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20,000 series Questions: 30 X2=60mints

1. Which types of joints are considered synovial?

a. Suture joint, medial joint, and articulation joint

b. Ball-and-socket joint, hinge joint, and saddle joint
c. Pivot joint, talus joint, and cranial joint
d. Ball-and socket joint, nasal joint, and elevation joint

b - There are six types of freely moving or synovial joints: ball and socket,
Hinge, pivot, condyloid, saddle, and gilding joints.

2. A physician applied a cast and also provided all of the subsequent fracture care.
The same physician may report the application of the cast separately from the
fracture care.

a. True
b. False

b - (false) when a physician applies the initial cast and assumes all of the
subsequent fracture care, the physician cannot report the application of the cast
separately because it is included in the treatment of the fracture.

3. A physician designed and prepared prosthesis for palatal lift prosthesis. How
should you report the physician’s professional service for this process?

a. 21083
b. 21083-26
c. L9900
d. L8699-26

SKYLINE MEDICAL CODING

a - One way to find this answer in the CPT Professional Edition index is under the
main term Impression, then Maxillofacial, and Palatal Lift Prosthesis-21083.
The subcategory guidelines provide direction for reporting these codes. (OR)
Under Head prosthesis: Codes 21076-21089 describes professional service so no
need of appending modifier 26. Palatal lift prosthesis (21083).

4. The patient presented for medial meniscal tear left knee. Arthroscopy with
partial medial menisectomy left knee and arthroscopic picking (drilling pick holes)
of the lateral femoral condyle left knee was performed. Code the procedure and
diagnosis codes.

a. 29880-LT, 29879-51-LT, S89.212A

b. 29881-LT, 29879-51-LT, S89.212A

c. 29882-LT, 29885-51-LT, S89.219A

d. 29881-RT, 29885-51-LT, S89.219A

b - One way to narrow down the choices is to code for the diagnosis first, which
is a medial meniscus tear of the left knee. In the ICD-9-CM index, look up
Tear/meniscus/medial; you are referred to code 836.0. You eliminated choices C
and D. 29881 (medial OR lateral) is the correct procedure code, since the
menisectomy (removing torn fragments) was performed on the medial meniscus
only. arthroscopic picking (drilling pick holes) 29879.

5. A 37-year-old patient was previously treated with external fixation for a Grade
III left tibia fracture. There is now nonunion of the left proximal tibia and he is
admitted for open reduction of tibia with bone grafting. Approximately 30 grams
of cancellous bone was harvested from the iliac crest. The fracture site was
exposed and the area of nonunion was osteotomized, cleaned, and repositioned.
Intrafragmentary compression was applied and three screws and the harvested
bone graft were packed into the fracture site. What are the correct codes for this

SKYLINE MEDICAL CODING

diagnosis and procedure?

a. 27724
b. 27758
c. 27722
d. 27759

a - Codes are 27758 and 27759 are not reported with this scenario since the
fracture is not an acute traumatic fracture. The physician is repairing a nonunion
tibia fracture (failure of two ends of a fracture to completely heal). Next you need
to find out what type of graft was used. Your hints are bone grafting and iliac
crest, which leads you to the code 27724. The bone graft was harvested from the
iliac crest, and then the graft is placed at the fracture site of the tibia compressing
it for desired position and alignment and the screws were used to stabilize the
fracture.

6. Patient complains of chronic/acute arm and shoulder pain following bilateral

carpal tunnel surgery. Patient is followed by pain management for over a year.
Physician finally diagnoses patient with reflex dystrophy syndrome (RSD).
Physician performs six trigger point injections into four muscle groups. Code the
procedure(s).

a. 20552
b. 20553 x 6
c. 20551 x 6
d. 20553

d- Trigger point is your key term in this scenario, eliminating choice C. Trigger
points are coded by the number of muscles that the injections are performed on,
not by the number of trigger point injections. The scenario tells you that six

SKYLINE MEDICAL CODING

trigger points were injected into four muscle groups which lead you to the
procedure code 20553.

7. A Grade I, high velocity open right femur shaft fracture was incurred when a
15-year-old female pedestrian was hit by a car. She was taken to the operating
room within four hours of her injury for thorough irrigation and debridement,
including excision of devitalized bone. The patient was then reprepped, redraped,
and repositioned. Intramedullary rodding was then carried out with proximal and
distal locking screws. What are the correct codes for this diagnosis and
procedure?

a. 27506, 11044-51
b. 27506, 11012-51
c. 27507, 11012-51
d. 27507, 11044-51

B - The only difference between choices A and B are the second procedure codes.
Code 11012 is the correct code since extensive debridement was performed all the
way to the bone on an open fracture. Clues: locking screws (27506), debridement
including excision of bone (11012).

8. Dr. Roy completed a deep transfer of the anterior tibial and flexor digitorum
tendons. Which codes should be used to report this procedure?

a. 27658 x2

b. 27690, 27692-51

c. 27691, 27692

d. 27691, 27692 x2

c - deep transfer of the anterior tibial and flexor digitorum (27691), tendons
(+27692). Modifier 51 should not be appended for add on codes.

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9. Which codes would you report for an aspiration and injection of ganglion cyst to
the bone of the left great toe?

a. 20600

b. 20612

c. 20615

d. 20600, 20612-59

Answer: C - deep transfer of the anterior tibial and flexor digitorum (27691), tendons
(+27692). Modifier 51 should not be appended for add on codes.

10. Roy is a 25 years old patient who underwent a subcutaneous excision of an 8-cm
spongy tumor on her upper abdominal wall. How should you report this procedure?

a.22902

b.22903

c.22900

d.22905

Answer: B - Excision of an 8-cm spongy tumor on her upper abdominal wall (22903 –
3 cm or greater).

11. A patient presents for a steroid injection into the bilateral SI joint under
fluoroscopic guidance. How should you report this?

a. 27096, 77003-26
b. 27096-50
c. 27096-50, 77003-26
d. 27096

b - Fluoroscopic guidance (77003) is an inclusive component of 27096 Injection

SKYLINE MEDICAL CODING

procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy
or CT) including arthrography when performed; therefore, answers A and C are
incorrect. Modifier 50 Bilateral procedure is applicable to 27096, as the
documentation indicates the procedure was performed bilaterally.

12. A patient presents for injection of steroid into the right SI joint, as well as trigger
points in the trapezius, iliopsoas, and quadriceps muscles. How will you report this?

a. 20553
b. 20553, 20552-59
c. 20553, 27096
d. 20553, 27096-RT

a - Sacroiliac (SI) joint injection was done without radiological guidance; therefore,
you would not report 27096. Per National Correct Coding Initiative (NCCI) edits,
20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s), along with
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device) imaging supervision and interpretation, may not be billed with
20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s).

13. A 56-year-old female undergoes bilateral SI joint injection with ultrasonic

guidance. How should you report this?

a. 20552, 76942
b. 20552-50
c. 27096
d. 27096, 76942

C - Report only 27096 for SI joint injection with ultrasonic guidance or if done without
radiological guidance. Under CPT Code 76942, we can find code 27096 as one among
Do not report code list with 76942.

14. Posterior placement of pedicle screws and rods at L2-S1 is reported using which

SKYLINE MEDICAL CODING

instrumentation code?

a. +22840
b. +22842
c. +22843
d. +22845

b - L2-S1 consists of five vertebral segments — L2, L3, L4, L5, and S1 — and is
considered to be segmental instrumentation; therefore, +22842 Posterior segmental
instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar
wires); 3 to 6 vertebral segments (List separately in addition to code for primary
procedure) is the appropriate code.

15. A patient suffered a fracture of the femur head. He had an open treatment of the
femoral head with a replacement using a Medicon alloy femoral head and methyl
methacrylate cement. How would you report this procedure?

a. 27236

b. 27235

c. 27238

d. 27275, 27236-59

a - One way to find this answer is in the index of the CPT Professional Edition under
Fracture, Femur, Neck, Open Treatment. There is an illustration under the code
27236 for a prosthetic replacement.

16. What modifier should you report when the same physician provided a re-

SKYLINE MEDICAL CODING

reduction of a fracture?

a. 76

b. 59

c. 77

d. 54

a - 76 You can find this answer in the CPT Professional Edition in the main section
guidelines for the Musculoskeletal System.

17. This is a 32-year-old female who presents today with sacroiliitis. On the physical
exam, there was pain on palpation of the left sacroiliac joint and fluoroscopic
guidance 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-LT, 77003-26
b. 27096-LT, 77003-26
c. 27096-LT
d. 20551

c - The injection is being performed in a joint, eliminating multiple choice answer D.

The injection was performed on the sacroiliac joint with imaging confirmation
eliminating multiple choice answers A. Fluoroscopic guidance is included and should
not be reported separately.

18. 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

SKYLINE MEDICAL CODING

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
b. Appropriate E&M code
c. 22315
d. 22318

d - The procedure performed is the reduction of an odontoid fracture, by incising

(open treatment) the anterior neck (anterior approach) to reduce the fracture and
placement of internal fixation (Kirschner wire and lag screw). Gardner-Wells tongs
(20660) were applied originally to try to reduce the fracture with axial traction;
however, this procedure is listed as a separate procedure and it should not be
reported during the same session for reduction of the fracture.

19. 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

SKYLINE MEDICAL CODING

bluntly with a few attachments divided with electrocautery. What CPT® should be
reported?

a. 21932
b. 21935
c. 21931
d. 21925

c - The mass growing turned out to be a lipoma found in the subcutaneous tissue of
the flank. The 4 cm tumor was found in the subcutaneous tissue code 21931 is the
correct code to report. (right flank, excision, the subcutaneous tissue)

20. 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
distalward. 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

SKYLINE MEDICAL CODING

b. 25624-RT
c. 25645-RT
d. 25651-RT

a - Patient had an open reduction, meaning an incision was made to get to the
fracture, eliminating multiple choice answers B. The fracture site was the
scaphoid of the wrist (carpal), eliminating multiple choices C and D.

21. The surgeon performs a diagnostic endoscopy on a Medicare patient, followed

by a surgical endoscopy in the same family. How should you code?

a. Report only the diagnostic endoscopy

b. Report only the surgical endoscopy
c. Report both the diagnostic and surgical endoscopy codes, with no modifiers
d. Report both the diagnostic and surgical endoscopy codes, but attach
modifier 51 to the diagnostic scope code

b - Report only the surgical endoscopy (As diagnostic endoscopy included in

surgical endoscopy).

22. Per 2018 CPT® guidelines, vertebral augmentation means?

a. Process of Cavity Creation

b. Injection of Cement
c. Vertebroplasty
d. Both A & B

d – Vertebral augmentation includes Injection of cement and process of cavity

creation.

23. Which procedure would be reported when a patient had all five toes on a
single foot amputated at the metatarsals during the same operative session?

SKYLINE MEDICAL CODING

a. 28800
b. 28805
c. 27888
d. 28820

b - Amputation of foot, transmetatarsals (28805) is defined as amputation of all

toes at the metatarsals.

24. Which of the following is a method to treat fractures where a fixation, such as
a rod or nail, is placed across the fracture?

a. Open
b. Closed
c. Endoscopy
d. Percutaneous

d - There are three major approaches to treat fractures: closed, open, and
per uta eous. • Closed treat e t ea s the fra tured o e is ot e posed to
the surgeon’s ie . • Ope treat e t ea s the o e is e posed i isio . •
Percutaneous treatment (aka percutaneous skeletal fixation) involves the
placement of a fixative device through the skin—such as a rod, wire, or pin—
across the fractured bone under imaging guidance.

25. An 87-year-old man with history of falling presents for repair of fractured
proximal ulna and dislocated radial head. This time he slipped on ice on the
walkway in front of his house. He fell into soft snow and the impact was only on
his right elbow. He sustained a Monteggia fracture. The orthopedic surgeon
performed an ORIF over this site. The correct CPT® and ICD-9-CM codes to
describe this scenario are:

a. 24635-RT,

SKYLINE MEDICAL CODING

b. 24640-RT
c. 24620-RT
d. 23670-RT

a - 24635-RT Open treatment of Monteggia type of fracture dislocation at elbow

(fracture proximal end of ulna with dislocation of radial head), includes internal
fixation, when performed to describe the open reduction and internal fixation
(ORIF).

26. A 28-year-old football player fell to his knees upon being tackled. The impact
was so severe that he suffered a broken left tibia. A medic was called onto the
field and the man was transported to the nearest ER. Two days later, an
orthopedic surgeon repaired the fracture by placing four screws into the injured
area under ultrasonic guidance. The correct CPT® code for this procedure is:

a. 27750-LT
b. 27752-LT
c. 27756-LT
d. 27758-LT

c - Because the screws are a form of fixation placed under imaging guidance, this
is a percutaneous—rather than an open or closed—treatment. The correct code is
27756 Percutaneous skeletal fixation of tibial shaft fracture (with or without
fibular fracture) (eg, pins or screws) with modifier LT appended to denote Left
side.

27. A 41-year-old woman fell off a rickety chair she was standing on and suffered
a trimalleolar fracture of her right ankle. An open treatment was performed.
Correct coding for this scenario is:

a. 27816-RT
b. 27822-RT

c. 27818-RT

SKYLINE MEDICAL CODING

d. 27823-RT

b - This is an open treatment reported with 27822; therefore, 27816 Closed

treatment of trimalleolar ankle fracture; without manipulation is incorrect. This is
an open treatment of a closed fracture because there is no documentation
indicating that the fracture itself is open (protruding the skin). As such, the ICD-9-
CM code is 824.6 Fracture of ankle; trimalleolar, closed. CPT® code 27823 Open
treatment of trimalleolar ankle fracture includes internal fixation, when
performed, medial and/or lateral malleolus; with fixation of posterior lip is
incorrect because there is no mention or implication of fixation of posterior lip.

28. Which CPT® code should you report when a physician performs an endoscopic
gastrocnemius recession?

a. 27687
b. 29999
c. 27687-52
d. 29893

b - There is no code that specifically describes an endoscopic gastrocnemius

recession. It (27687) would be incorrect to report the open procedure code with a
reduced modifier. Instead, follow American Medical Association (AMA) guidance
and use unlisted endoscopic code 29999 Unlisted procedure, arthroscopy/
endoscopic.

29. Which CPT® code should you report when a physician performs manipulation
of spine requiring anesthesia, lumbar region?

a. Appropriate E&M code

b. 22326-52
c. 22505

SKYLINE MEDICAL CODING

d. 29893

c - Manipulation of spine requiring anesthesia, any region (22505).

30. Renny suffered with dislocation of right fourth metacarpal. Dr. Ross
completed a closed manipulation under anesthesia and repaired Renny’s injury.
What code should Dr. Ross report for her service?

a. 26605
b. 26641
c. 26670
d. 26675

d - Closed treatment of carpometacarpel dislocation, manipulation under

anesthesia.

SKYLINE MEDICAL CODING