3470 HEALTHCARE TRAINING AND PLACEMENT SOLUTIONS

20,000 series

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

2.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 - 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.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 - 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.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
trigger points were injected into four muscle groups which lead you to the
procedure code 20553.

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

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

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

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 - 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.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.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.

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

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

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

creation.

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

all toes at the metatarsals.

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24.d - There are three major approaches to treat fractures: closed, open, and
perutaeous. • Closed treatet eas the fratured oe is ot eposed to the surgeon’s ie. • Ope treatet
eas the oe is eposed iisio. • 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.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.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.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.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.c - Manipulation of spine requiring anesthesia, any region (22505).

30.d - Closed treatment of carpometacarpel dislocation, manipulation under

anesthesia.

31.b. You can find this procedure in the index of CPT® Professional Edition under
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Excision/Tumor/ Abdominal Wall. Read the codes carefully to report the depth of
the excision and size of the tumor.

32.c. You can find the procedure in the index of CPT® Professional Edition under
Arthroscopy/ Surgical/Hip. Carefully review the codes to find the code that indicates
“with femoroplasty.”The x-ray and CT scan were not completed with today’s
services and should not be coded. A cam lesion is a condition that causes the
femoral head to be aspherical.

33. d. Careful review of the approach and level of spinal surgery is important to
determine the correct code selection. Modifier -51 should not be appended to add-
on codes for spinal instrumentation; however, guidelines with spinal fusion
exploration indicate modifier -51 should be appended to this code when performed
with a definitive procedure.

34. c. This question is specifically for a bone cyst. There is no mention of an

arthrocentes is in this question.

35. c. This procedure was completed under general anesthesia, not moderate
sedation. The codes for moderate sedation should not be reported with this
procedure as the description of the code includes the words “general anesthesia.”

36. A.This patient is having a mass removed from the shoulder area, eliminating
multiple choices B, which is biopsy and D, which is incision and drainage of an
abscess. The size of the mass that was excised was 4.5 cm, which leads you to code
23076.

37. 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.

38. C The injection of is being performed in a joint, eliminating multiple choice

answers B and D. The injection was performed on the sacroiliac joint with imaging
confirmation eliminating multiple choice answer A. Arthrography was not
performed; therefore, fluoroscopic guidance is reported with 77003-26 as noted in
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the notes below 27096.

39. D. 20612-LT reports the first injection and 20612-59-LT reports the second
injection. See the CPT instructional notes regarding the use of these codes. Modifier
LT is correctly used to indicate the left side. M67.432is assigned to a ganglion cyst of
LEFT WRIST.

40. B. 28299-RT, Rationale: A double osteotomy can be performed on the phalanx

and the metatarsal, or by making two incisions on the metatarsal bone. Look in the
CPT® Index for Osteotomy/Phalanges/Toe.

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