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Created 8/28/08

Non-VAMC Combination Facility Coding Test


(IP, OPS, ER)

Name of Applicant: ______________________________________

Year of coding book used: __________________

PART 1: MULTIPLE CHOICE

INSTRUCTIONS: Review each question & circle the most appropriate answer

1. Hypertension with chronic renal insufficiency is coded as:


A. 401.9, 593.9 C. 403.90, 593.9
B. 403.90, 585.9 D. 403.91, 585.9

2. A patient who has had a recurrence of colon carcinoma is admitted following


attempted suicide by ingesting an unknown quantity of Valium. Final diagnosis: Depression and
anxiety, attempted suicide by ingesting Valium resulting in hypotension, and colon carcinoma.
Which of the following identifies the appropriate principal diagnosis for this scenario?

A. Depression B. Valium poisoning


C. CA colon D. Hypotention

3. A patient presents to OP surgery for a planned inguinal hernia repair. Following the
surgery, the patient experienced severe abdominal pain and was admitted to the hospital for
further workup. No specific cause of the pain was identified and it was resolved within 24 hours.
Which of the following identifies the principal diagnosis for the inpatient admission?

A. Inguinal hernia (550.90)


B. Other specified postop complication (998.89)
C. Abdominal pain (789.00)
D. Aftercare following surgery or oral cavity & digestive system (V58.75)

4. Which of the following statements is FALSE regarding coding of fractures?

A. When a patient has both a dislocation and fracture at the same site, both the dislocation
and fracture are coded.
B. When a patient has both a dislocation and fracture at the same site and reduction of both
is performed, only the fracture reduction is coded.
C. A compound fracture is an open fracture.
D. Compression fractures may be due to either disease or trauma.

5. What is the principal diagnosis for a patient admitted with septic shock from
streptococcal septicemia due to pneumonia?

A. 486, pneumonia
B. 995.92, severe sepsis

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C. 038.0, streptococcal septicemia
D. 785.52, septic shock

6. Which of the following is an adverse reaction?

A. Patient took his wife’s prescribed Ambien to help him sleep, which resulted in altered
mental status.
B. The nurses inadvertently gave too little potassium, resulting in muscle spasms.
C. Dilantin toxicity resulting in nystagmus.
D. Interaction between beer and Paxil as taken as prescribed for depression.

7. With which of the following hernia repairs is it appropriate to assign a separate code for the use
of mesh or other prosthesis?

A. Recurrent inguinal hernia


B. Initial inguinal hernia
C. Recurrent femoral hernia
D. Initial incisional hernia

8. In which of the following scenarios is it appropriate to assign a code from category V10 –
Personal history of malignant neoplasm?

A. Colon cancer recurred at the original site and adjunct therapy is being directed to that
site.
B. Prostate cancer was eradicated 5 years ago and now presents with brain metastasis
requiring radiation therapy.
C. Status post mastectomy for cancer of the right breast and is admitted for initiation of
adjunct chemotherapy.
D. All of the above
E. None of the above

9. A physician excises a scar and repairs the defect with an advancement skin flap. In CPT, which
of the following procedure(s) should be coded?

A. Free skin graft only


B. Adjacent tissue transfer only
C. Excisional preparation and free skin graft
D. Excision of lesion and adjacent tissue transfer

10. A malignant melanoma (skin) of the face measuring 1.0 cm was excised. To ensure all the
margins were free of tumor, an additional 2.0 cm was excised from both the top and the bottom.
Intermediate closure of the resulting 5.5 cm defect was performed. Given the codes below,
which of the following identifies the correct coding of this procedure?

A. 11641 & 12053


B. 11646 & 12053
C. 11641
D. 11646

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11. A patient arrives in the ER with severe right lower quadrant pain. He is taken to the
operating room for appendectomy for possible appendicitis. The path report states that the
specimen is “suggestive of acute appendicitis”. The patient is sent home the same day in
stable condition. What would be the appropriate diagnosis code for this patient?

A. 789.03
B. 540.9
C. 541
D. V71.89
E. V50.49

12. Patient presents for repair of the following lacerations: layered closure of a 4.0 cm laceration of
the forehead; 1.5 cm layered closure of the left external ear; simple closure of a 2.5 cm
laceration of the lip; 4.5 layered laceration of the left hand and 2.0 simple laceration of the trunk.
Which of the following describes the correct coding?

A. 12052; 12051-59; 12011; 12001; 12042


B. 12053; 12032; 12042
C. 12054; 12032
D. 12053; 12042; 12011; 12001

13. Which of the following diagnostic statements would be appropriate to assign a code from
category 402 – Hypertensive heart disease?

A. Left heart failure with benign hypertension


B. Acute congestive heart failure with hypertension
C. Hypertensive cardiovascular disease with congestive heart failure
D. Cardiomegaly with hypertension

14. Patient was brought to the ER after swallowing a marble. An emergency esophagoscopy to
remove the marble was performed with success. Which of the following identifies the correct
coding?

A. 938, E915 & 43215


B. 935.1, E915 & 43215
C. 935.1, E912 & 43215
D. 935.1, E915, 43200 & 43215
E. 938, E915, 43200 & 43215
F. 935.1, E912, 43200 & 43215

15. Patient presents to the ER after having been shot. Final diagnosis: Gunshot wound of the
forearm with bullet still present. Which of the following identifies the correct coding of this
condition?

A. Open wound, complicated


B. Late effect of open wound
C. Post-traumatic wound infection
D. Open wound, simple

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PART 2: EMERGENCY

Question 16-20: Review each scenario and assign the appropriate ICD-9-CM diagnosis and
CPT procedure codes. Do not assign ICD-9-CM procedure codes. Append hospital-specific
modifiers where appropriate.

16. A patient presents to the ER with a spider bite of the left leg. The spider was brought along
thinking it might be venomous – it is not. There is no evidence of any infection. The wound was
cleaned and dressed and patient was sent home.

17. Patient returns to the ER as instructed for a wound check. He sustained a laceration of the lower
leg 4 days ago while working. A simple closure was performed at that time. Since he had no
primary care physician, he was told to return to the ER for follow-up. The wound was healing
nicely with no evidence of infection. Dressing was changed. He will return in one week.

18. Patient was involved in an automobile accident where he was the unrestrained driver of a vehicle
hit by another car on a major street. Patient suffered a 3.4 cm laceration of the forehead,
multiple contusions involving the lower leg, several abrasions involving the right lower arm and
possible concussion. The forehead wound was repaired using a layered closure. The abrasions
were cleaned. He refused admission to the hospital to monitor for the presence of concussion.

19. Patient presents to the ER with severe nosebleeds for the past week. Blood work is performed
revealing acute blood loss anemia. The ER doctor performs a limited, bilateral packing of the
anterior nasal cavity. Patient’s anemia will be following by her primary care physician.

20. Patient presents to the ER stating she took 13-15 Bayer aspirin tablets. She states she is feeling
depressed. Gastric lavage was performed with 3 liters of water until clear. She is discharged
into the care of her psychologist. Diagnosis: Suicide attempt, aspirin poisoning, and depression.
Assign the appropriate diagnosis and procedure codes for this scenario.

PART 3: OUTPATIENT SURGERY

Questions 21-28: Review each scenario and assign the appropriate ICD-9-CM diagnosis and
procedure codes as well as the appropriate CPT procedure codes. Include hospital-approved
modifiers as appropriate.

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21. A 14-year-old patient is taken to the emergency room after falling from her bicycle on the road.
She is found to have a fracture and dislocation of the shaft of her radius and ulna. She is taken
to the OR for open reduction and internal fixation of the right radius and ulna.

22. A 12-year-old patient presents for a tonsillectomy and possible adenoidectomy for chronic
tonsillitis. The surgeon determined that the patient also had chronic adenoiditis and removed
both the tonsils and adenoids.

23. Patient presents to the Cardiac Cath lab with known diagnosis of arteriosclerotic heart disease.
He has no previous history of heart surgery. The following procedures were performed:
Percutaneous transluminal coronary atherectomy with balloon angioplasty of the left circumflex
coronary artery and percutaneous transluminal coronary balloon angioplasty involving the left
descending coronary artery.

24. Patient presented to the OP Surgery Department for a FESS under general anesthesia. The
procedure included: Left frontal sinus endoscopy including exploration and removal of diseased
tissue; Bilateral anterior & posterior ethmoidectomy; and, Bilateral maxillary antrostomy.
Pathologic diagnosis: Chronic sinusitis involving the frontal and ethmoid sinuses.

25.Patient presents for colonoscopy for diarrhea and right lower quadrant abdominal pain. The
transverse colon showed aphthous ulcerations. Multiples biopsies were taken of the ulcerated
area to rule out Crohn’s disease. A 2 cm sessile polyp was removed from the descending colon
via snare technique. The sigmoid colon revealed minimal scattered diverticulosis. Path report
revealed a benign villoglandular polyp and active chronic colitis of the transverse colon, Crohn’s
disease ruled out.

26. Patient presents with cataract of the left eye. Phacoemulsification and aspiration was performed.
An intraocular lens was implanted during the same surgical episode.

27. Patient presents with recurrence of transitional cell carcinoma of the bladder. He is taken to the
Cystoscopy Suite where 2 medium anterior wall bladder tumors each measuring 2.0 cm were
fulgurated via a cystoscope.

28. A two year old patient presents for placement of tympanostomy tubes for bilateral chronic otitis
media with effusion. The patient is placed under general anesthesia and the surgeon creates a
myringotomy in the right ear. He then suctions out all fluid in the ear and places a
tympanostomy tube into the eardrum. He concludes by placing antibiotic drops in the ear. The
same procedure is then performed on the left ear.

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PART 4: INPATIENT

Questions 29-35: Review each scenario and assign the appropriate ICD-9-CM diagnosis and
procedure codes. Include E codes where appropriate. List first the appropriate principal
diagnosis code.

29. A 60-year-old man was admitted to Hospital A for an acute subendocardial infarction.
Left heart cath revealed critical stenosis of the coronary arteries. The patient was transferred to
Hospital B for coronary artery bypass grafting (CABG). Cardioplegia and hypothermia were
achieved and the patient was placed on extracorporeal circulation. Saphenous vein graft was
used to bring blood from the aorta to the right coronary artery, left coronary artery, and left
anterior descending artery. Assign the appropriate diagnosis and procedure codes for Hospital
B.

30. A single newborn was delivered at 37 weeks via cesarean section because of fetal
distress noted early in labor. Final diagnosis: cesarean delivery of male infant, cord compression
causing fetal distress. Assign the appropriate codes for the newborn.

31. A patient was admitted for severe right-sided abdominal pain. Work up revealed severe
diverticulitis and colonic abscess of the ascending colon. The patient was taken to the OR for a
right hemicolectomy. During the procedure the physician inadvertently perforated the small
bowel. Sutures were used to repair the laceration. No other complications were noted. On
postop day 2, the patient began vomiting. KUB showed a diffuse ileus and nasogastric tube was
placed. The patient was maintained on nasogastric suction and IV hydration for the following 2
days. On postop day 4, the tube was removed. He was discharged home in good condition.
Final diagnoses: Diverticulitis, colonic abscess, and ileus.

32. Patient was admitted for back surgery. Diagnoses include: intervertebral
disc discplacement of the L2-L3 and L3-L4 spaces with spinal stenosis. Patient was taken to the
OR where the following procedures were performed: Laminectomy with diskectomy of L2-L3
and laminectomy decompression at L3-L4.

33. Patient was admitted for a right total hip arthroplasty due to severe osteoarthritis.
The arthroplasty was performed with no complications. Three days post-surgery, the patient
went into respiratory failure. Endotracheal intubation was performed followed by 15 hours of
mechanical ventilation. Final diagnosis: Osteoarthritis of the right hip and postoperative
respiratory failure.

34. Patient was admitted in labor with 27-week pregnancy. The fetus was in a complete
breech position. Labor ceased within a few hours after admission, but the patient was observed
closely because she has a history of being a habitual aborter. By the 2 nd day, contractions
recurred and she rapidly progressed to complete dilation. Because the fetus remained in breech
presentation, an emergent low cervical cesarean section was performed and a healthy baby girl
was delivered. The postpartum course was uneventful and the patient was discharged home in
good condition on the 3rd day post-delivery. Final diagnoses: Preterm delivery, complicated by
breech presentation and obstructed labor and habitual aborter.

35. A 72-year-old patient with a history of breast cancer, status post mastecomy and

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chemotherapy 3 years ago, is admitted for headaches and memory disturbances. Past history is
positive for seizure disorder, hypertensive heart disease, and cardiomyopathy. She is currently
taking Dilantin and Lopressor daily. A CT scan of the brain was performed and revealed
hemorrhagic metastasis from her breast cancer. An MRI was also performed which revealed
metastatic lesions to the brain with hemorrhage into one of the lesions. The patient is diagnosed
with metastatic brain tumor and intracerebral hemorrhage.