Mock 7 answers

1. C.The physician is taking a split-thickness skin autograft from the thigh and
grafting it to the patient’s left leg, which needs repair. In the CPT® manual look up
Split/Grafts, you are referred to 15100-15101, 15120-15121. Code 15100 is the correct
code because there was less than 100 sq cm taken from the leg (thigh). The second
procedure 15002 is coded because the patient had a hypertrophic scar on the leg and the
physician is preparing the recipient’s site by excising the scar, which left a 90 sq cm defect,
to provide healthy blood vessels onto which the skin graft will be placed.

2. C.First, list all lacerations by the anatomical site and/or the type of wound closure. The
only site that has a layered closure is the chin (4 cm), which is coded 12052. The
remaining repairs are complex: (Forehead) 8.6 cm + (RT and LT cheek) 9.5 cm = 18.1
cm, which is coded 13132, 13133 x 3 (13132 for the first 7.5 cm and 13133 x 3 for the
remaining 10.6 cm). The last site is the chest at 12.5 cm, which is coded 13101, 13102.

3. B Keywords in this scenario are “actinic keratoses,” of which there are five. Code 17000
is the correct code since the code description gives an example of what a “premalignant
lesion” is in parenthesis and for the first lesion being destroyed. Code 17003 has the
word “each” in its code description, which indicates each of the four remaining actinic
keratoses lesions is reported separately. Code 17110 is the correct code for the last
procedure because it covers the destruction of the three benign lesions. Code 17110 is
not reported by each lesion separately destroyed because the code describes when there
are 14 lesions or less destroyed.

4 C To first tackle this scenario, you need to find out what type of graft was used
on this patient. It was a porcine graft, which is a type of xenograft, which is a skin
substitute. Code 15040 (Harvest of skin for tissue skin autograft, 100 sq cm or
less) was performed when a split thickness skin graft was harvested using
dermatome (skin harvesting) from a separate donor site (autograft). Add the
group body areas together with their total sq cm. The first group to add is: Face,
scalp, neck 500 cm + hands & feet 300 cm = 800 sq cm coded, 15277, 15278 x7.
Your next group is the trunk 950 cm + arms & legs 725 = 1675 cm coded, 15273,
15274 x 16. Those took care of the xenograft codes. The next set of codes deal
with the excision of the burn eschar to provide healthy skin onto which the skin
graft will be placed. You would use the same sq cm totals that are grouped in the
same body areas that you used for the xenograft codes. Face, scalp, neck, hand,
and feet are coded 15004, 15005 x 7. Trunk, legs and arms are coded 15002,
15003 x 16

5 A One way to get to the correct answer is by the diagnosis. This patient is having
the procedure performed due to a breast mass. The only two choices that have
the ICD-9-CM code for breast mass are A and B. The diagnosis is indexed in the
ICD-9-CM manual under Mass/breast. The CPT® guidelines state: Partial
mastectomy procedures (eg, lumpectomy, tylectomy, quadrantectomy, or
segmentectomy) describe open excision of breast tissue with specific attention to
adequate surgical margins.
There is no documentation supporting removal of surgical margins when
removing the breast mass.
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6 BYou can start by looking at the modifiers to guide you to the correct answer.
The keywords in the question are that the patient is here for the “second stage”
of the procedure. This indicates that a planned or anticipated (staged) related
procedure is being performed. The patient is coming in for a division and inset of
cheek flap to the right upper lip.
7 D The two face lacerations were closed with steri-strips (adhesive strips).
According to CPT® guidelines when wound closure uses adhesive strips as the
only repair material it should be coded using the appropriate E/M service. Code
12011 is inappropriate to report for this scenario, eliminating multiple choices A
and B. The repairs for the wounds on the arm and leg are intermediate closures.
According to CPT® guidelines single-layer closure of heavily contaminated
wounds that have required extensive cleaning or removal of particulate matter
also constitutes intermediate repair. This eliminates multiple choice C. To report
multiple wounds that are repaired in the same classification and from the
anatomic sites that are grouped together into the same code descriptor, add
together the length of the wounds. When more than one classification of wounds
is repaired, append modifier 59 to the least complicated repair(s).

8 B This patient is coming in to have an in-grown toe nail removed, eliminating

multiple choice answer D (Evacuation of Subungual Hematoma), which is
evacuating blood from under the nail. You are now left with choices A, B, and C
that involves the removal of an ingrown toenail. Code 11752 is not correct. The
scenario does not mention an amputation. The clue to help you narrow down
between the codes 11765 and 11750 is that there is a partial removal of the nail
and nail matrix (maxtrixectomy).

9 A You need to first find out if this lesion is benign or malignant. For this scenario
the patient has a basal cell carcinoma. This falls under malignant lesion, which
eliminates multiple choice codes C and D as they deal with benign lesions. Now
you need to find out where the lesion is located and the size of the removal. The
malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm = .3 cm = 3.6
cm, leading you to code 11644. CPT® guidelines state: For excision of malignant
lesion(s) requiring intermediate or complex closures should be reported
separately. For this scenario the wound was closed in two layers qualifying the
closure to be coded with an intermediate repair of the chin (4 cm), 12052. The
diagnosis, basal cell carcinoma of the chin, is indexed in the ICD-9-CM manual in
the Neoplasm Table, under Skin/face/basal cell.

10 D For narrowing down to the correct procedure code for the Mohs micrographic
surgery, you should find out where on the body the tumor was removed. For this
scenario, it is the neck; eliminating multiple choice codes B and C, which involve
the trunk, arms or legs. The tissue block removals were performed in two stages,
coding 17311 and 17312. Code 17315 is not coded for this scenario, since the
physician would have to remove more than five tissue blocks in any stage. There
were only four tissue blocks removed in the first stage and two tissue blocks
removed in the second stage, both falling short of six or more tissue blocks
removed in either stage.
11 D 27096 is the correct code since a steroid injection (Celestone and Marcaine) is
placed into the sacroiliac (SI) joint. Fluoroscopic and computed tomography (CT)
guidance is included and is not reported separately. There is a parenthetical note
 Mock 7 answers
under the code description that states: (27096 is to be used only with CT or
fluoroscopic imaging confirmation of the intra-articular needle positioning).

12 C.The fracture of the lateral condyle is closed since the scenario does not
mention that a piece of bone has broken through the skin and is exposed. In the
ICD-9-CM manual, look up Fracture/humerus/condyle(s)/lateral (external). You
are referred to code 812.42. You have eliminated multiple choice answers A and
D. The next step is to figure out if the fracture care is opened or closed treatment.
Hint: The surgeon made “an incision” to get to the fracture site. Code 24579 is
the correct code because this was an open treatment due to the surgeon making
an incision to get to the fracture site and performing an internal fixation (two
pins). Open reduction and internal fixation (ORIF) is also an indication that an
open approach is used to perform the surgery.

13 C.The keyword in this op note is “disectomy,” which in this scenario is a removal

of the herniated disk in the cervical spine (neck). Eliminating multiple choice B.
There is no documentation of the vertebrae being fused together (arthrodesis),
eliminating Multiple choice D. The scenario documents end plates were
decorticated to insert an artificial disk (Kineflex-C device) to replace the cervical
disk that was removed, guiding you to code 22856.
14 A ruptured distal bicep tendon is a tendon injured around the elbow joint. A long
tendon bicep runs over the top of the humerus bone (upper arm) and attaches to
the top of the shoulder. There is no documentation of a reinsertion, removal, or
transplantation of a bicep tendon.

15 D. Trigger point is your key term in this scenario, eliminating choice B. 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
trigger points were injected into four muscle groups which lead you to the
procedure code 20553.

16 B.One way to start finding the correct answer is to look up the diagnosis in the
ICD-9-CM manual. It is indexed under Fracture/femur/shaft/open which refers
you to code 821.11, eliminating codes C and D. 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

17 A.This patient is having a mass removed from the shoulder area, eliminating
multiple choices B, which is a biopsy. This is not a radical resection since that
includes removal of the entire tumor along with large surrounding tissue,
including adjacent lymph nodes. The size of the mass that was excised was 4.5
cm, which leads you to code 23076.

18 A.This surgery is being performed by arthroscopy, eliminating multiple choice

answer C, which is an open procedure code without using any type of scope. Our
next clue is that a “subacromial decompression” was performed, which leads you
to code 29826. The scenario does not mention that the physician lyses and
resects adhesions, eliminating multiple choice answers B and D. 29824 is
performed when the physician opens the AC (acromioclavicular) joint to the
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anterosuperior portal grinding off (technique used to remove) 10 mm of “distal
clavicle” due to a cyst.

19 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.

20 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. In the ICD-9-CM index, look up Fracture/nonunion referring
you to code 733.82. The late effect code is also appropriate in this case.

21 D The provider performs the initial insertion of a cardioverter-defibrillator pulse generator

with leads inserted in the atrium and ventricle. Code 33249 is the correct code since electrical
leads were inserted for a dual chamber pacemaker defibrillator in connecting it to a generator.
Fluoroscopic guidance is used for the procedure. In the coding guidelines in the beginning of
the subsection it states that radiologic supervision and interpretation is included in code range
33206-33249 therefore the fluoroscopic guidance is not reported separately.

22 D. This procedure was a transposition, which eliminates multiple choices A and B. The
location of the transposition directs us to the correct code.

23 A .A surgical puncture in the chest cavity using a needle to withdraw fluid (aspirate) from
the pleural cavity is a thoracentesis. There is no documentation of a tube being
connected to a water seal for continuous removal of fluid. Pneumocentesis is the removal
of fluid within the lung.

24 A. The multiple choice answers are between a rhinoplasty and septoplasty for which you
will need to know the difference. Rhinoplasties are performed on patients that are having
cosmetic surgery, restorative, or reconstruction on the nose. This patient is coming in to
correct a deviated septum, which falls under a septoplasty which is removing a portion of
the deviated septum and straightening the septum to correct airway obstruction. You
eliminate multiple choice answers B and D. C is incorrect since the patient is not coming
in for a dermatoplasty, which is surgical replacement of destroyed skin.

25 D The procedure code with an appropriate modifier needs to be reported since the
patient had been prepared for surgery, received anesthesia, and the procedure had
already started. An indication in guiding you to choose the correct modifier is that the
procedure was stopped due to the patient’s drop in blood pressure, which threatens the
well-being of the patient. Procedure was not performed in the out-patient hospital or
ambulatory surgery center setting.
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26 A This is an insertion of a new dual chamber pacemaker. The provider is inserting the
pulse generator as well as two leads. There is no documentation that the patient
previously had a single chamber system and is upgrading it to a dual chamber system.

27 C The patient is having a coronary artery bypass graft (CABG) involving three venous
grafts. Code 33508 is an add-on code, which does not need a modifier 51 appended to
the procedure. 33254 is the correct code since a modified maze was performed on the
patient.

28 C One way to choose the correct choice is by the modifiers. The patient is still in a post-
op period from an initial cardiac procedure and is having an unplanned return to the
operating room due to a malfunctioning pacemaker battery that is going to be replaced. 
The ICD-9-CM code is indexed under Malfunction/pacemaker – see Complication,
mechanical. Complications/mechanical/pacemaker/cardiac guides you to code 996.01.

29 C Procedure performed is for placement of a central venous catheter eliminating multiple

choice A. An access device is not inserted eliminating multiple choice D. The
documentation supports that a subcutaneous tunnel is created to place the catheter
guiding you to code 36557.

30 B To narrow down your choices, you can start with coding the diagnosis first. The patient
is having the procedure done due to a lung mass. A specimen was sent to pathology and
came back indicating that the lung mass is cancerous. In the ICD-9-CM index, look up in
the Neoplasm Table lung/malignant/primary column. You are referred to code 162.9,
eliminating multiple choice answers C and D. You would not code 31622 since this is a
separate procedure. A diagnostic procedure is not coded if performed at the same
session as a surgical procedure in the same area. A surgical procedure (biopsy) was
performed with the bronchoscopy.

31 A Because the patient has a history of colon cancer, a sigmoidoscopy is performed for a
diagnostic colorectal cancer screening. During the procedure the removal of three polyps
are done by hot biopsy forceps. The correct procedure is 45333. According to ICD-9-CM
guidelines, when a patient comes in for a screening exam only and a condition is
discovered during the screening, then the code for the condition is assigned as an
additional diagnosis. So for this procedure, the polyps were discovered during the
screening, not before, and can only be assigned as an additional diagnosis. The
screening code is indexed under Screening/colonoscopy, which refers you to code
V76.51. Code 211.3 is coded because polyps were found. Since the patient has a history
of colon cancer, V10.05 is coded. This is indexed in your ICD-9-CM manual,
History/malignant neoplasm (of)/colon.

32 B The provider performs an endoscopic retrograde cholangiopancreatogram (ERCP),

eliminating multiple choices C and D. This is an initial placement of the stent, not a
changing of one; eliminating multiple choice A. A biopsy was also performed which is
reported with 43261.

33 B Hemorrhoids were removed by rubber band ligation, eliminating C and D. There were
two different scopes used to identify the internal hemorrhoids. Code 45300
(proctosigmoidoscopy) will be billed, since this scope was not used to perform the
removal of the internal hemorrhoids but to visualize the colon and rectal lumen. 46600
(anoscopy) is a “separate procedure,” so it is only coded when it is not an integral part of
 Mock 7 answers
another procedure performed at the same time. For this procedure, the doctor removes
the hemorrhoids while performing the anoscopy, making the diagnostic anoscopy an
integral component (included) in the procedure code for the hemorrhoids removal.
Modifier 51 is appended to the second procedure code because there was an additional
procedure performed in the surgery.
34 B Documentation supports the physician removing portion of the colon (partial
colectomy), the ileum and an ileocolostomy through an incision not laparoscopically.

35 A This colonoscopy involved two polyps being removed by hot biopsy forceps which
leads to code 45384. This is only coded once regardless of the number of polyps that
was removed with this one technique. According to CPT® guidelines a surgical
endoscopy always includes diagnostic colonoscopy. The diagnostic colonoscopy is not
reported separately.

36 D You first need to look at the approach of the surgery, which is the physician incising the
chest (thoracotomy) to expose the esophagus, eliminating multiple choice answer C. The
physician is not removing a lesion from the esophagus; the physician is removing the
esophagus (esophagectomy) and replacing it with the stomach, eliminating multiple
choice answer A. The next key term to help you choose between procedure code 43112
and 43117 is “cervical”. 43112 is the correct code since the stomach is pulled through the
middle of the chest into the neck and the stomach is connected to the stump of the
esophagus in the neck (cervical).

37 B Patient is having an endoscopic retrograde cholangiopancreatography (ERCP),

Radiological guidance was used for this procedure; there are parenthetical notes that
inform you for each of these ECRP procedure codes to use 74328, 74329, or 74330 for
radiological supervision and interpretation. The catheterization went all the way into the
biliary ductal system where a stone was found. Since the surgery is being performed in
an outpatient hospital, the physician does not own the equipment so modifier 26 needs to
be appended to the radiology code eliminating multiple choice answers C and D. 43264
is the correct code since there was a removal of a calculus (stone) from the common bile
duct.

38 A To start narrowing down your choices, you need to identify the type of hernia. The
operative note indicates that it is an inguinal hernia. Next does the op not mention if the
hernia is incarcerated or strangulated? No, so this eliminates multiple choice answers C
and D. Code 49568 (Mesh) would not be coded. According to CPT® guidelines the mesh
is only coded for incisional hernia repairs. This statement is found in the subsection
above the hernia repair codes. In the ICD-9-CM index, look up, Hernia/inguinal referring
you to 550.9X. Your fifth digit is “0” since there is no indication in the op note that the
hernia is recurrent or bilateral.

39 D One way to narrow down your choices is by looking up the diagnosis first. In the ICD-9-
CM index, look up Adenoiditis/with chronic tonsillitis, referring you to code 474.02. This
eliminates multiple choice answers A and C. The patient is having a tonsillectomy and an
adenoidectomy, which leads to code 42821. It is not appropriate to report two separate
procedure codes for a tonsillectomy and adenoidectomy, since there is combination
procedure code that reports the removal of both in one According to CPT® guidelines the
codes for tonsillectomy and adenoidectomy (42820-42836) are intended to represent
 Mock 7 answers
bilateral procedures. It is not appropriate to append the 50 modifier when performed
bilaterally.

40 B Patient is having an Upper GI endoscopy, eliminating multiple choice answers C and D,

which report an esophagoscopy. Your key terms to look for are “balloon dilation” which is
in code description 43249. Code 43235 is noted as a separate procedure and a
diagnostic procedure which means it is included in a surgical endoscopy (43249) when
performed at the same time, not coded separately.
41 B According to CPT® guidelines, when twins are delivered, the global code (prenatal,
delivery and post partum) is only reported once. When one twin is delivered via c-section,
select 59510 for the global procedure and select 54909 for the vaginal delivery only for
the second twin. Modifier 51 is appended to indicate multiple procedures are performed.
To code for the twin delivery in the ICD-9-CM manual, look up Delivery/twins, you are
referred to 651.0X, the fifth digit being 1 indicating a delivery. The second diagnosis is
coded due to the second twin being in a transverse lie, the reason for the cesarean. This
is indexed under Delivery/complicated / transverse/presentation or lie, referring to
652.3X, the fifth digit being a 1.There is no documentation that the baby was causing
obstruction during the onset of labor

42 B Two different procedures were performed on each ovary. The removal of the cyst from
the ovary is coded 58925. Modifier RT is appended to indicate to the payer the ovarian
cystectomy was performed on the right side. The removal of the salpingo-oophorectomy
is coded 58720. Modifiers 51 and LT are appended to this procedure code because the
removal of the ovary and fallopian tube was on the left side and it was an additional
procedure performed during the surgery. Modifier 50 is not appended to code 58925 and
58720 because the word “bilateral” is already included in their code description

43 A .A hydatidiform is the keyword to help you to select the correct CPT® code. An induced
abortion was not performed, nor was the patient in the postpartum phase. The first listed
diagnosis code is indexed under hydatidiform mole, which guides you to code 630. There
is no indication that the molar pregnancy is invasive or malignant. The second diagnosis
code is indexed under Hemorrhage/pregnancy/threatened abortion guiding you to code
640.0x. The fifth digit is “3” for the antepartum condition.

44 C Because only needle biopsies were performed, without mapping the prostate under a
template guide through a transperineal route, 55700 is the correct code. Documentation
does not support fine needle aspiration (10022).There are parenthetical notes under code
55700, one of them states: If imaging guidance is performed, use 76942. Since ultrasonic
guidance (imaging guidance) is used, code 76942. Appending modifier 26 indicates the
professional component; the procedure was done in an outpatient surgical center where
the physician does not own the equipment.
45 B The patient is having the circumcision performed with a ring device (other device),
guiding you in selecting code 54150. It is inappropriate to code 64450 with 54150 since
penile block is included and stated in the code description.

46 B Per CPT® when specific circumstances for the conversion of the laparoscopic
procedure to an open procedure have been determined, it is then appropriate to report
the code for the “attempted” laparoscopic procedure with the appropriate modifier
appended. The code for the open procedure is reported as the primary procedure with
the modified laparoscopic code reported as a secondary procedure. From a CPT® coding
 Mock 7 answers
perspective, this method of reporting allows accurate tracking and reporting of specific
procedures(s) performed. (CPT® Assistant March 2000)
47 C Excision of endocervical tissue in a cone shape of the cervix is conization. The code
description includes fulguration, dilation and curettage, or repair when performed and are
not reported separately.
48 D The patient presents for a ureteral catheter exchange via the ileal conduit. 50398 is not
correct because it is for a nephrostomy tube which is in the kidney. 50393 is performed
using a percutaneous approach, which is not used in this case. 50385 is performed using
a transurethral approach, which is not correct. The exchange is performed via the ileal
conduit, which is reported with 50688. Imaging is performed. There is a parenthetical
note under 50688 that states that imaging is reported with 75984.

49 B The colporrhaphy codes are chosen by the approach and type of herniation. The
operative note indicates the patient had an anterior approach in correcting a grade IV
cystocele (herniation of the bladder causing the anterior vaginal wall to bulge
downwards). The colpopexy codes are also coded by approach. Colpopexy is suturing a
prolapsed vagina to its surrounding structures for vaginal fixation. Operative note
documents a sacrospinous ligament fixation.

50 D Patent had a retrograde pyelogram eliminating multiple choices B and C. A cystoscope

is passed through the urethra into the bladder. Then a French catheter was passed into
the right ureter (ureteral catheterization) to introduce the contrast for radiologic study of
the renal pelvis and ureter.

51 D Keywords, single injection, will guide you to choosing the correct CPT® code. There is
a single injection at the T4 intercostal nerve that will affect intercostals nerves T5-T7.
When more than one intercostal space is injected to achieve the regional block, you
report 64420.

52 B The key word in this scenario is “ectropion,” which eliminates answer D referring to one
who has entropion. One of the eyelids had an excision of the tarsal wedge, coded with
67916. Modifier E4 is appended to indicate the procedure was performed on the right
lower lid. The other eyelid had a suture repair coded with 67914, and modifier E2 is
appended to it indicating the repair was done on the left lower lid. A different procedure
was performed on each eyelid. Modifier 50 would not be appended to the codes because
both lids did not have the same procedure performed.

53 B The key word in this encounter is “injection” which eliminates spinal puncture
procedure codes. 62273 is the correct code because the patient’s blood is injected to
plug the wound that is causing the CSF leak (blood patch). This is the only code to bill for
this visit, since the lumbar puncture was performed three days ago.

54 B Code 67145 is the correct procedure code since the patient had a retinal tear (retinal
break) and the physician uses a laser light (photocoagulation) to seal the retina back into
place. Code 92004 is used to report the evaluation of the complete visual field. The
patient is a new patient. An evaluation of the eye was performed in addition to performing
the procedure. Modifier 25 is appended to the evaluation code.
 Mock 7 answers
55 A A laminectomy is performed, eliminating multiple choice B. The laminectomy is
performed with a facetectomy and foraminotomy. Modifier 50 is not reported with code
63047 since bilateral is included in the code description.

56 C Patient already has a shunt; a new one is not being created, eliminating multiple choice
A. There is a replacement of the valve and ventricular catheter; not a removal of the
whole shunt system.

57 D An intracapsular catatract extraction is being performed. An intraocular lens prosthesis

(Cystalens) was inserted in the same surgery session with the cataract extraction. Code
66985 is reported when only an intraocular lens is being inserted on a patient who had
previously undergone cataract removal.
58 C The patient is implanting the osseointegrated implant for the first time, not a
replacement. Documentation does not support that a mastoidectomy was performed with
the implantation procedure.
59 C The patient is having a “thyroid lobectomy,” eliminating multiple choice answers A and
D, which is a thyroidectomy (removal of the thyroid). 60220 is the correct code since the
scenario indicates that a small thyroid lobe (total lobe) is dissected free; it does not
indicate that part of the lobe was removed.
60 D When coding for facet joint or facet joint nerve injections, you report each level that is
injected. In this case, the joints for L4-L5 and L5-S1 were injected. The codes for facet
joint and facet joint nerve injections are unilateral. The procedure was performed
bilaterally at each level, therefore modifier 50 should be reported. A parenthetical note
states: If ultrasound guidance is used, report 0213T-0218T The ultrasound guidance
should not be reported separately.
61 D Emergency Department Services requires meeting three of the three key components.
Detailed history + comprehensive exam + moderate MDM = 99284
The diagnosis is kidney stones. In the alphabetic index look for Stone(s), kidney, which
guides you to code 592.0.
Back pain, nausea, and chills are symptoms of kidney stones. ICD-9-CM guideline
(section I.B.7) states: Signs and symptoms that are associated routinely with a disease
process should not be assigned as additional codes, unless otherwise instructed by the
classification.

62 B The patient was not referred by another physician for a second opinion for his sleep
apnea, so this is not a consultation visit. The patient decided to go on his own to get the
opinion from another doctor. According to CPT® guidelines: If a "consultation" is
requested by a patient and/or family and not requested by a physician (self-referral), an
office visit code may be used to report this service The doctor is seeing the patient for the
first time, making him a new patient. In the CPT® index, look up Evaluation and
Management/Office or Outpatient. You are referred to 99201-99215. Review the codes to
choose the appropriate level of service. 99203 is the correct code. Detailed history
(extended HPI, extended ROS, and pertinent PFSH) + comprehensive exam + moderate
MDM (New patient to examiner; 1 data point; moderate risk) = 99203.

63 D For this encounter the established patient is coming into a doctor’s office to get an
evaluation before he goes in for surgery. In the CPT® book, look up Evaluation and
Management/Office and Other Outpatient. You are referred to 99201-99215. Review the
codes to choose the appropriate level of service. Two out of three key components are
required. The provider performs a detailed exam and moderate MDM. 99214 is the
 Mock 7 answers
correct code. After the evaluation, the patient needs the physician to address questions
and concerns he has regarding the liver transplant surgery. According to CPT®
guidelines, 99354-99355 are used to report the total duration of the face-to-face time
spent by a physician beyond the usual service in either the inpatient or outpatient setting.
The prolonged service includes the time he spent in face-to-face contact with the patient
when he was not performing the history, physical examination, and MDM related to the
E/M service level he reported. In the CPT® index, look up Prolonged Services. You are
referred to 99354-99357, 99360. 99354 is the correct code, since 30 minutes was spent
face-to-face.
64 A The patient is in the hospital for 3 days being seen by the physician for subsequent
hospital care. Documentation does not support the patient is in observation care or
observation status. In the CPT® index, look up Hospital Services/Inpatient
Services/Subsequent Hospital Care. You are referred to 99231-99233. Review codes to
choose appropriate level of service. 99231 is the correct code. Two out of three key
components are needed for subsequent hospital care codes. The physician documented
a problem focused exam (1 system) + Low MDM (Established problem to examiner;
stable, 2 data points [reviewing lab test and ordering an ECG], low level of risk) =99231

65 C The E/M service is at the request of the ED physician to render an opinion on whether
the patient needs surgery. A written report of the findings is documented in the ED chart.
According to CPT® coding guidelines, the requirements for a consultation have been
met. The service is provided in the ED, which is an outpatient setting. The plastic surgery
performs a detailed history (extended HPI, extended ROS and pertinent PFSH), a
detailed exam (extended 4 body area/organ system exam) and moderate MDM (New
problem to examiner no additional workup planned and need for major surgery). For an
outpatient consultation three of the three key components are required. 99243 is the
appropriate code. During this encounter, the physician made the decision to perform a
major surgery, which is scheduled for the next day. Modifier 57 is appended to the E/M
service.

66 D During this encounter, the physician performs resuscitation, endotracheal intubation,

and inserts an umbilical line. According to CPT® coding guidelines, “procedures that are
performed as a necessary part of the resuscitation are reported separately in addition to
99465”. Code 99464 cannot be reported with 99465. The critically ill neonate is admitted
to critical care. According to CPT® coding guidelines, 99468 can be reported with 99465.
The guidelines also state “other procedures performed as a necessary part of the
resuscitation are also reported separately when performed as part of the pre-admission
delivery room care". In this scenario the intubation (31500) and the umbilical line (36510)
were performed pre-admission for resuscitation so they are both reported. Modifier 59 is
required because both services are bundled with 99468 when performed during after
admission. Modifier 25 is reported to indicate a separate and significant E/M service.
67 B Patient was not seen in the Emergency Department, eliminating multiple choice answer
D. According to CPT® subsection guideline for Initial Hospital Care: When the patient is
admitted to the hospital as an inpatient in the course of an encounter in another site of
service (eg, hospital emergency department, observation status in the hospital,
physician’s office, nursing facility) all evaluation and management services provided by
that physician in conjunction with that admission are considered part of the initial hospital
care when performed on the same of admission. The means the evaluation that was
performed in the physician’s office will not be reported since the physician also admitted
the patient to the hospital on the same date of service, eliminating multiple choice A.
The Initial Hospital Care codes (99221-99223) require all three key components (History,
Examination, and Medical Making Decision). When all three do not meet exactly, you
 Mock 7 answers
report the E/M service that has the lowest key component.
In the scenario the physician performed a: Detailed History + Comprehensive Exam +
Comprehensive MDM = 99221.
The lowest key component was the Detailed History which brings the level down to a
99221.

68 B According to CPT® guidelines an established patient is one who has received

professional services from the physician or another physician of the same specialty who
belongs to the same group practice, within the past three years. This eliminates multiple
choices A and C. The documentation supports a Comprehensive History +
Comprehensive Exam + Medical Decision Making of High Complexity = 99215. Please
refer to the Evaluation and Management Services Guidelines under the heading of
Instructions for Selecting a Level of E/M Service

69 C The patient is designated as being in observation status, eliminating multiple choice A.

According to the Initial Observation Care guidelines it states: For a patient admitted and
discharged from observation or inpatient status on the same date, the services should be
reported with codes 99234-99236.

70 C According to CPT® guidelines, “Critical care is the care of the unstable critically ill or
unstable critically injured patient who requires constant physician attendance (the
physician need not be constantly at bedside per se but is engaged in physician work
directly related to the individual patient's care). The critical care codes may be reported
wherever critical care services are provided. It is important to recognize that the critical
care codes are reported based upon the type of care rendered not the location of where
the care is rendered. The critical care codes are used to report the total duration of time
spent by a physician providing constant attention to an unstable critically ill or unstable
critically injured patient even if the time spent by the physician providing critical care
services on that date is not continuous.” For this encounter the physician was called to
the floor to evaluate a critically ill patient. The physician documents 65 minutes of critical
care time which is reported with 99291. The blood gas (82803) and the ECG (93000) are
services included in the Critical Care and not reported separately.
71 B There is no indication that one lung ventilation is used. The correct anesthesia code for
this procedure is 00540. The anesthesiologist reports the anesthesia with modifier QK to
identify medical direction. The CRNA uses modifier QX to indicate it is a medically
directed service.

72 C The block is reported because it is done for postoperative pain management and is not
the mode of anesthesia. The block is reported with 64417. The procedure is reported with
64721, which crosswalks to 01810. In the CPT® manual look up Anesthesia/Wrist. The
anesthesia is reported with 01810 because the performed procedure is for releasing a
nerve in the wrist (carpal tunnel). Modifier 59 is appended because these services are
bundled.

73 D From the CPT® index, look up Anesthesia/Thyroid. You are referred to 00320-00322.
The procedure performed is a thyroid needle biopsy, which is reported with 00322.
Anesthesia time starts when the anesthesiology provider begins to prepare the patient
and ends when they are no longer in personal attendance. In this case, the anesthesia
time starts at 0900 and ends at 1000, which is one hour.
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74 D The patient received a neuraxial epidural for labor for a planned vaginal delivery, which
is reported with 01967. During the course of labor the patient requires a caesarean
section. The patient begins to hemorrhage requiring a hysterectomy. The add-on code
01969 is used to report the anesthesia for the caesarean and hysterectomy.

75 C From the index, look up anesthesia/ heart/ coronary artery bypass/grafting. You are
referred to 00566 and 00567. In the scenario it states that cardiopulmonary bypass is
used, which indicates that the code that includes pump oxygenator is the correct answer.
The patient has COPD, which is a severe systemic disease, but there is no indication that
is a threat to the patient’s life. Append physical status indicator P3.

76 C Anesthesia is performed for cleft lip repair. From the index, look up anesthesia/cleft lip
repair. You are referred to 00102. Refer to the code description to verify accuracy. The
patient is healthy, which means P1 is the correct physical status modifier. 99100 is
reported because the patient is under one year of age and the patient’s age is not
included in the CPT® code for the anesthesia service.
77 B In this case MAC is performed, which requires modifier QS. This eliminates answer
options A and C. The patient had a diagnostic arthroscopy. There is no indication that a
surgical procedure was performed. Because the service was provided by an
anesthesiologist, modifier AA is appended to the anesthesia code.

78 C The patient receives anesthesia for a tracheostomy. From the CPT® index, look up
anesthesia/trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-
old which eliminates answer options A and B. There is a parenthetical note under code
00326 which states “Do not report 00326 in conjunction with 99100”.

79 C A biophysical profile is an evaluation of the fetal well-being during pregnancy. There

are either four or five tests performed with a BPP. A full BPP includes five tests. Four of
the tests are ultrasound evaluations; the fifth is a non-stress test. The non-stress requires
a fetal monitor, so a radiology department would not perform the non-stress test.
Documentation does support that the non-stress test will be performed in the
obstetrician’s office, indicating the non-stress test was not performed in the radiology
department.

80 D When selective catheter placement is performed, it includes  procedure 36200 to gain

access. In this case, femoral access is performed. The physician performed selective
catheter placement in the right renal artery and renal angiography is performed. Codes
for selective renal catheter placement include access, contrast injections, and imaging.
The only code to report in this case is 36251. Modifier RT is appended to indicate the
procedure is performed on the right renal artery.

81 A The patient receives seven sessions of radiation treatments (or fractions), which is
reported with 77427. Radiation therapy management codes are reported once for every
five sessions of treatment. In the coding guidelines for this section, it states, “one or two
fractions beyond a multiple of five at the end of a course of treatment are not reported
separately.”
 Mock 7 answers
82 C Codes for Magnetic resonance imaging (MRI) are determined by anatomical site and
whether contrast is used. In this case, the MRI is of the lumbar spine. From the index,
look up Magnetic Resonance Imaging (MRI)/spine/lumbar. You are referred to 72148-
72158. Option A is an X-ray so it is not the correct answer. 72148 is without contrast,
which is the correct code. According to ICD-9-CM Official Coding Guidelines, do not
report signs and symptoms of a definitive diagnosis. In this case the patient complains of
lower back pain and leg pain. He is diagnosed with lumbar spinal stenosis. The
symptoms he presents with are symptoms associated with his diagnosis and should not
be reported. From the index, look up Stenosis/spinal/lumbar, lumbosacral (without,
neurogenic claudication). You are referred to 724.02. Verify the code in the tabular
section.

83 D The first radiology code is for the computed tomography (CT) of the head or brain
without contrast. Second radiology code is for the CT of the thorax without contrast. The
last radiology code is a total of four views of both (bilateral) sides of the ribcage and
includes the posteroanterior chest view.
ICD-9-CM codes: Fracture of the skull base with no hemorrhage is indexed under
Fracture/skull/base referring you to code 801.0x. Documentation has the patient being
unconscious, but no time frame on how long was documented. The fifth digit is 6.  Three
ribs are fractured, this is indexed under Fracture/rib(s) (closed) referring you to code
807.03. E codes are found in the Alphabetic Index to External Cause under
Collision/motor vehicle/object referring you to code E815.x. The patient was the driver,
fourth digit being a 0. Accident occurred on the highway. This is indexed under
Accident/occurring/highway referring you to code E849.5.

84 D In the beginning of the obstetric ultrasound subsection in CPT®, there are descriptions
of what is required for the OB ultrasound codes. In this case the ultrasound is limited
because only two elements are examined the fetal heart rate and fetal position. This type
of ultrasound is reported with 76815. In the code description it states “1 or more” which
means the code is only reported once whether it is a single fetus or multiple fetuses.

85 C This is a radiopharmaceutical localization of tumor (lymphoma), not for an inflammatory

process. Eliminating multiple choice A. The whole body was imaged for three days.

86 C Ultrasound codes are selected by anatomic site. The liver is an organ in the abdomen.
Because the ultrasound is performed on one organ, it is reported as limited. Please note
in the parentheses following code 76705 it states “one organ.” 76970 is not appropriate
because this is an initial ultrasound and not a follow-up.

87 B Documentation supports stereotactic body radiation therapy, treatment management.

This eliminates multiple choices A and D. According to ICD-9-CM guidelines (Section
I.C.2.a): If a patient admission/encounter is solely for the administration of chemotherapy,
immunotherapy or radiation therapy, assign the appropriate V58.x code as the first listed
or principal diagnosis, and the diagnosis or problem for which the service is being
performed as a secondary diagnosis. The metastasized or secondary neoplasm is
indexed under Neoplasm/lung/upper lobe/Malignant/Secondary referring you to code
197.0.
88 B The physician inserts the needle through the skin which indicates this is a
percutaneous approach and not an open procedure. Answer options A and C can be
 Mock 7 answers
eliminated. Fluoroscopic guidance was used, which is reported with 77002 for this type of
procedure.

89 B The encounter mentions that a specimen was removed from the proximal jejunum,
which is part of the small intestines, during a resection for cancer (malignant tumor).
Code 88309 is the only lab code that covers the small intestine resection of a tumor.

90 C The first three labs (HDL - 87318, total serum cholesterol – 82465, and triglycerides
-84478) are part of the lipid panel for code 80061. That leaves the lab, quantitative
glucose, to be added with code 82947.

91 A This is a therapeutic drug test, since the patient is taking gold for rheumatoid arthritis.
80172 is the correct code since the physician wants to measure the level of gold found in
the blood stream.
92 C In this scenario, three CPK enzyme levels are performed. Modifier 91 is appended to
the second, and third CPK CPT® to indicate the services were repeat clinical diagnostic
tests. Since each of the CPK enzymes were elevated, the isoenzymes were also tested,
which is reported with 82552. Modifier 91 is appended to the second and third test to
indicate the tests are repeat clinical diagnostic tests.

93 A The lab test ordered by the physician is to detect Streptococcus, Group B. The direct
observation (vaginal swab that visually showed the result) is important since her
membranes are ruptured and an immediate result is needed.

94 B First the physician performs a UA dipstick with no indication of a microscopic test. This
test is reported with 81002. The urine culture is performed with identification for each
isolate, which is reported with 87088. 87086 is a quantitative test for a colony which is
incorrect.

95 C Unbundling is reporting components of a code separately that can be reported with one
code. In this case 80061 includes 83718 and 84478. It is unbundling to report
components of a panel separately.

96 B The identification of ooctyes in the follicular fluid is performed. The stage in this
scenario does not include the culture or preparation of the oocyte, only the identification
of them. This service is reported with 89254.

97 B To report codes for drug testing depends on the method and how many drug classes
are to be tested. The scenario documents the immunoassay method for multiple drug
classes, guiding you to code 80104. A drug confirmation was performed for both the
alcohol and benzodiazepines, reporting code 80102 twice.

98 A The pathologist services are not reported with E/M codes, which eliminates answer
option B. 80502 is clinical consultation requested by an attending physician for the
pathologist medical interpretive judgment, which is not described in this scenario. The
service is not performed during surgery, which eliminates D as a correct answer. The
code description for 88325 matches the scenario in the question making it the correct
answer.
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99 B Although the patient is scheduled for chemotherapy, only hydration therapy is
performed. Hydration therapy codes are selected based on time. The total time for this
procedure is one hour and 10 minutes. There is a parenthetical note following code
96361 which states: Report 96361 for infusion intervals greater than 30 minutes beyond
one hour increments. There are only 10 additional minutes beyond the first hour, so only
96360 is reported.

100 A Because a left retrograde heart catheterization is performed for a coronary angiography
and left ventrilculography, multiple choice C and D are eliminated. There is no mention of
catheterization in bypass graft(s), which eliminates multiple choice B. The procedure is
performed in the hospital. There is a professional and technical component for the
cardiac catheterization codes in which modifier 26 is appended.

101 C OMT was only performed on two body regions (cervical and thoracic). The OMT codes
are only reported for the number of body regions involved, not the number of lesions in a
particular body region.

102 D The key to this encounter is time and the cerebral seizures monitoring using a radio 16
channel EEG. A nurse is in attendance during the test. CPT® guidelines state: Codes
95950-95953 and 95956 are used per 24 hours of recording. For recording of 12 hours or
less, use modifier 52.

103 C Stents were placed in the left anterior descending coronary artery (LD) and right
coronary artery (RC) (additional vessel). There is a bull’s-eye symbol in front of code
92980 indicates moderate sedation is included in the code and is not reported separately.

104 D We know this patient is established because she is “returning to her pediatrician.” The
well check up is coded as a preventive service. The patient is two-months-old. The
proper code is 99391. According to NCCI, modifier 25 is appended when a significant
and separately identifiable E/M service is performed with other services at the same
encounter. In this case vaccinations are performed. A vaccine administration for each is
coded as well as the vaccine itself. In this case three vaccines are performed; rotavirus
(90680), combination vaccine DTaP-Hib (90721) and Pneumococcal (90669). The
physician counsels the patient’s mother regarding the vaccinations. This eliminates
multiple choices B and C. Add-on-code 90461 is reported when a combination vaccine is
given. DTaP-HIB is a combination vaccine that has a total of four components. Code
90460 is reported three times for the administration of the rotavirus, diphtheria (first
component of the combination vaccine), and pneumococcal. Add-on-code 90461 is
reported three times for the remaining three components (tetanus toxoids, acellular
pertussis and Hemophilus influenza B) in the combination vaccine.

105 A In this case the patient presents for allergen immune therapy for food allergies. The
injections are prepared and provided by the physician, which is reported with 95125 for
two injections. Code 95144 is reported when the antigen extract is prepared and supplied
in a vial. The therapy is not for an insect which makes 95146 incorrect answers. 95117
does not include the provision of the extract so it is also incorrect.
 Mock 7 answers
106 C The photodynamic therapy is performed externally in this case which eliminates option
A. Photo chemotherapy is not used, which eliminates option D. The code description for
96567 reports the services provided for this patient.

107 B In this case, the ED physician performed an E/M service and moderate conscious
sedation so the orthopedic surgeon could provide fracture care. The E/M services are
performed in the ED setting, which is reported with codes 99281-99285. This category
requires three of three key components for the E/M code. The physician performs a
detailed history, expanded problem focused exam and moderate MDM. The
documentation supports a 99283. Modifier 25 is appended to the E/M service because a
significant and separately identifiable E/M service is performed during the same
encounter as a procedure which is the moderate conscious sedation MCS). When coding
for MCS, you need to know the age of the patient, the amount of time and whether the
physician providing MCS is the same physician performing the diagnostic or therapeutic
procedure for which the patient requires MCS. In this case, the ED physician is providing
the MCS. He is not performing the fracture care (therapeutic) service. The patient is four-
years-old and the MCS is provided for 30 minutes. The correct code is 99148.

108 B The services are provided in an inpatient setting which eliminates 90804. The physician
performs 30 minutes of psychotherapy, which is reported with 90816. A diagnostic
interview is not performed nor is psychoanalysis.  echocardiogram was performed by the
pediatrician.
109 C Orchitis is marked by painful swelling of the testis. It may occur without cause, or be
the result of infection. The Greek root “orchis” means testicle, and – “itis" is a suffix
indicating inflammation or infection. Looking up orchitis in the alphabetic index in your
ICD-9-CM manual refers you to code 604.90. In the tabular index this code is found
under Diseases of the Male Genital Organs.

110 C Paratubal cysts are benign, they are frequently found adjacent to the fallopian tubes.
Follicle cysts are cysts on the ovary from ovulation. Myomas or leiomyomas are benign
tumor of the uterus. Accessory ovarian cysts don’t exist. Using the ICD-9-CM alphabetic
index, Cysts/ paratubal (fallopian) guides you to where these cysts are located.
111 C Meconium is fetal stool, composed of materials ingested in utero. It is odorless and
tarlike. Meconium is usually expelled in a neonate’s first bowel movements, but during
stress before or during birth, may be expelled into the amniotic fluid. It can be inhaled into
the fetal lung and cause pneumonia at birth. Meconium staining refers to discoloration of
the amniotic fluid, or of the neonate (for example, meconium staining of fingernails). Look
up Meconium/staining in the alphabetic index, which refers you to a newborn code when
verified in the tabular index.

112 A Both the heart and the nose have a septum, defined as a wall dividing two chambers.
The nasal septum separates the two nostrils. A septum also divides the right and left
atriums and right and left ventricles of the heart. In the CPT® index, looking up the word
septum or septal refers you to codes pertaining to the nose or heart.

113 A Lordosis is a spinal deformity in which the anterior curvature of the lumbar spine is
excessive. It is also called a “sway back.” Lordosis may be caused by tight lower back
 Mock 7 answers
muscles, obesity, or pregnancy. It can lead to lower back pain. The answer to this
question is found easily by looking in the ICD-9-CM index.

114 A A blowout fracture is a fracture of the walls or floor of the orbit. The orbit is the cavity or
socket of the skull which the eye and its appendages are situated. In the alphabetic
index, look up Fracture/orbit/floor (blowout).
115 C Kyphosis is an exaggerated thoracic (upper back) curvature of the spine, sometimes
referred to as a hunchback. Kyphosis is indexed to code 737.10. This code falls under
category code 737 Curvature of spine.

116 D The root word metr/o or metr/i means uterus. In the alphabetic index look for a word
that starts with metro. You will see the medical term Metrorrhexis – see Rupture, uterus.

117 D Using Appendix L as a guide for the vascular families, we begin in the Innominate
artery (first order). Then from there you will enter R. (right) common carotid (second
order). Next you will pass through the R. internal carotid (third order) ending up at the R.
a. cerebral artery.
118 B CKD is for Chronic Kidney Disease. The abbreviation is found in the tabular index
under category code 585. The tabular index also shows CKD is under the Genitourinary
System.

119 D Nephritis is inflammation of the kidney. In the alphabetic index look under
Inflammation/kidney (see also Nephritis).
120 A In ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically
caused by cirrhosis, malignancy, or heart failure. It is usually managed medically but may
be treated with paracentesis. Ascites is indexed in ICD-9-CM, and this answer could have
been found by reviewing the tabular entry, which notes, “Fluid in peritoneal cavity.”

121 D Exotropia is an outward deviation of the eye. The muscles of the eye are controlled by
the fourth cranial nerve. The facial nerve is the seventh cranial nerve. This distinction can
be found in illustrations and written information within your ICD-9 and CPT® code books.
Tarsal tunnel syndrome is nerve impingement in the foot, and brachial plexis lesions refer
to a complex of nerves found between the neck and armpit. Bell’s palsy, is a common
disorder of the facial nerve, and causes an inability to control facial muscles of
expression. It may be caused by a brain tumor, stroke, or Lyme disease, but can be
idiopathic and transient.
122 A Tricuspid is the first heart valve that blood encounters as it enters into the heart.
Superior Vena Cava is a vein that returns blood to the heart from the head, neck and
both upper extremities. Carotid is a major artery located in the front of the neck. Atrium is
one of the two upper receiving chambers of the heart. An illustration of the heart is found
in the Professional Edition of the CPT® manual in the Cardiovascular System Table of
Contents.
123 C Hypernatremia is the when one has too much sodium in the system. Hypernatremia is
indexed to code 276.1.

124 A The term percutaneous means through the skin. Procedure code 49041 is when a
physician uses a drainage needle that goes through the skin into the abscess allowing it
to drain.
125 B The patient has acute and chronic bronchitis. In the alphabetic index look for
Bronchitis/acute or subacute, which guides you to code 466.0. In the alphabetic index
look for Bronchitis/chronic/due to tobacco smoking, which guides you to code 491.0.
Verify both codes in the tabular index for accuracy. ICD-9-CM guidelines (section I.A.10):
 Mock 7 answers
If the same condition is described as both acute (subacute) and chronic, and separate
subentries exist in the alphabetic index as the same indentation level, code both and
sequence the acute (subacute) code first.

126 C Congestive heart failure has many codes, but without more information, we must
choose 428.0 (Failure/heart/congestive). The heart failure is an adverse effect of the drug
trastuzumab, an antineoplastic antibiotic agent. The adverse affect in therapeutic use is
reported with E930.7 (in therapeutic use), according to the table of drugs and chemicals.
Reporting from the poisoning classification (960-979) is not appropriate since the patient
was not poisoned, but is having an adverse effect to the drug that is properly
administered. Finally, report the breast cancer  because suspension of therapy for the
breast cancer will need to be addressed at some point in this patient’s plan of care. We
don’t have enough information on the breast cancer to report anything but 174.9. The
patient is still being treated with trastuzumab and the physician notes that treatment is
being discontinued for contraindications, she is still considered to have active cancer, and
a history code would be inappropriate. Note that separate codes exist for antineoplastic
drugs vs antineoplastic antibiotics. Only answer C captures the clinical situation correctly.

127 B Always pause to consider the meaning of “history” when you see it in a note. Physician
documentation does not always dovetail with the language of ICD-9-CM. History is a
good example of this. A physician may document that the patient has a history of a
disease, and this usually means the disease has been eradicated. It may, however, mean
that the disease is not a diagnosis new at this encounter, but something ongoing in the
patient’s care. It may also mean that this is a problem that the patient has had and
resolved in the past, and that it has recurred. In the case of “history of symptomatic HIV,”
we all know this is not a disease that resolves. Once a patient has symptomatic HIV, the
patient whether they have symptoms at the time of the service, or not, the diagnosis is
coded as 042. According to the Official Guidelines, once a patient with HIV develops
symptoms or an opportunistic disease, report code 042.

128 C Codes from V27 are reserved for the mother’s chart, automatically eliminating A and D
as options. Guidelines (section I.C.15.i) tell us that a code from 765.2 should be assigned
in addition to codes from 764 and 765, and these codes are omitted from B. Further, B
listed as a diagnosis 763.4, indicating the patient was adversely affected by the c-section,
and no adverse affects were documented.

129 D In the Official ICD-9-CM Coding Guidelines, there is a list of V codes that can be
reported as a first listed diagnosis code. The list can be found in the ICD-9-CM manual in
the section of the ICD-9-CM Official Guidelines for Coding and Reporting, section
I.C.18.e.
130 C According to ICD-9-CM guidelines on Late Effect codes (Section I.A.12): The code for
the acute phase of an illness or injury that led to the late effect is never used with a code
for the late effect. This eliminates multiple choices B and D. The same guidelines also
states: Coding of the late effects generally requires two codes sequenced in the following
order: The conditions or nature of the late effect is sequenced first.  The late effect code
is sequenced second.
 Mock 7 answers
131 A The reason for this encounter is pain management. According to ICD-9-CM guidelines
(Section I.C.6.a.5) pain in neoplastic disease (338.3) should be the first listed diagnosis.
The patient has metastatic cancer (secondary malignancy) of the lung, which is reported
with 197.0 as a secondary diagnosis.

132 B According to ICD-9-CM guidelines (Section I.C.3.a.2): If the type of diabetes mellitus is
not documented in the medical record the default is type II. Guidelines further say
(Section I.C.3.a.3) that the use of insulin does not mean that a patient is a type I diabetic.
This eliminates multiple choices A and C.  When assigning codes for diabetes and its
associated conditions, the code(s) from category 250 must be sequenced first then its
associated condition. The primary code is indexed under Diabetes/with gangrene
referring you to code 250.7x [785.4].

133 C Patient is in the post-partum period since she delivered the baby a week ago. This
eliminates multiple choices B and D.  According to ICD-9-CM guidelines (Section
I.C.11.i.4) states when a complication occurs during the admission of the delivery or the
patient has remained in the hospital after the delivery, not yet discharged you assign the
fifth digit 2. When encounters for post-partum complications happens after the delivery
when the patient has been discharged from the hospital and is coming back for a
subsequent visit then you assign the fifth digit 4. Code V24.0 is only assigned when there
are no complications noted after the delivery

134 A According to ICD-9-CM Official Coding Guidelines, when the patient has completed
treatment for cancer and there is not an existing malignancy, select a personal history of
malignancy by site. From the index, look up history/malignant neoplasm (of)/thyroid.
135 D The reason for this encounter is for radiation therapy. The ICD-9-CM Coding
Guidelines instruct us that V58.0 is to be “first listed, followed by the diagnosis code when
a patient’s encounter is solely to receive radiation therapy or chemotherapy for the
treatment of a neoplasm.” In this case, 174.1 would be sequenced secondarily. Because
the cancer is still being treated, a history code would be inappropriate.

136 D Barrett’s esophagus describes changes at the cellular level in the epithelium of the
esophagus, a precursor to cancer. It is usually caused by gastrointestinal reflux disease
(GERD, 530.81). A biopsy found Barrett’s changes (530.85). The FB (935.1) has been
resolved, and so would not be reported.. Proper coding would be for the Barrett’s and the
GERD, or multiple choice D.
137 D According to the ICD-9-CM Official Coding Guidelines, do not report signs and
symptoms that are integral to a definitive diagnosis. When the same condition is
diagnosed as acute and chronic and there is a separate code for both, report both codes.
An ICD-9-CM code is not valid unless it is coded to the highest level of specificity.
Combination code instructions are also in the tabular section. Do not rely solely on the
alphabetic index to select the correct code.
138 A The patient is receiving diabetes self-management training services one-on-one (or
individually), not in a group of two or more. Documentation does not support supplies
being given, nor does it specify home management of gestational diabetes.
139 C The nutrition pump is stationary and it was a supply kit given for seven days. HCPCS
codes B4220-B4224 are reported per day.

140 C In this scenario we are selecting a code to report the refill of insulin pump. J1815
reports insulin but not for a pump. J1817 is insulin through a pump which is the correct
code. J1817 reports 50 units. Two units are reported to account for 100 units of the
insulin.
 Mock 7 answers
141 B Multiple choices A and D are for a generator, and a cardioverter-defibrillator. Code
C1767 is the appropriate code to choose since documentation has the event recorder
implanted without memory, activator and programmer.

142 C To select the correct code for casting supplies, you need to know the type, material
and age of the patient. In this case the patient is a 12-year-old, which eliminates Q4011
and Q4012. The cast is made of fiberglass, which makes Q4010 the correct answer.

143 B The description for code 61535 is indented which means the description from 61533 up
to the semicolon is the beginning of the full description for 61535.

144 D Place of service codes are reported on the claim form to identify the site of the service
provided. In this case, the services are rendered in the ED which is reported with POS
23. The place of service codes can be found in the CPT® manual.
145 A Critical care services can be provided at any site. If the patient is critically ill, the
services provided can be coded with critical care regardless of where the services take
place. A minimum of 30 minutes of critical care must be performed in order to report
99291. If less than 30 minutes, select the appropriate E/M code based on the three key
components. Time spent reviewing results and discussing the critically ill patient with
medical staff is included in the critical care time.
146 B an ABN is a waiver of liability. When a patient has been informed a service that is
otherwise covered by Medicare but might not be covered in a particular instance an ABN
is signed by the patient prior to receiving the service. To inform Medicare the ABN has
been signed, append modifier GA. If an ABN is signed, the claim is the patient’s
responsibility if the claim is denied.
147 Answer B is the only example of unbundling of CPT® which would result in a fraudulent
claim. According to National Correct Coding Initiative (NCCI) and CPT® coding
guidelines, a biopsy performed on the same lesion as an excision during the same
encounter is an incidental service and is not reported separately. If ultrasound guidance
is performed for a liver biopsy, it is billable. X-rays performed in a physician’s office do
not require modifier 26. Since the physician owns the equipment and performs the
interpretation, he bills the global service. Lab panels can be reported with additional lab
tests that are not listed in a lab panel
148 C An ABN must include the service that may be denied, an estimated cost of the patient’s
responsibility if Medicare denies the service and the response for the potential denial.
Generic ABNs are not allowed. Signing of the ABN cannot be obtained during a medical
emergency. The patient must be stable. The ABN must be signed prior to providing the
service.

149 B Services performed by physicians are covered by Medicare Part B. Inpatient services
are covered by Part A. Medicare does not cover routine dental care.
150 B under HIPAA regulations, patients have the right to receive a copy of their medical
record and request that errors are corrected.