, Y93.23

B. 27514-LT, S82.045B, V00.321A, Y93.17
C. 27514-LT, 27350-51-LT, S82.042A, W18.49XA, Y93.23
D. 27524-LT, 27350-59-LT, S82.042B, V00.321A, Y93.24

81. A 30-year-old male injured one of his shoulders at work, tearing his rotator cuff.
The provider performs an arthroscopic repair, but due to the extent of the shoulder
injury, the provider also performs a biceps tenotomy, subacromial bursectomy, and a
coracoid decompression. A debridement of the anterior labrum is done. An
examination of the AC joint reveals some narrowing. Osteophytes are removed from
the undersurface of the acromion, converting it to a type I morphology. A distal
claviculectomy is performed with the removal of 6 mm of bone. Combined, the
procedures create a 1 cm space in the AC joint. How would this surgery be coded?
1 point

A. 29827, 29999-59, 29999-59, +29826, 29807, 29824, and 29823-59

B. 29827, 29999-59, +29826, 29822-59, 29823-59
C. 29827, +29826
D. 29827, 29824-51, +29826, 29823-59
82.OPERATIVE REPORTPREOPERATIVE DIAGNOSIS: Thrombosed
hemorrhoidsPOSTOPERATIVE DIAGNOSIS: SameANESTHESIA: GeneralBRIEF
HISTORY: A 41-year-old man whose occupation is driving a semi-trailer truck
presented in the office I week ago with very painful hemorrhoids. He had not had a
bowel movement for 10 days as a result of the pain he has recently encountered.
Theprocedure was explained to him for the removal of the hemorrhoid, and his
consent was obtained.PROCEDURE: Induction of general anesthesia was
completed and the patient was prepped and draped in the usual manner. The patient
was placed in the supine position, and a retractor was placed in the anus. A large
external hemorrhoid, partially thrombosed, yeas identified at 4 o’clock in the
lithotomy position. It was grasped with a hemorrhoidal clamp, and a 4-0 chromic
stitch was placed at the apex. Electrocautery was used to elliptically excise the
hemorrhoid, which was deemed simple, keeping superficial to the sphincter muscle.
The hemorrhoid was then passed off to pathology. Bleeding was controlled with
electrocautery, and the mucosa was closed with a running stitch. There was no
prominent hemorrhoidal tissue remaining. Xeroform wrapped around 4 × 4s was
placed in the anus as a dressing, with ABD placed over the top. The patient was
then taken to the recovery room. Estimated blood loss was 100 cc. No complications
were present. What codes would be reported in this case?
1 point

A. 46250, 46940-51
B. 46250
C. 46255
D. 46221, 46940-51

83. A 4-month-old infant underwent a repair of an initial,incarcerated inguinal hernia

with hydrocelectomy, but the repair was discontinued halfway through because of
physiological disturbances the infant was experiencing. What code would be
reported in this case?
1 point

A. 49496-53,-63,-99
B. 49492-53
C. 49492,-53,-63,-99
D. 49496-53

84. ENDOSCOPY REPORTPATIENT: xxxx xxxxxDATE: xx/xx/xxxxBRIEF

HISTORY: The patient is a 77-year-old female with symptoms of dysphagia while
eating solids × 2 weeks. Patient has a history of Alzheimer’s disease with
hypercholesterolemia and arthritis and is in poor health.PROCEDURE: Gastroscopy;
esophageal dilationINDICATIONS: Barium swallow showed a smooth stricture at the
LEX. Patient was administered Versed.Conscious sedation was monitored in the
usual manner. The video endoscope was introduced into the esophagus with balloon
dilation to 25 ram. A tightstricture was noted at the LES. The stomach to the
duodenum was visualized and appeared normal. The scope was withdrawn, and the
patient was serially dilated. The patient tolerated the procedure well and was sent to
recovery without complications.What code(s) would be reported in this case
1 point

A. 43220
B. 43249
C. 43235, 91040
D. 43235, 43456

85. A patient received a repair of a recurrent incisional, reducible hernia. The coder
assigned code 49566. What is wrong with this coding assignment?
1 point

A. Nothing, the coding assignment is correct

B. The code assigned should be 49560
C. The code assigned includes incarcerated, which is not mentioned
D. The code assigned should be 49565

86. What code would you assign to an intestinal allo transplantation from a living
donor?
1 point

A. 44120, 44135
B. 44140
C. 44136
D. 44120, 44121

87. A patient underwent a laparoscopic gastric restrictive procedure with placement

of only a gastric band. This is considered an individual component placement. How
should you report this service?
1 point

a.43659-59
b.43770-22
c.43659-58
d.43770-52

88. Which codes could you report with add-on code 49568?
1 point

a. 11004-11006
b. 49560-49566
c. All of the above
d. None of the above

89. A 13 year old child has his tonsils and adenoids removed due acute tonsillitis and
chronic tonsilitis and adenoiditis.
1 point

a. 42826, 42831, J36 , J35.01

b. 42826, 42836, J03.90, J35.03
c. 42821, J03.90, J35.03
d. 42821-50, J03.90, J35.01

90.A patient was fully prepped for a diagnostic colonoscopy; however an object then
shifted  into the descending colon just below the splenic flexure. The physician was
unable to advance the scope beyond the splenic flexure. How would you report this
diagnostic colonoscopy.
1 point

a. 44388 – 52
b.45330
c.45378 – 53
d. none of the above

91.How would the following case be coded?Preoperative diagnosis: lesion, buccal

sub mucosa, right lower lipPost operative diagnosis: sameProcedure performed:
excision of lesion, buccal submucosa ,right lower lipAnesthesia : local
Procedure:The patient was placed in the supine position. A measured 7 *8 mm hard
lesion is felt under the submucosa of the right lower lip. After application of 1%
Xylocane with 1:1000 epinephrine, the lesion was completely excised. The lesion
does not extend into the muscle layer. The 8cm wound was closed with complex
mattress sutures to the submucosal level and dressed in typical sterile fashion. The
patient tolerated the procedure well and returned to the recovery area in satisfactory
condition.
1 point

a. 40816, D10.39
b. 40814,40831-51, D10.39
c. 40814,K13.70
d.40814 , D10.39

92. The following may be considered if reported separately when performed during
the same operative session using the same approach. 58740 Repair: Lysis of
adhesions49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic,
with or without collection of specimen(s) by brushing or washing
1 point
A. Separate procedures
B. Unbundling
C. Add-on codes
D. Diagnostic procedures

93. When would a coder report an unlisted procedure?

1 point

A. When a procedure is commonly carried out in addition to the primary procedure

B. When a reduction of services is indicated
C. When a more specific code is not available
D. When the service is greater than usually required for the listed procedure

94. Which code(s) would you assign for a home visit for a homebound, elderly
patient who needs stoma care and colostomy maintenance?
1 point

A. 99505
B. 50810, 99505
C. 99504
D. 99505, 99507

95. Today, a 36-year-old male patient underwent five needle biopsies of the prostate.
The needle placement for these biopsies was completed under ultrasonic guidance.
Which code(s) should you report for these professional services?
1 point

a. 55700 x 5, 76942
b. 55700, 76942-26
c. 55706, 76942-26
d. 55700 X 5, 55706, 76942

96. Which code(s) should Dr. Orange report in the following case? Surgeon: Dr.
OrangeAnesthesiologist: Dr. MeePreoperative diagnosis: Prominent left
spermatocelePostoperative diagnosis: SameProcedure performed: Left spermato
cystectomy with epididymectomyIndications for procedure: The patient is a 66-year-
old male with a progressively enlarging left sided spermatocele causing discomfort in
this area. This lesion is four times the size of the testicle. After careful explanation of
the risks, benefits, and alternatives, he agreed to the procedure.Operative report:
The patient was taken to the operating room, prepped and draped in the usual
fashion, and induced under general anesthesia. He was placed in a supine position.
Midline raphe incision was made using a skin knife, and Bovie® electrocautery was
used to dissect through the subcutaneous tissues down to the level of the tunica
vaginalis, which was incised. The testicle and spermatocele were exposed. A portion
of the epididymis was overlying the spermatocele, and I dissected this carefully with
resection of a portion of the epididymis, which was tied off using a 3-0 Vicryl® free
tie. I proceeded to dissect circumferentially to free the spermatocele, leaving
adequate blood supply to the testicle. The testicle was placed back within the tunica
vaginalis; I proceeded to reapproximate this without difficulty using a 3-0 Vicryl stitch.
Subcutaneous closure was performed using a 3-0 Vicryl in a running fashion,
followed by closure of the skin using 3-0 chromic in a running horizontal mattress
fashion. The patient tolerated the procedure well with no complications. He was
taken to the recovery room in satisfactory condition.
1 point

a. Q55.8, 54860-LT, 54840-LT

b. Q55.8, 54840-LT
c. N43.40, 54860-LT, 54840-LT
d. N43.41, 54840-LT

97. A 26 year old patient who is Gravida 2 Para 1 presents to the ER in her 36th
week of pregnancy with twin gestations who are monochorionic and monoamniotic.
She is in active labor, 6 cm dilated, and her water is intact. Her OBGYN, who
provided 12 antepartum visits, admitted her to labor & delivery. Although the patient
had a previous cesarean during her first pregnancy the physician allowed her to
attempt a vaginal birth. After pushing for three hours the patient was exhausted and
taken to the OR for a cesarean delivery with a transverse incision. Two healthy
newborns were born 15 minutes later. During the hospital stay and afterward the
same physician provided the postpartum care to the mother.
1 point

a. 59426, 59622, 59620, O30.003, O60.14X0, Z38.4 , O30.019

b. 59618, 59620-51, O30.003, O60.14X0, O82, Z37.2, O30.019
c. 59618, 59618-51, O30.003, Z37.2, O30.019
d. 59618-22, O30.003, O60.14X0, Z38.4 , O30.019

98.One week ago, Marion underwent a surgical laparoscopy with vaginal

hysterectomy including removal of a 275-g uterus tube and ovaries due to cancer of
the endometrium. Today she was admitted for a planned insertion of vaginal
radiation after loading apparatus for clinical brachytherapy. During this procedure,
the surgeon inserted the device and took x-rays to ensure placement. Once the
device was in proper location, it was fixed into position by tightening the applicator
base plate and locking mechanism. Marion tolerated the procedure well and was
sent to the recovery room in satisfactory condition. How should today’s professional
services be reported?
1 point

a.58554,57156-58
b.57156-59, 77316 – 26
c.58554,57156 – 59, 77316- 26
d.57156 – 58

99.Diane suffered a spontaneous incomplete miscarriage during the second

trimester and required surgical completion of this event. How should this procedure
be reported?
1 point

a.59812
b.59820
c.59821
d.59840

100.A patient had three needle biopsies of the prostate completed under imaging
and guidance. Which codes capture the professional services for this procedure?
1 point

a.55700*3 , 76942 -26

b.10022, 55700*3 , 76942 -26
c.55700 , 76942 – 26
d.55705 *3, 10022 , 76942 -26

101. What CPT code should you report for UFR (simple uroflowmetry)?
1 point

a. 51736
b. 51741
c. 51772
d. 51785

102. Which of the following codes should you report for stereotactic implantation of
depth electrodes into the cerebrum for long-term seizure monitoring?
1 point

a. 61760
b. 61735
c. 61761
d. 61793

103. A 73-year-old female was diagnosed with a myotonic cataract caused by

Steinert’s disease. An extracapsular cataract removal with insertion of intraocular
lens prosthesis, one-stage procedure, by manual technique was performed. What
codes would be reported in this case?
1 point

A. H25.032, E83.50, 66983

B. H28, E83.50, 66982
C. H26.9, G71.19, 66983
D. H28, G71.19, 66984

104.  A 37-year-old female presented with swelling of the neck and lethargy for over
1 month. The physician suspected lymphoma, and a biopsy was scheduled. A large
hollow core needle was passed into the thyroid, and a specimen was taken and sent
to histopathology for examination. A diagnosis of lymphoma was confirmed. The
patient was sent to ontology for consultation. What codes would be reported in this
case?
1 point

A. C82.91, 10021
B. C81.41, 10021
C. C82.91, 60100
D. C81.41, 60100

105. Dr. Hewes completed an anterior arthrodesis fusion, with a structural allograft,
and minimal discectomy at L1-2, L3-4, and L4-5. Anterior instrumentation was
required and inserted for stabilization of the entire lumbar region. How should Dr.
Hewes report this procedure?
1 point

a. 22612, 22614 x 2, 20931, 22846

b. 22558, 22585 X 2, 20931, 22846
C. 22558, 22585 X 2, 20931-51,22846-62
d. 63075, 22558, 22614 X 2, 20931-51,22846-62

106. 73-year-old female undergoes the following procedure:1. L3-L4, L4-L5

laminectomies, medial facetectomies, and foraminotomies2. L3-L4, L4-L5
posterolateral fusion with pedicle screws and rods, as well as bone graft harvested
from the spinous processes.What is the correct CPT code?
1 point

a.63047, 63048, 22612, 22614, 20936, 22842

b.63047,63048,22611,22613,20936,22484
c.63048,22610,22600,22481,22840,22612
d.63047,63048,22613,22418,22841,22850

107. What code should you report for exenteration of orbit (does not include the skin
graft), removal of orbital contents; only?
1 point

a. 65105
b. 65110
c. 65112
d. 65114

108. Dr. Grant  injected Mrs. Brown with two units of chemodenervation
(onabotulinumtoxinA) to treat her bilateral blepharospasm. How should Dr. Grant
report his services?
1 point

a. 67345-50, 10585 x 2
b. 67345
C. 64612-50
d. 64612

109. A patient underwent the insertion of a Jones tube to create proper drainage
(fistulization) from the conjunctiva to the nasal cavity. The tube was manipulated into
place by the surgeon and checked for proper placement, not touching the middle
turbinate or septum. How should you report this procedure?
1 point

a. 68750
b. 68745
c. 68720
d. 68815

110. Mary Jo, a 33-year-old patient, was diagnosed with a lesion in her auditory
canal. After consulting with Dr. Pearsall, she agreed to undergo an excision of the
lesion. Dr. Pearsall completed a  soft tissue lesion excision from Mary Jo's external
auditory canal. How should you report this procedure?
1 point

a.69915
b.69150
c.69145
d.69105,69150-59

111. Dr. Evans completed a bilateral tympanostomy on a 3-year-old patient with a

history of recurrent otitis media and tympanic membrane perforation. Dr. Angell, the
anesthesiologist, placed the patient under general anesthesia prior to the procedure.
How should Dr. Evans report this procedure?
1 point

a. 69436-50
b. 00126-AA-P1
c. 00126-AA-P1, 69436-51
d. 69433-50
112. OPERATIVE REPORTPROCEDURES: 1. Cardiac catheterization 2. Stent to
the marginal vein graftBRIEF HISTORY: The patient was a 52-year-old male with
known coronary artery disease who was experiencing recent chest pain, fatigue,
hyperhidrosis, and dyspnea. The patient had a history of myocardial infarction
followed by a three-vessel coronary artery bypass.PROCEDURE: The combined
right and left heart cardiac catheterization was performed by left ventricular puncture
and revealed a sluggish left ventricular function and mildanterior hypo kinesis. The
left anterior descending had a 60% occlusion in the anterior segment and an 80%
occlusion in the distal segment. The left circumflex artery had a 90% occlusion. The
first marginal branch had a 100% occlusion, and the second marginal branch also
had a 100% occlusion. The right coronary artery had a 50% occlusion. Three grafts
were identified. The graft to the left anterior descending to the left marginal and then
to the second marginal was 100% occluded at the ostium of the left anterior
descending and had a 90 occlusion at the junction of the left marginal. The lesion at
the junction of the marginal artery and the saphenous veingraft was successfully
stented. Stenosis was reduced to less than 20%. The patient tolerated the procedure
well and was taken to recovery.DISCHARGE MEDICATIONS: Plavix 100 mg t.i.d. for
60 days Enteric-coated aspirin 100 mg b.i.d. Combivent 2 puffs t.i.d.PLAN: Patient to
comply with medication treatments. Follow-up care with cardiologist × 2 weeks
postop. Patient was instructed to resume normal activities if cleared by cardiologist
after follow-up visit. Patient was advised to report recurrent symptoms to PCP or
office.What codes would be reported in this case?
1 point

A. 93453,92928-51
B. 93458, 37200, 37211 × 2
C. 93452,37200-51
D. 93453, 92933-51

113. OPERATIVE REPORT:PROCEDURE(S): Primary rhinoplastyBRIEF HISTORY:

A 32-year-old female presented with symptoms of nasal airway obstruction that had
been chronic for more than 10 years with recent exacerbation. She was concerned
about her difficulties and the appearance of her nose. She had a history of
ubinectomy and septoplasty to address her airway problems. The patient was well
informed concerning the rhinoplasty procedure and elected to proceed.
PROCEDURE: The complete rhinoplasty including bony pyramid and lateral and alar
cartilages, and elevation of nasal tip was carded out through a columellar chevron
incision by the primary surgeon and the minimum assistant surgeon. The nose was
infiltrated with 2% lidocaine without epinephrine before incision. The incision was
made and carried to bilateral rim incisions. The nasal skin was excised using
dissecting scissors. The irregular nasal bones were smoothed with a rasp. Excision
of the dorsal nasal bone was then carried out with a straight guarded osteotome. An
approximately2-mm thickness of bone was removed. The cartilaginous nasal dorsum
was then smoothed and brought down by using direct shave excision with a #10
blade. Portionsof the upper lateral cartilage were also excised. The dorsum was fully
straightened; the upper lateral cartilage was resutured to the septum. The nasal
fibrofatty tissue between the lower cartilage was excised. The nasal tip was
narrowed with interrupted 5-0 PDS sutures. The alar domes were also sharpened
with narrowing suture of 5-0 PDS. Dissection was then carried down through the
inferior columellar base for a 2.0-cm reconstruction. The caudal septum was excised.
The skin was redraped, and closure was carded out by using interrupted 4-0 Prolene
for the columellar and stab incisions. Xeroform packs were placed lateral to the nasal
splints. The dorsum of the nose was taped, and a dorsal thermoplast spint was also
placed. The patient was extubated; she tolerated the procedure well and was sent to
recovery. What codes would be reported in this case?
1 point

A. 30400-82
B. 30410, 13152-82
C. 30410, 13151-81
D. 30450, 13151-81

114.The exchange of oxygen and carbon dioxide between the body and the air we
breathe in is called:
1 point

A. External respiration
B. Cellular respiration
C. Internal respiration
D. Active transport

115. A 7-year-old female was seen for a well-child check up for first grade. Her father
returned 2 weeks later with her for a removal of a nose ring that became lodged
when she tried to insert it in her nose. The father’s attempt to retrieve it exacerbated
her symptoms. The physician removed the nose ring from the child’s nose in the
office without anesthesia. The coder assigned codes 99212, 30310, T17.1XXA.
What is incorrect with the coding assignment?
1 point

A. Nothing is wrong with the coding assignment

B. Code 30310 should be code 30300
C. There is no need for code 99212, and code 30310 should be 30300
D. There is no need for code 99212, and code T17.1XXA should be T17.200A
116. OPERATIVE NOTEPATIENT: xxxx xxxxxDATE: xx/xx/xxxxBRIEF HISTORY:
The patient was a 66-year-old female with chronic hypertension and Parkinson’s
syndrome, with a unilateral mass on the lung. The patient had lost more than 30
pounds and was expofieneing lethargy,anorexia, dyspnea, and bilateral chest
pain.PROCEDURE: Bronchoscopy with washings and brushingsPROCEDURE IN
DETAIL: The patient was administered Versed with 10 mg of Fentanyl by an
anesthesiologist who remained during the procedure.The bronchoscope was placed
in the right naris and was passed first the right tracheobronchial tree and then to the
left where no lesions or bleeding were noted. With the use of fluoroscopic guidance,
biopsies of the left upper lobe mass were accomplished with brushings and
washings. There was minimal bleeding associated with the biopsies. The patient
tolerated theprocedure well. Oxygen saturation was 94%, pulsewas 88, and BP was
122/76. The patient was taken to the recovery room with no complications. The
biopsies were sent to pathology.What codes would be reported in this case?
1 point

A. 31625, 31623-51
B. 31622, 31623, 31625-51
C. 31622, 31625-52
D. 31622, 31625, 31628-51

117. The following is an operative note for a 46-year-old male who is returning to the
operating room for a related heart procedure during his initial postoperative period.
Choose the correct codes based on the information provided.OPERATIVE
REPORTPATIENT: xxxx xxxxxDATE: xx/xx/xxxxBRIEF HISTORY: A 46-year-old
male was admitted with a diagnosis of acute systolic heart failure complicated by
congestive heart failure.PREOPERATIVE DIAGNOSIS: Acute systolic heart failure;
congestive heart failurePOSTOPERATIVE DIAGNOSIS: SamePROCEDURE:
Insertion of permanent pacemaker with transvenous electrodes.The patient was
placed supine on the operating table and was prepped and draped in the usual
manner. General anesthesia was administered by an anesthesiologist and was
monitored in the usual fashion. A subcutaneous incision was made creating a pocket
for the pulse generator. By guide wire, a sheath technique lead was introduced into
the subclavian vein and subsequently directed to the right ventricle.The pacemaker
was positioned at the threshold 0.5 volts, current 2.0 milliamps and R wave 10. The
leadwas secured under the clavicle with multiple sutures of 2-0 Vicryl. The
pacemaker was programmed at 68 beats per minute. The pulse generator was then
anchored in the pocket with a single 2-0 PDS suture. Sterile dressing was applied.
The patient tolerated the procedure well and was taken to the recovery room.
1 point
A. I50.1,I50.31, 33211
B. I50.41,I50.9, 33208-76
C. I50.21, 33206-78
D. I50.21,I50.9, 33206-78

118. PROCEDURE:IVC Filter PlacementIndications: DVT Following informed written

consent, the patient's right groin was prepped and draped in the usual sterile
manner. 2% lidocaine was given locally for anesthesia. Additionally, the patient
received 1 mg of IV Versed and 50 mcg of IV fentanyl for conscious sedation and
pain control. Vital signs were monitored and remained stable. Access was gained in
the right common femoral vein and a 5 French omniflush catheter was placed over a
wire, into the inferior vena cava and used to perform an inferior venacavogram. The
catheter was then exchanged over the wire for a folded when achieved. A greenfield
filter was successfully deployed in the infrarenal IVC without immediate
complications. Findings: Images obtained of the inferior vena cava prior to filter
placement demonstrate moderate irregularity and a filling defect at and just above
the level of the renal veins along the left side of the cava, consistent with adherent
thrombus. The suprarenal IVC is markedly tapered in its intrahepatic segment,
consistent with hepatomegaly as a result of patient's known diffuse hepatic
metastasis. The IVC filter is noted to lie within a patent segment of the infrarenal IVC
with a moderate amount of tilt  Impression   1. Moderate filling defect in the
suprarenal IVC and a focal tapering of the intrahepatic IVC segment, consistent with
IVC thrombus and the patient's known hepatomegaly as a result of diffuse hepatic
metastasis. 2. Successful uncomplicated deployment of an infrarenal IVC filter.
1 point

a) 37191, I82.409
b)37192, I82.409
c)37193, I82.409
d)37195 , I82.412

119. From a right femoral approach the catheter in placed into both the main renal
arteries with imaging bilateral.  
1 point

a. 36200(x2) & 75625

b. 36251
c. 36252
d. 36253 (x2)

120. Placement of a catheter into the arterial or venous side of an AV- fistula is
defined by code:
1 point
a. 36120
b. 36005
c. 36901
d. 36905

121. A 20 month old child is admitted to the hospital with pneumonia and acute
respiratory distress. The physician spends 3 minutes intubating the child and spends
90 minutes of Critical Care time stabilizing the patient.
1 point

a. 99291; 99292-25; 31500; J80; J18.9

b. 99471-25; 31500; R06.00; J18.9
c. 99291-25; 99292-25; 31500; R06.00; J18.9
d. 99471; J80; J18.9

122. Certain procedures are a combination of a physician component and a technical

component. When the physician component is reported separately, the service may
be identified by adding which modifier?
1 point

A. -22
B. -26
C. -62
D. -82

123. RADIOLOGY REPORTPATIENT NAME: xxxx xxxxxBIRTH DATE:

xx/xx/xxSTUDY: Chest x-ray, front and lateralPATIENT HISTORY: Patient is a 45-
year-old female with complaints of dyspnea, chest tightness, blood in sputum,
congestion, and lethargy × 1 week.IMPRESSION: Moderate eventration of the
anterior portion of the fight hemidiaphragm is present. Partial collapse of the fight
middle lobe is identified, and an unusual spherical density is seen over the apex of
the fight hemidiaphragrn on the PA projection. PLAN: A follow-up examination is
recommended in 1 week.What code would be reported in this case?
1 point

A. 71035
B. 71030
C. 71020
D. 71021

124. ACT scan was performed on a 27-year-old male baseball player who was hit in
the face with a baseball during a game. The CT scan was made of the maxillofacial
area without contrast material, followed by a scan with contrast material and further
sections. A 3-D rendering with interpretation and  report of the CT scan, which did
not require an independent workstation, was included. What codes would be
reported in this case?
1 point

A. 70482, 76377
B. 70488, 76376
C. 70487, 76376
D. 70470, 76376

125. RADIOLOGY REPORTPATIENT NAME: xxxx xxxxxBIRTH DATE:

xx/xx/xxSTUDY: MRI, no contrast material: spinePATIENT HISTORY: The patient is
a 54-year-old female, postmenopausal, who has complaint of chronic back pain for
more than 4 years and was diagnosed 3 years ago with degenerative arthritis of the
spine. Recent symptoms have exacerbated, and anMRI was
indicated.IMPRESSION:CERVICAL SPINE: Degenerative disk disease is noted
throughout the cervical spine but is most severe from C4 to C6. Marked spur
formation is noted to the intervertebral foramina unilaterally at these levels. No
fracture or dislocation is identified.THORACIC SPINE: The vertebral bodies have
normal height and alignment, and the disks are or normal width.LUMBAR SPINE:
Progressive degenerative changes  have occurred on the leR side between the first
and third lumbar vertebrae inclusive. No fracture is identified.What code(s) would be
reported in this case?
1 point

A. 72159
B. 72141, 72146, 72148
C. 72156, 72157, 72158
D. 72125, 72128, 72131

126. A physician performed an ultrasound on the pregnant uterus of a 21-year-old

female, with realtime image documentation; fetal and maternal evaluation was
included. The transabdominal approach was used for ultrasound of the first trimester,
12-week-old pregnancy. Code for the physician component only.
1 point

A. 76805-26
B. 76816-59
C. 76801-26
D. 76813, 76801-26

127. Code for a red cell survival study with hepatic sequestration and platelet
survival study.
1 point
A. 78130, 78190
B. 78130, 78191
C. 78130, 78201, 78191
D. 78130, 47505, 78191

128. What scan implies a one-dimensional ultrasonic measurement procedure with

movement of the tract to record amplitude and velocity of moving
echoproducingstructures?
1 point

A. A-mode scan
B. B-scan
C. Real-time scan
D. M-mode scan

129. What code(s) would be assigned for a therapeutic radiology plan that includes
three or more converging ports, two separate treatment areas, multiple blocks,or
special time-dose constraints?
1 point

A. 77262
B. 77285
C. 77261,77262
D. 77523

130. A 16-year-old female underwent a tumor-imaging PET scan with a concurrently

acquired CT for attenuation correction and anatomical localization from skull base to
midthigh. What codes would be reported in this case?
1 point

A. 78812, 70450
B. 78812, 70450, 70470
C. 78815
D. 78608, 70470

131.RADIOLOGY REPORTPATIENT NAME: xxxx xxxxxBIRTH DATE:

xx/xx/xxSTUDY: X-ray; wristPATIENT HISTORY: The patient is a 13-year-old male
with a history of wrist soreness, stifflless, intermittent swelling, and erythema. The
patient shams that he hurt his right wrist last month playing basketball but did not tell
his coach or parents.IMPRESSION: The four views showed an ill-d~f’med 2.0-mm
bony fragment on the dorsal aspect of the right wrist, which could represent a small
avulsion fracttum from either the capitate or lunate bone. No evidence of any joint
disease is noted. Whatcode(s)wouldbereportedinthiscase?
1 point

A. 73115
B. 73110
C. 73721
D. 73100,73110

132. When pathology and laboratory tests are performed on the same date of
service to obtain multiple results,what modifier should be used?
1 point

A.-51
B. -91
C. -90
D. -56

133.PATHOLOGY REPORTNAME: xxxx xxxxxBIRTH DATE: xx/xx/xxHISTORY: A

55-year-old male with a history of transurethral resection of the bladder for grade II
TCC with miroinvasion; multiple tumors. GROSS DESCRIPTION: The specimen is
labeled "biopsy bladder tumor" and consists of multiple fragments of gray-brown
tissue that appear slightly hemorrhagic. They are submitted for
processing.MICROSCOPIC DESCRIPTION: Section of the bladder contains areas of
transitional cell carcinoma. No area of invasion can be identified. A marked acute
and chronic inflammatory reaction with eosinophils is noted, with some
necrosis.DIAGNOSIS: Papillary transitional cell carcinoma, grade II, bladder
biopsy.What code(s) would be reported in this case?
1 point

A. 88305
B. 88309
C. 88305, 88307
D. 88307

134. A routine venipuncture was performed on a 29-yearold female. Quantitative

therapeutic drug assays were performed for haloperidol and phenobarbital.
Whatcodes would be reported in this ease?
1 point

A. 80173, 80184
B. 36410, 80173, 80184
C. 36415, 80173, 80184
D. 80103, 36410, 80173, 80184

135. What code would you assign for the sweat collection by iontophoresis?
1 point

A. 82438
B. 89230
C. 89240
D. 88189

136. Code for elevation and pH of blood gases CO2, pCO2 and HCO3.
1 point

A. 82810
B. 82803
C. 82800, 82820
D. 82805

137.PATHOLOGY REPORTNAME: xxxx xxxxxBIRTH DATE: xx/xx/xxHISTORY:

The patient was a 17-year-old male experiencing RLQ pain for the previous 12 hours
with recent exacerbation. Radiology report showed inflamed appendix.GROSS
DESCRIPTION: The specimen was labeled appendix and was received in formalin.
The specimen consisted of an appendix that measured 5 × 1 × 1cm in greatest
dimension.MICROSCOPIC DESCRIPTION: The serosa surface had some white
fibrinoid material attached to it across it and on a cross-section necrosis was noted.
The representations were submitted.DIAGNOSIS: Acute appendicitis. What codes
would be reported in this case?
1 point

A. K35.2, 88300
B. K35.80, 88302
C. K35.80, 88304
D. K38.2, 88304

138. Which is the study of diseased tissues?

1 point

A. Cytology
B. Histopathology
C. Cytopathology
D. Hematology

139. Code for the qualitative analysis of organic acids, 2 specimens.

1 point

A. 83919 × 2-91
B. 83918, 83919-51
C. 83921 x 2-91
D. 83918 × 2-91

140. Code for a qualitative urinalysis for a bacteriuria screen.

1 point

A. 81000, 86609
B. 81002, 86609
C. 81007
D. 81007, 86609

141. A pathology consultation during surgery was performed for three tissue blocks
with frozen sections. What codes would be reported in this case?
1 point

A. 88329,88331,88332 × 2
B. 88329,88332 × 2
C. 88331 × 3
D. 88331,88332 × 2

142. A physician who specializes in the study of electromyography and nerve

conduction tests is a(n):
1 point

A. Immunologist
B. Internist
C. Cardiologist
D. Neurologist

143. Which code(s) would be correct for the 8-channel EEG monitoring for
identification and lateralization of cerebral seizure focus, with
electroencephalographic recording and interpretation for 48 hours?
1 point

A. 95951 × 2
B. 95950 x 2
C. 95813
D. 95812, 95950

144. A 54-year-old female went into the hospital for chemotherapy administration by
intravenous infusion technique for three hours. What code(s) would be reported in
this case?
1 point

A. 96401
B. 96405, 96411 × 2
C. 96413, 96415 × 2
D. 96420, 96423 X 2

145. What codes would be assigned to the intravenous hydration for 5 hours for an
11-month-old infant who has RSV and hyperemesis?
1 point

A. 90706, 90761 × 3-63

B. 90761 × 5-63
C. 96360,96361 × 4
D. 90765, 90766 × 4

146. Mild sedation services were rendered to a 4-year-old male who underwent
repair (12 sutures) in the left forearm as a result of a complex wound he received
from a dog bite. The same physician who repaired the wound also provided the
sedation support, which also required a trained observer  to assist in the monitoring
of the patient’s levelof consciousness and physiological status for 45 minutes. What
codes would be reported in this case?
1 point

A. 99152, 99153*2
B. 99156, 99157
C. 99151, 99153*2
D. 99156, 99157*2

147. A 61-year-old female with disorganized schizophrenia who is an inpatient at a

mental ward took part in individual psychotherapy, insight oriented with a behavior-
modifying focus. The physician spent 80 minutes face-to-face with the patient. What
code would be reported in this case?
1 point

A. 90837
B. 90832
C. 90834
D. 90837,90838

148. In what subsection in the Medicine section of the CPT manual would you t’md
comprehensive computer-based motion analysis by video taping and 3-D kinetics?
1 point

A. Functional Brain Mapping

B. Neurostimulators, Analysis Programming
C. Evoked Potentials and Reflex Testing
D. Motion Analysis

149. Code for Maximum breathing capacity, maximal volunatary ventilation

1 point

A. 94772
B. 94375
C. 94200
D. 94370
150. An 18-year-old male with a history of detached retina of the left eye underwent
external ocular slitlamp photography with interpretation and report for documentation
of medical progress on his injury.What code would be reported in this case?
1 point

A. 92230
B. 92250
C. 92285
D. 92020