MOCK-2

10000 Series
1. The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his
nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on
his forehead; he says it is from a piece of sheet metal from an injury to his forehead. He has an X-ray
showing a foreign body, we have offered to remove it. After obtaining consent we proceeded. The area
was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He
observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin
ellipse over the mass to give better access to it, the mass was removed. There was a capsule around this,
containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a
permanent black mark on his forehead. I offered to excise the metal, he wanted me to, so I went ahead
and removed the capsule with the stain and removed all the black stain. I consider this to be a
complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers
using 4-0 Monocryl and 6-0 Prolene. What CPT® and ICD-10-CM codes are reported?
a. 10121, L92.3, Z18.10 c. 10121, M79.5, Z18.10
b. 11010, S01.82XA, Z18.10 d. 11010, M79.5, Z18.10

2. The patient is here because the cyst in her chest has come to a head and is still painful even though
she has been on antibiotics for a week. I offered to drain it for her. After obtaining consent, we
infiltrated the area with 1 cc of 1% lidocaine with epinephrine, prepped the area with Betadine and
incised opened the cyst in the relaxed skin tension lines of her chest, and removed the cystic material.
There was no obvious purulence. We are going to have her clean this with a Q-tip. We will let it heal on
its own and eventually excise it. I will have her come back a week from Tuesday to reschedule surgery.
What CPT® and ICD-10-CM codes are reported?
a. 10140, L70.8 c. 10061, L70.1
b. 10060, L72.3 d. 10160, R22.2

3. Patient has returned to the operating room to aspirate a seroma that has developed from a surgical
procedure that was performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-
cloudy serosanguinous fluid. What codes are reported?
a. 10160-78, L76.34 c. 10140-78, L76.34
b. 10180-58, L76.34 d. 10140-58, T88.8XXA
4. Operative Report
PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp.
POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp.
PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin-Yang flap repair
ANESTHESIA: Local, using 4 cc of 1% lidocaine with epinephrine.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 5 cc.
SPECIMENS: Squamous cell carcinoma, scalp sutured at 12 o’clock, anterior tip
INDICATIONS FOR SURGERY: The patient is a 43-year-old white man with a biopsy-proven
basosquamous cell carcinoma of his scalp measuring 2.1 cm. I marked the area for excision with gross
normal margins of 4 mm and I drew my planned Yin-Yang flap closure. The patient observed these
markings in two mirrors, so he can understand the surgery and agreed on the location and we
proceeded.
DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The patient was placed
prone, his scalp and face were prepped and draped in sterile fashion. I excised the lesion as drawn to
include the galea. Hemostasis was achieved with the Bovie cautery. Pathologic analysis showed the
margins to be clear. I incised the Yin-Yang flaps and elevated them with the underlying galea.
Hemostasis was achieved in the donor site using Bovie cautery. The flap rotated into the defect with
total measurements of 2.9 cm x 3.2 cm. The donor sites were closed and the flaps inset in layers using 4-
0 Monocryl and the skin stapler. Loupe magnification was used. The patient tolerated the procedure
well. What CPT® and ICD-10-CM codes are reported?
a. 14060, C43.31 c. 14041, C44.42
b. 14040, C43.39 d. 14020, C44.42

5. The patient is coming in for removal of fatty tissue of the posterior iliac crest, abdomen, and the
medial and lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest
area and was continued on the right and the lateral trochanteric and posterior aspect of the medial
thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount
infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a
compression garment was applied. What CPT® code(s) are reported?
a. 15830, 15832-50-51 c. 15830, 15839-50-51, 15847
b. 15877, 15879-50-51 d. 15877, 15878-50-51

6. Operative Report
PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration.
POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration.
OPERATION PERFORMED: Debridement and split thickness autografting of left foot
ANESTHESIA: General endotracheal.
INDICATIONS FOR PROCEDURE: This patient with multiple complications from Type II diabetes has
developed ulcerations which were debrided and homografted last week. The homograft is taking quite
nicely; the wounds appear to be fairly clean; he is ready for autografting.
DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the operating room and
placed in the supine position on the operating table. Anesthetic monitoring was instituted, internal
anesthesia was induced. The left lower extremity is prepped and draped in a sterile fashion. Staples
were removed and the homograft was debrided from the surface of the wounds. One wound appeared
to have healed; the remaining two appeared to be relatively clean. We debrided this sharply with good
bleeding in all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked
sponges. With good hemostasis a donor site was then obtained on the left anterior thigh, measuring
less than 100 cm2. The wounds were then grafted with a split-thickness autograft that was harvested
with a patch of Brown dermatome set at 12,000 of an inch thick. This was meshed 1.5:1. The donor site
was infiltrated with bupivacaine and dressed. The skin graft was then applied over the wound,
measured approximately 60 cm2 in dimension on the left foot. This was secured into place with skin
staples and was then dressed with Acticoat 18's, Kerlix incorporating a catheter, and gel pad. The
patient tolerated the procedure well. The right foot was redressed with skin lubricant sterile gauze and
Ace wrap. Anesthesia was reversed. The patient was brought back to the ICU in satisfactory condition.
What CPT® and ICD-10-CM codes are reported?
a. 15220-58, 15004-58, L97.509, E11.621
b. 15120-58, 15004-58, E11.621, L97.509
c. 15950-78, 15004-78, E11.9, L97.409
d. 11044-78, 15120-78, 15004-78, E11.621, L97.409

7. Operative Report
Diagnosis: Basal Cell Carcinoma
Procedure: Moh’s micrographic excision of skin cancer.
Site: face left lateral canthus eyelid
Pre-operative size: 0.8 cm
Indications for surgery: Area of high recurrence, area of functional and/or cosmetic importance
Discussed procedure including alternative therapy, expectations, complications, and the possibility of a
larger or deeper defect than expected requiring significant reconstruction. Patient’s questions were
answered.
Local anesthesia 1:1 marcaine and 1% lidocaine with epinephrine. Sterile prep and drape.
Stage 1: The clinically apparent lesion was marked out with a small rim of normal appearing tissue and
excised down to subcutaneous fat level with a defect size of 1.2 cm. Hemostasis was obtained and a
pressure bandage placed. The tissue was sent for slide preparation. Review of the slides show clear
margins for the site.
Repair: Complex repair.
Repair of Moh’s micrographic surgical defect. Wound margins were extensively undermined in order to
mobilize tissue for closure. Hemostasis was achieved. Repair length 3.4 cm. Narrative: Burrows
triangles removed anteriorly (medial) and posteriorly (lateral). A layered closure was performed.
Multiple buried absorbable sutures were placed to re-oppose deep fat. The epidermis and dermis were
re-opposed using monofilament sutures. There were no complications; the patient tolerated the
procedure well. Post-procedure expectations (including discomfort management), wound care and
activity restrictions were reviewed. Written Instructions with urgent contact numbers given, follow-up
visit and suture removal in 3-5 days
What CPT® and ICD-10-CM codes are reported?
a. 13152, 11642-51, C44.319 c. 17313, 13152-51, C44.111
b. 13152, 11442-51, C44.319 d. 17311, 13152-51, C44.119
8. PREOPERATIVE & POSTOPERATIVE DIAGNOSES: Macromastia, Back pain, Neck pain, Shoulder pain,
Shoulder grooving, Intertrigo.
NAME OF PROCEDURE:
 Right breast reduction of 1950 g.
 Right free-nipple graft.
 Left breast reduction of 1915 g.
 Left free-nipple graft.
INDICATIONS FOR SURGERY: The patient is a 43-year-old female with macromastia and associated
back pain, neck pain, shoulder pain, shoulder grooving and Intertrigo. She desired a breast reduction.
Because of the extreme ptotic nature of her breasts, we felt she would need a free-nipple graft
technique. In the preoperative holding area, we marked her for this free-nipple graft technique of
breast reduction. The patient observed these markings so she could understand the surgery and agree
on the location, and we proceeded. The patient also was morbidly obese with a body mass index of
54. Because of this, we felt she met the criteria for DVT prophylaxis, which included Lovenox injection.
The patient understood this would increase her risk of bleeding. She also made it known she is a
Jehovah's Witness and refused blood products, but she did understand her risk of bleeding would
significantly increase and we proceeded.
DESCRIPTION OF PROCEDURE: The patient was given 40 mg of subcutaneous Lovenox in the
preoperative holding area. She was then taken to the operating room. Bilateral thigh-high TED hose, in
addition to bilateral pneumatic compression stockings were used throughout the procedure. IV Ancef 1
g was given. Anesthesia was induced. Both arms were secured on padded arm boards using Kerlix rolls.
A similar body bear hugger was placed. The chest and abdomen were prepped and draped in sterile
fashion. I began by circumscribing around each nipple-areolar complex using a 42-mm areolar marker.
On each side the free-nipple grafts were harvested. They were marked to be side specific and were
stored on the back table in moistened lap sponges. Meticulous hemostasis was achieved using Bovie
cautery. The tail of the apex of each breast was deepithelialized using the scalpel. I amputated the
inferior portion of the breast from the right side. Again, meticulous hemostasis was achieved using the
Bovie cautery. There were also large feeder vessels divided and ligated using either a medium Ligaclip or
3-0 silk tie sutures. I then moved to the left and again amputated the inferior portion of the breast.
Meticulous hemostasis was achieved using the Bovie cautery. Each of these wounds was temporarily
closed using the skin stapler. The patient was then sat up. I felt we had achieved a very symmetrical
result. The new positions for the nipple-areolar complexes were marked with a 42-mm areolar marker
and methylene blue. The patient was then placed in the supine position and the new positions for the
nipple-areolar complexes were deepithelialized using the scalpel. Meticulous hemostasis was then
achieved again using the Bovie cautery. The free-nipple grafts were then retrieved from the back table.
They were each defatted using scissors and were placed in an onlay fashion on the appropriate side, and
each was inset using 5-0 plain sutures. Vents were made in the skin graft to allow for the egress of fluid
on each side. A vertical mattress suture was used, tied over a piece of Xeroform in critical areas of each
of the nipple-areolar complexes. A Xeroform bolster wrapped over a mineral oil-moistened sponge was
affixed to each of the nipple-areolar complexes using 5-0 nylon suture. The vertical and transverse
incisions were closed using 3-0 Monocryl, both interrupted and running suture, and 5-0 Prolene. The
patient tolerated the procedure well. Again, meticulous hemostasis was achieved using the Bovie
cautery. She was given another 1 g of Ancef at the 2-hour mark by our anesthesiologist, and was taken
to the recovery room in good condition.
What CPT® codes are reported?
a. 19316-50, 19355-59-50 c. 19318-50, 19355-59-50
b. 19318-50, 19350-59-50 d. 19340-50, 19350-59-50

9. INDICATIONS FOR SURGERY: The patient is an 82-year-old white male with biopsy-proven basal cell
carcinoma of his right lower eyelid and cheek laterally. I marked the area for rhomboidal excision and I
drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the
surgery and agreed on the location and we proceeded.
DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped
and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was
achieved using Bovie cautery. Modified Mohs analysis showed the margin to be clear. I incised the
rhomboid flap as drawn and elevated the flap with a full-thickness of subcutaneous fat. Hemostasis
was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap
was rotated into the defect. The donor site was closed and flap inset in layers using 5-0 Monocryl and
6-0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm
What CPT® code(s) should be reported?
a. 14020 c. 14040, 14060
b. 14060 d. 11643

10. Wire placement in the lower outer aspect of the right breast was done by a radiologist the day prior
to this procedure. During this operative session, the surgeon created an incision through the wire track
and the wire track was followed down to its entrance into breast tissue. A nodule of breast tissue was
noted immediately adjacent to the wire. This entire area was excised by sharp dissection, sent to
pathology and returned as a benign lesion. Bleeders were cauterized, and subcutaneous tissue was
closed with 3-0 Vicryl. Skin edges were approximated with 4-0 subcuticular sutures and adhesive strips
were applied. The patient left the operating room in satisfactory condition. What should be the correct
code(s) for the surgeon’s services?
a. 19125-RT c. 19125-RT, 19285
b. 11400-RT d. 19120-RT

20000 Series
11. A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture
while on vacation. The patient was put under general anesthesia and the elbow was reduced and was
stable. The medial elbow was held in the appropriate position and was reduced in acceptable position
and elevated to treat non-surgically. A long arm splint was applied. The patient is referred to an
orthopedist when she returns to her home state in a few days. What CPT® code(s) are reported?
a. 24575-54-RT, 24615-54-51-RT c. 24577-54-RT, 24600-54-51-RT
b. 24576-54-RT, 24620-54-51-RT d. 24565-54-RT, 24605-54-51-RT
12. A 45-year-old presents to the operating room with a right index trigger finger and left shoulder
bursitis. The left shoulder was injected with 1 cc of Xylocaine, 1 cc of Celestone, and 1 cc of Marcaine.
An incision was made over the A1 pulley in the distal transverse palmar crease, about an inch in length.
This incision was taken through skin and subcutaneous tissue. The Al pulley was identified and released
in its entirety. The wound was irrigated with antibiotic saline solution. The subcutaneous tissue was
injected with Marcaine without epinephrine. The skin was closed with 4-0 Ethilon suture. Clean
dressing was applied. What CPT® codes are reported?
a. 26055-F6, 20610-76-LT c. 26055-F6, 20610-51-LT
b. 20552-F6, 20605-52-LT d. 20553-F6, 20610-51-LT
13. A patient presents with a healed fracture of the left ankle. The patient was placed on the OR table
in the supine position. After satisfactory induction of general anesthesia, the patient’s left ankle was
prepped and draped. A small incision about 1 cm long was made in the previous incision. The lower
screws were removed. Another small incision was made just lateral about 1 cm long. The upper screws
were removed from the plate. Both wounds were thoroughly irrigated with copious amounts of
antibiotic containing saline. Skin was closed in a layered fashion and sterile dressing applied. What
CPT® code(s) should be reported?
a. 20680-LT c. 20670-LT
b. 20680-LT, 20680-59-LT d. 20680-LT, 20670-59-LT

14. A patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced
comminuted fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was
performed and included the following techniques: An incision was made in the area of the lateral
epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed.
Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to
manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This
was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound
was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast
were applied. What CPT® and ICD-10-CM codes are reported?
a. 24579-RT, 29065-51-RT, S42.451A c. 24579-RT, S42.451A
b. 24577-RT, S42.454A d. 24575-RT, S42.454A

15. A 47-year-old patient was previously treated with external fixation for a Grade III left tibial 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 with three screws. The harvested bone graft was packed
into the fracture site. What CPT® and ICD-10-CM codes are reported?
a. 27724-LT, S82.102N c. 27722-LT, S82.201M
b. 27722-LT, S82.102M d. 27724-LT, S82.201N
16. 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 prepped,
draped, and positioned. Intramedullary rodding was carried out with proximal and distal locking
screws. What CPT® codes should be reported?
a. 27506-RT, 11044-51-RT c. 27507-RT, 11012-51-RT
b. 27506-RT, 11012-51-RT d. 27507-RT, 11044-51-RT

17. A 49-year-old female had two previous rotator cuff procedures and now has difficulty with
shoulder function, deltoid muscle function, and axillary nerve function. An arthrogram is scheduled.
After preparation, the shoulder is anesthetized with 1% lidocaine, 8 cc without epinephrine. The
needle was placed into the shoulder area posteriorly under image intensification. It appeared as if the
dye was in the shoulder joint. She was moved and a good return of flow was obtained. The shoulder
was then mobilized and there was no evidence of any cuff tear from the posterior arthrogram. What
CPT® codes are reported?
a. 20551, 73040-26 c. 23350, 73040-26
b. 20610, 73040-26 d. 20552, 73040-26

18. A 31-year-old secretary returns to the office with continued complaints of numbness involving three
radial digits of the upper right extremity. Upon examination, she has a positive Tinel’s test of the median
nerve in the left wrist. Anti-inflammatory medication has not relieved her pain. Previous
electrodiagnostic studies show sensory mononeuropathy. She has clinical findings consistent with carpal
tunnel syndrome. She has failed physical therapy and presents for injection of the left carpal canal. The
left carpal area is prepped sterilely. A 1.5 inch 25 or 22 gauge needle is inserted radial to the palmaris
longus or ulnar to the carpi radialis tendon at an oblique angle of approximately 30 degrees. The needle
is advanced a short distance about 1 or 2 cm observing for any complaints of paresthesias or pain in a
median nerve distribution. The mixture of 1 cc of 1% lidocaine and 40 mg of Kenalog-10 is injected
slowly along the median nerve. The injection area is cleansed and a bandage is applied to the site. What
codes are reported?
a. 20526, J3301 x 4 c 20526, J3301
b. 20551, J3301 x 4 d. 20550, J3301

19. An elderly female presented with increasing pain in her left dorsal foot. The patient was brought to
the operating room, and placed under general anesthesia. A curvilinear incision was centered over the
lesion itself. Soft tissue dissection was carried through to the ganglion. The ganglion was clearly
identified as a gelatinous material. It was excised directly off the bone and sent to pathology. There was
noted to be a large bony spur at the level of the head of the 1st metatarsal. Using double action
rongeurs, the spur itself was removed and sequestrectomy was performed. A rasp was utilized to
smooth the bone surface. The eburnated bony surface was then covered, utilizing bone wax. The
wound was irrigated and closed in layers. What CPT® codes are reported?
a. 28122-LT2, 28090-51-LT c. 28045-LT, 28090-51-LT
b. 28111-LT, 28092-51-LT d. 28100-LT, 28092-51-LT
20. Under general anesthesia, a 45-year-old patient was sterilely prepped. The wrist joint was injected
with Marcaine and epinephrine. Three arthroscopic portals were created. The articulating surface
between the scaphoid and the lunate clearly showed disruption of the ligamentous structures. We
could see soft tissue pouching out into the joint; this was debrided. There was abnormal motion noted
within the scapholunate articulation. At this point the C-arm was brought in; arthroscopic instruments
were placed in the joint and confirmed the location of the shaver as a probe in the scapholunate
ligament. There was a significant gap between the capitate and lunate. K-wire was utilized from the
dorsal surface into the lunate, restoring the space. Further examination revealed gross instability
between the capitate and lunate. With the wrist in neutral position, a K-wire was passed through the
scaphoid, through the capitate and into the hamate. This provided stabilization of the wrist joint.
Stitches were placed, and a thumb spica cast was applied. What CPT® code(s) should be reported?
a. 29847 c. 29840
b. 29846 d. 29847, 29840-51

30000 Series
21. A patient underwent bilateral nasal/sinus diagnostic endoscopy. Finding the airway obstructed the
physician fractures the middle turbinates to perform the surgical endoscopy with total ethmoidectomy
and bilateral nasal septoplasty. What CPT® codes are reported?
a. 30930, 31255-51, 30520-51 c. 31231, 30130-51, 31255-50
b. 31255-50, 30520-50-51 d. 31255, 30520-51

22. 55-year-old female smoker presents with cough, hemoptysis, slurred speech, and weight loss. Chest
X-ray done today demonstrates a large, unresectable right upper lobe mass, and brain scan is suspicious
for metastasis. Under fluoroscopic guidance in an outpatient facility, a percutaneous needle biopsy of
the lung lesion is performed for histopathology and tumor markers. A diagnosis of small cell carcinoma
is made and chemoradiotherapy is planned. What CPT® and ICD-10-CM codes are reported?
a. 32098, 77002-26, C34.10, R07.9, R04.89, R47.1, R63.4
b. 32400, 77002-26, C34.90
c. 32607, 77002-26, R22.2
d. 32405, 77002-26, C34.11
23. A surgeon performs a high thoracotomy with resection of a single lung segment on a 57-year-old
heavy smoker who had presented with a six-month history of right shoulder pain. An apical lung biopsy
had confirmed lung cancer. What CPT® and ICD-10-CM codes are reported?
a. 32100, M79.709 c. 32503, C34.10
b. 32484, C34.10 d. 19271, 32551-51, M79.709

24. A 3-year-old girl is playing with a marble and sticks it in her nose. Her mother is unable to dislodge
the marble so she takes her to the physician’s office. The physician removes the marble with
hemostats. What CPT® and ICD-10-CM codes are reported?
a. 30300, T17.1XXA c. 30150, T17.1XXA
b. 30310, T17.0XXA d. 30320, T17.0XXA
25. An ICU diabetic patient who has been in a coma for weeks as the result of a head injury becomes
conscious and begins to improve. The physician performs a tracheostomy closure and since the
scar tissue is minimal, the plastic surgeon is not needed. What CPT® and ICD-10-CM codes are
reported for this procedure?
a. 31820, E11.641, Z93.0 c. 31825, Z43.0, E11.9, S09.8XXA
b. 31820, Z43.0, S06.9X5A, E11.9 d. 31825, Z43.0, E11.641, S09.90XA

26. A patient has a complete TTE performed to assess her mitral valve prolapse (congenital). The
physician performs the study in his cardiac clinic.
a. 93303 c. 93308
b. 93306 d. 93312

27. A patient has a Transtelephonic rhythm strip pacemaker evaluation for his dual chamber
pacemaker. It has been more than two months from his last evaluation due to him moving. The
physician evaluates remotely retrieved information, checking the device’s current
programming, battery, lead, capture and sensing function, and heart rhythm. The monitoring
period has been 35 days. What can the physician report for the service?
a. 93293-52 c. 93296
b. 93295 d. 93293

28. A patient is brought to the operating suite when she experiences a large output of blood in her
chest tubes post CABG. The physician performing the original CABG yesterday is concerned about
the post-operative bleeding. He explores the chest and finds a leaking anastomosis site and he
resutured.
a. 35761 c. 35820-78
b. 35761-78 d. 35241

29. MAZE procedure is performed on a patient with atrial fibrillation. The physician isolates and
ablates the electric paths of the pulmonary veins in the left atrium, the right atrium, and the
atrioventricular annulus while on cardiopulmonary bypass.
a. 33254 c. 33256
b. 33255 d. 33259

30. Patient undergoes a mitral valve repair with a ring insertion and an aortic valve
replacement, on cardiopulmonary bypass.
a. 33464, 33406-51 c. 33430, 33405-51
b. 33426, 33405-51 d. 33468, 33426-51
 40000 Series
31. 66-year-old female is admitted to the hospital with a diagnosis of stomach cancer. The surgeon
performs a total gastrectomy with formation of an intestinal pouch. Due to the spread of the
disease, the physician also performs a total en bloc splenectomy. What CPT® codes are reported?
a. 43622, 38100-51 c. 43634, 38115-51
b. 43622, 38102 d. 43634, 38102-51

32. A patient suffering from cirrhosis of the liver presents with a history of coffee ground emesis. The
surgeon diagnoses the patient with esophageal gastric varices. Two days later, in the hospital GI
lab, the surgeon ligates the varices with bands via an UGI endoscopy. What CPT® and ICD-10-CM
codes are reported?
a. 43205, K70.30, I85.11 c. 43400, K70.30, I85.11
b. 43244, K74.60, I85.11 d. 43235, K74.60, I85.11

33. A patient was taken to the emergency room for severe abdominal pain, nausea and vomiting. A
WBC (white blood cell count) was taken and the results showed an elevated WBC count. The
general surgeon suspected appendicitis and performed an emergent appendectomy. The patient
had extensive adhesions secondary to two previous Cesarean-deliveries. Dissection of this altered
anatomical field and required the surgeon to spend 40 additional intraoperative minutes. The
surgeon discovered that the appendix was not ruptured nor was it hot. Extra time was
documented in order to thoroughly irrigate the peritoneum. What CPT® and ICD-10-CM codes are
reported?
a. 44960-22, R10.9, R11.2, D72.829K35.3 c. 44960-22, K35.2
b. 44950-22, R10.9, R11.2, D72.829 d. 44005, 44955, R10.9, R11.2, K35.2

34. The patient was taken to the operating room and placed in the dorsal lithotomy position, prepped
and draped in the usual sterile fashion. A vertical paramedian incision was made along the left side
of the umbilicus from the symphysis and taken up to above the umbilicus. This incision was carried
down to the rectus muscles, which were separated in the midline. The peritoneal cavity was
entered with findings as described. The ascitic fluid was removed and hand-held retractors were
used to assist in surgical exposure. The tumor was resected from the hepatic flexure into the mid
transverse colon. The resection was extended into the left upper quadrant and the attachments
were also clamped, cut and suture ligated with 2-0 silk sutures in a stepwise fashion until
mobilization of the tumor mass could be brought medial and hemostasis was obtained. Attempts
to find a dissection plane between the tumor mass and the transverse colon were unsuccessful as
it appeared that the tumor mass was invading into the wall of the bowel with extrinsic
compression and distortion of the bowel lumen. Given the mass could not be resected without
removal of bowel, attention was directed to mobilization of the splenic flexure. Retroperitoneal
dissection was started in the pelvis and continued along the left paracolic gutter. The ligamentous
and peritoneal attachments were taken down with Bovie cautery in a stepwise fashion around the
splenic flexure of the colon until the entire left colon was mobilized medially. Similar steps were
then carried on the right side as the right colon and hepatic flexures were mobilized. The
 peritoneal and ligamentous attachments were taken down with Bovie cautery. Vascular
attachments were clamped, cut, and suture ligated with 2-0 silk until the right colon was mobilized
satisfactorily. The GIA stapler was introduced and fired at both ends to dissect the tumorous bowel
free. The bowel was delivered off the operative field. Attention was then directed towards re-
anastomosis of the colon. Linen-shod clamps were used to gently clamp the proximal and distal
segments of the large bowel. The staple line was removed with Metzenbaum scissors, and the
colon lumen was irrigated. The silk sutures were used to divide the circumference of the bowel into
equal thirds, and the proximal and distal edges of the bowel were reapproximated with silk
sutures. The posterior segment of the bowel was then retracted and secured with a TA stapler,
ensuring a full thickness bowel wall insertion into the staple line. The additional two thirds were
also isolated and, with the TA stapler, clamped, ensuring that all layers of the bowel wall were
incorporated into the anastomosis. A third staple line was fired and the integrity of the
anastomosis was checked. First complete hemostasis was noted. There was well beyond a finger
width lumen within the large bowel. The linen-shod clamps were released and gas and bowel fluid
were moved through the anastomosis aggressively with intact staple line, no leakage of gas or
fluid. The abdomen was then irrigated and water was left over the anastomosis. The anastomosis
was manipulated with no extravasation of air. The abdomen and pelvis were then irrigated
aggressively. The Mesenteric trap was then reapproximated with interrupted 3-0 silk suture
ligatures. All sites were inspected and noted to be hemostatic. Attention was directed towards
closing.
a. 44140, C18.8, C18.4, C18.3 c. 44160, C18.8
b. 44140, 44139, C18.8 d. 44147, 44139, C18.3, C8.4

35. Margaret has a cholecystoenterostomy with a Roux-en-Y; five hours later she has an enormous
amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for
an exploratory laparotomy and subsequent removal of a sponge that remained behind from
surgery earlier that day. The area had become inflamed and peritonitis was setting in. What is the
correct coding for the subsequent services on this date of service? The same surgeon took her
back to the OR as the one who performed the original operation.
What CPT® code is reported?
a. 49000-58 c. 49402-77
b. 49000-77 d. 49402-78

36. Operative Report

Indications: This is a third follow-up EGD dilation on this patient for a pyloric channel ulcer which
has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation.
Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray.
Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was
inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was
unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in
the antrum. The pyloric channel was again widened. However, the ulcer as previously seen was
well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm
 endoscope could be introduced into the second portion of the duodenum revealing normal
mucosa. Marked deformity and scarring was seen in the proximal bulb. Following the diagnostic
exam, a 15 mm balloon was placed across the stricture, dilated to maximum pressure, and
withdrawn. There was minimal bleeding post-op. Much easier access into the duodenum was
accomplished after the dilation. Follow-up biopsies were also taken to evaluate Helicobacter noted
on a previous exam. The patient tolerated the procedure well.
Impressions: Pyloric stricture secondary to healed pyloric channel ulcer, dilated.
Plan: Check on biopsy, continue Prilosec for at least another 30 days. At that time, a repeat
endoscopy and final dilation will be accomplished. He will almost certainly need chronic H2
blocker therapy to avoid recurrence of this divesting complicated ulcer.
What CPT® and ICD-10-CMcodes are reported?
a. 43245, 43239-51, K31.1, Z87.11 c. 43235, 43239-51, K31.4, Z87.19
b. 43236, 43239-59, K31.1, Z87.11 d. 43248, 43239-59, K31.4, Z87.11

37. A patient with hypertension presents to the same day surgery department for removal of her
gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be
cleared for surgery. What ICD-10-CM codes are reported?
a. K80.21, Z01.810, I10 c. Z01.810, K80.20, I10
b. I10, K80.21, Z01.810 d. I10, K80.20, Z01.810

38. A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This
attempt was unsuccessful. The physician then dilates the esophagus transendoscopically using a
balloon (25mm).
a. 43450, 43220 c. 43220, 43450-52
b. 43450-53, 43220 d. 43220

39. Surgical laparoscopy with a cholecystectomy and exploration of the common bile duct, for
cholelithiasis. What CPT® and ICD-10-CM codes are reported?
a. 47610, K80.20 c. 47562, 47552, K80.42
b. 47564, K80.20 d. 47610, 47560, K80.42

40. 45-year-old patient with liver cancer is scheduled for a liver transplant. The patient’s brother is a
perfect match and will be donating a portion of his liver for a graft. Segments II and III will be
taken from the brother and then the backbench reconstruction of the graft will be performed,
both a venous and arterial anastomosis. The orthotopic allotransplantation will then be
performed on the patient. What CPT® codes are reported?
a. 47140, 47146, 47147, 47135 c. 47140, 47147, 47146, 47136
b. 47141, 47146, 47135 d. 47141, 47146, 47136
 50000 Series
41. 67-year-old gentleman with localized prostate cancer will be receiving brachytherapy
treatment. Following calculation of the planned transrectal ultrasound, guidance was provided
for percutaneous placement of 1-125 seeds into the prostate tissue. What CPT® code is
reported for needle placement to insert the radioactive seeds into the prostate?
a. 55860 c. 55875
b. 55920 d. 55876

42. Benign prostatic hypertrophy with outlet obstruction and

hematuria. Operation: TURP
Anesthesia: Spinal
Description of procedure: The patient was placed on the operating room table in sitting position
and spinal anesthesia induced. He was placed in the lithotomy position, prepped and draped
appropriately. Resection was begun at the posterior bladder neck and extended to the
verumontanum (a crest near the wall of the urethra). Posterior tissue was resected first from
the left lateral lobe, then right lateral lobe, then anterior. Depth of resection was carried to the
level of the circular fibers. Bleeding vessels were electrocauterized as encountered. Care was
taken to not resect distal to the verumontanum, thus protecting the external sphincter. At the
end of the procedure, prostatic chips were evacuated from the bladder. Final inspection
showed good hemostasis and intact verumontanum. The instruments were removed, Foley
catheter inserted, the patient returned to the recovery area in satisfactory condition. What
CPT® code is reported for this service?
a. 52601-50 c. 52640
b. 52630 d. 52601

43. The patient presents to the office for CMG (cystometrogram). Complex CMG cystometrogram
with voiding pressure studies is done, intraabdominal voiding pressure studies, and complex
uroflow are also performed. What CPT® code(s) is/are reported for this service?
a. 51726 c. 51728, 51797, 51741-51
b. 51726, 51728-51, 51797 d. 51728-26, 51797-26, 51741-51-26

44. A 56-year-old woman with biopsy-proven carcinoma of the vulva with metastasis to the lymph
nodes has complete removal of the skin and deep subcutaneous tissues of the vulva in addition to
removal of her inguinofemoral, iliac and pelvic lymph nodes bilaterally. The diagnosis of carcinoma
of the vulva with 7 of the nodes also positive for carcinoma is confirmed on pathologic review.
What are the CPT® codes reported for this procedure?
a. 56637 c. 56632-50
b. 56640-50 d. 56633, 38765-50
45. A woman with a long history of rectocele and perineal scarring from multiple episiotomies
develops a rectovaginal fistula with perineal body relaxation. She has transperineal repair with
perineal body reconstruction and plication of the levator muscles. What are the CPT® and ICD-
10-CM codes reported for this procedure?
a. 57250, N81.6 c. 57300, 56810-51, N82.4, N90.89
b. 57308, N82.4, N90.89 d. 57330, N82.1

46. An 88-year-old widow with uterine prolapse and multiple comorbid conditions has been
unsuccessful in the use of a pessary for treatment elects to receive colpocleisis (LeFort type) to
prevent further prolapse and avoid more significant surgery like hysterectomy. The treatment is
successful. What are the CPT® and ICD-10-CM codes reported for this procedure?

a. 59320, N81.2 c. 57120, N81.2

b. 57130, N81.1 d. 57020, N81.1

47. A 37 year old woman presents with abdominal pain, bleeding unrelated to menses and an
abnormal pap showing LGSIL (low grade squamous intraepithelial lesion). Treatment is
hysteroscopy with thermoablation of the endometrium and cryocautery of the cervix. This is
performed without difficulty. What are the CPT® and ICD-10-CM codes reported for this
procedure?
a. 58555, 58353-51, C54.3 c. 58350, 57510-51, C54.3
b. 58565, 57511-51, R87.612 d. 58563, 57511-51, R87.612

48. A patient is diagnosed with an injury to the facial nerve. The surgeon performs a neurorrhaphy
with nerve graft to restore innervation to the face using microscopic repair. The surgeon created a
2 cm incision over the damaged nerve, dissected the tissues and located the nerve. The damaged
nerve was resected and removed. The 3.0 cm graft taken from the sural nerve was sutured to the
proximal and distal ends of the damaged nerve. What CPT® and ICD-10-CM codes are reported?
a. 64885, S09.93XA c. 64886, 69990, S04.50XA
b. 64886, S04.50XA d. 64885, 69990, S04.50XA

49. 47-year-old male presents with chronic back pain, and lower left leg radiculitis. A laminectomy is
performed on the inferior end of L5. The microscope is used to perform microdissection. There
was a large extradural cystic structure on the right side underneath the nerve root as well as the
left. The entire intraspinal lesion was evacuated. What CPT® code(s) is/are reported for this
procedure?
a. 63267, 69990 c. 63272
b. 63252, 69990 d. 63277
50. A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear medicine
scan) and ultrasound and is found to have only one diseased parathyroid. A minimally invasive
parathyroidectomy is performed. What CPT® and ICD-10-CM codes are reported for the surgery?
a. 60500-50, E21.3 c. 60505, E21.3
b. 60502-50, E21.3 d. 60500, E21.3

60000 Series
51. A physician uses cryotherapy for removal trichiasis. What CPT® and ICD-10-CM codes are reported?
a. 67820, H02.056 c. 67830, H02.053
b. 67825, H02.059 d. 67840, H02.059
52. A patient receives chemodenervation with Botulinum toxin injections to stop blepharospasms of
the right eye. What are the procedure and diagnosis codes?
a. 64650, R29.891 c. 64612-RT, G24.5
b. 67345-RT, G24.5 d. 64616-RT, R29.891

53. The surgeon performed an insertion of an intraocular lens prosthesis discussed with the patient
before the six-week earlier cataract removal (by the same surgeon). What CPT® code is reported?
a. 66985-58 c. 66984
b. 66983-58 d. 66985
54. The physician performs an iridotomy using laser on both eyes for chronic angle closure glaucoma;
Procedure includes local anesthesia. What CPT® and ICD-10-CM codes are reported?
a. 66710-50, H40.2130 c. 66762-50, 66990, H40.223
b. 66625, H40.2290 d. 66761-50, H40.2230
55. A physician extracts a tumor, using a frontal approach, from the lacrimal gland of a 14-year-old
patient. What CPT® and ICD-10-CM codes are reported?
a. 68500, C79.49 c. 68520, D09.20
b. 68505, C69.50 d. 68540, D49.89
56. 72-year-old patient is undergoing a corneal transplant. An anesthesiologist is personally performing
Monitored anesthesia care. What CPT® code and modifier(s) are reported for anesthesia?
a. 00144 c. 00144-AA-QS
b. 00144-AA d. 00144-QK-QS
57. A CRNA is personally performing a case, with medical direction from an anesthesiologist. What
Modifier is appropriately reported for the CRNA services?
a. QX c. QK
b. QZ d. QS

58. An anesthesiologist is medically supervising six cases concurrently. What modifier is reported
for the anesthesiologist’s service?
a. AA c. QK
b. AD d. QX
59. When an anesthesiologist is medically supervising six cases, what modifier is reported for the
CRNA’s medically directed service?
a. AD c. QX
b. QK d. QZ

60. 30-year-old patient had anesthesia for an extensive spinal procedure with instrumentation under
general anesthesia. The anesthesiologist performed all required steps for medical direction and
was not medically directing any other services at the time. What modifier(s) and CPT® code(s) are
reported for the anesthesiologist and CRNA services?
a. 00670-AA c. 00670-QK and 00670-QZ
b. 00670-QK and 00670-QX d. 00670-QY and 00670-QX
Evaluation & Management
61. Subjective: Six-year-old girl twisted her arm on the playground. She is seen in the ED
complaining of pain in her wrist.
Objective: Vital Signs: stable. Wrist: Significant tenderness laterally. X-ray is normal
Assessment: Wrist sprain
Plan: Over the counter Anaprox. give twice daily with hot packs. Recheck if no improvement.
What is the E/M code for this visit?
a. 99221 c. 99241
b. 99284 d. 99281

62. An infant is born six weeks premature in rural Arizona and the pediatrician in attendance
intubates the child and administers surfactant in the ET tube while waiting in the ER for the air
ambulance. During the 45 minute wait, he continues to bag the critically ill patient on 100 percent
oxygen while monitoring VS, ECG, pulse oximetry and temperature. The infant is in a warming unit
and an umbilical vein line was placed for fluids and in case of emergent need for medications.
How is this coded?
a. 99291 c. 99291, 31500,36510,94610
b. 99471 d. 99471, 94610, 36510

63. Mr. Trumph loses his yacht in a poker game and experiences a sudden onset of chest pain which
radiates down his left arm. The paramedics are called to the casino he owns in Atlantic City to
stabilize him and transport him to the hospital. Dr. H. Art is in the ER to direct the activities of the
paramedics. He spends 30 minutes in two-way communication directing the care of Mr. Trumph.
When EMS reached the hospital Emergency Department, Mr. Trumph is in full arrest with
torsades de pointes (ventricular tachycardia). Dr. H. Art spends another hour stabilizing the
patient and performing CPR. What are the appropriate procedure codes for this encounter?
a. 99288, 99291, 92950 c. 99288, 99291
b. 99291, 99292 d. 99291, 92950, 92960
64. Patient comes in today at four months of age for a checkup. She is growing and developing
well. Her mother is concerned because she seems to cry a lot when lying down but when she is
picked up she is fine. She is on breast milk but her mother has returned to work and is using a
breast pump, but hasn’t seemed to produce enough milk.
PHYSICAL EXAM: Weight 12 lbs 11 oz, Height 25in., OFC 41.5 cm. HEENT: Eye: Red reflex normal.
Right eardrum is minimally pink, left eardrum is normal. Nose: slight mucous Throat with slight
thrush on the inside of the cheeks and on the tongue. LUNGS: clear. HEART: w/o murmur.
ABDOMEN: soft. Hip exam normal. GENITALIA normal although her mother says there was a diaper
rash earlier in the week.
ASSESSMENT: Four month old well check Cold, Mild thrush, Diaper rash
PLAN: Okay to advance to baby foods, Okay to supplement with Similac
Nystatin suspension for the thrush and creams for the diaper rash if it recurs
Mother will bring child back after the cold symptoms resolve for her DPT, HIB and polio
What E/M code(s) is/are reported?
a. 99212 c. 99391, 99212-25
b. 99391 d. 99213

65. 28-year-old female patient is returning to her physician’s office with complaints of RLQ pain and
heartburn with a temperature of 100.2. The physician performs a detailed history, detailed exam
and determines the patient has mild appendicitis. The physician prescribes antibiotics to treat the
appendicitis in hopes of avoiding an appendectomy. What are the correct CPT® and ICD-9-CM
codes for this encounter?
a. 99214, K37, R12 c. 99213, K37
b. 99202, K37 d. 99203, R50.9, R12, R10.31, K37

66. Dr. Inez discharges Mr. Blancos from the pulmonary service after a bout of pneumococcal
pneumonia. She spends 45 minutes at the bedside explaining to Mr. Blancos and his wife the
medications and IPPB therapy she ordered. Mr. Blancos is a resident of the Shady Valley Nursing
Home due to his advanced Alzheimer’s disease and will return to the nursing home after
discharge. On the same day Dr. Inez re- admits Mr. Blancos to the nursing facility. She obtains a
detailed interval history, does comprehensive examination and the medical decision making is
moderate complexity. What is/are the appropriate evaluation and management code(s) for this
visit?
a. 99238, 99305 c. 99239
b. 99238 d. 99239, 99304

67. 37-year-old female is seen in the clinic for follow-up of lower extremity swelling.
HPI: Patient is here today for follow-up of bilateral lower extremity swelling. The swelling
responded to hydrochlorothiazide.
DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have moderate
pulmonary hypertension.
Exam: Patient is in no acute distress.
 ASSESSMENT:
1. Bilateral lower extremity swelling. This has resolved with diuretics, it may be secondary to
problem
2. Pulmonary hypertension: Etiology is not clear at this time, will work up and possibly
refer to a pulmonologist.
PLAN: Will evaluate the pulmonary hypertension. Patient will be scheduled for a sleep study.
a. 99213 c. 99214
b. 99212 d. 99215

68. 45-year-old established, female patient is seen today at her doctor’s office. She is complaining of
severe dizziness and feels like the room is spinning. She has had palpitations on and off for the
past 12 months. For the ROS, she reports chest tightness and dyspnea but denies nausea, edema,
or arm pain. She drinks two cups of coffee per day. Her sister has WPW (Wolff-Parkinson-White)
syndrome. An extended exam of five organ systems are performed. This is a new problem. An
EKG is ordered and labs are drawn, and the physician documents a moderate complexity MDM.
What CPT® code should be reported for this visit?
a. 99214 c. 99203
b. 99215 d. 99204

69. 33 year-old male was admitted to the hospital on 12/17/XX from the ER, following a motor vehicle
accident. His spleen was severely damaged and a splenectomy was performed. The patient is
being discharged from the hospital on 12/20/XX. During his hospitalization the patient
experienced pain and shortness of breath, but with an antibiotic regimen of Levaquin, he
improved. The attending physician performed a final examination and reviewed the chest X-ray
revealing possible infiltrates and a CT of the abdomen ruled out any abscess. He was given a
prescription of Zosyn. The patient was told to follow up with his PCP or return to the ER for any
pain or bleeding. The physician spent 20 minutes on the date of discharge. What CPT® code is
reported for the 12/20 visit?
a. 99221 c. 99238
b. 99231 d. 99283

70. 60-year-old woman is seeking help to quit smoking. She makes an appointment to see Dr. Lung
for an initial visit. The patient has a constant cough due to smoking and some shortness of
breath. No night sweats, weight loss, night fever, CP, headache, or dizziness. She has tried
patches and nicotine gum, which has not helped. Patient has been smoking for 40 years and
smokes 2 packs per day. She has a family history of emphysema. A limited three system exam
was performed. Dr Lung discussed in detail the pros and cons of medications used to quit
smoking. Counseling and education was done for 20 minutes of the 30 minute visit. Prescriptions
for Chantrix and Tetracylcine were given. The patient to follow up in 1 month. A chest X-ray and
cardiac work up was ordered. Select the appropriate CPT code(s) for this visit.
a. 99202 c. 99203, 99354
b. 99203 d. 99214, 99354
 Anesthesia
71. A pre-anesthesia assessment was performed and signed at 10:21 a.m. Anesthesia start time is
reported as 12:26 pm, and the surgery began at 12:37 pm. The surgery finished at 15:12 pm and
the patient was turned over to PACU at 15:26 pm, which was reported as the ending anesthesia
time. What is the anesthesia time reported?
a. 10:21 am to 15:12 pm (291 minutes) c. 12:26 am to 15:12 pm (146 minutes)
b. 12:26 am to 15:26 pm (180 minutes) d. 12:37 am to 15:26 pm (169 minutes)

72. Code 00350 Anesthesia for procedures on the major vessels of the neck; not otherwise specified
has a base value of ten (10) units. The patient is a P3 status, which allows one (1) extra base unit.
Anesthesia start time is reported as 11:02 am, and the surgery began at 11:14 am. The surgery
finished at 12:34 am and the patient was turned over to PACU at 12:47 am, which was reported
as the ending anesthesia time. Using fifteen-minute time increments and a conversion factor of
$100, what is the correct anesthesia charge?
a. $1,500.00 c. $1,700.00
b. $1,600.00 d. $1,800.00
73. Code 00940, anesthesia for vaginal procedures, has a base value of three (3) units. The patient
was admitted under emergency circumstances, qualifying circumstance code 99140, which
allows two (2) extra base units. A pre-anesthesia assessment was performed and signed at 2:00
a.m. Anesthesia start time is reported as 2:21 am, and the surgery began at 2:28 am. The
surgery finished at 3:25 am and the patient was turned over to PACU at 3:36 am, which was
reported as the ending anesthesia time. Using fifteen-minute time increments and a conversion
factor of $100, what is the correct anesthesia charge?
a. $800.00 c. $1,000.00
b. $900.00 d. $1,200.00

74. 94-year-old patient is having surgery to remove his parotid gland, with dissection and
preservation of the facial nerve. The surgeon has requested the anesthesia department place an
arterial line. What CPT® code(s) is/are reported for anesthesia?
a. 00300, 36620 c. 00100, 99100
b. 00100, 36620, 99100 d. 00400

75. 5- year-old patient is experiencing atrial fibrillation with rapid ventricular rate. The anesthesia
department is called to insert a non-tunneled central venous (CV) catheter. What CPT® code is
reported?
a. 00400 c. 36556
b. 36555 d. 36557
76. 43-year-old patient with a severe systemic disease is having surgery to remove an
integumentary mass from his neck. What CPT® code and modifier are reported for the
anesthesia service?
a. 00300-P2 c. 00322-P3
b. 00300-P3 d. 00350-P3

77. An 11-month-old patient presented for emergency surgery to repair a severely broken arm
after falling from a third story window. What qualifying circumstance code(s) may be reported
in addition to the anesthesia code?
a. 99100 c. 99140
b. 99116 d. 99100, 99140

78. 59-year-old patient is having surgery on the pericardial sac, without use of a pump
oxygenator. The perfusionist placed an arterial line. What CPT® code(s) is/are reported for
anesthesia?
a. 00560 c. 00561
b. 00560, 36620 d. 00562

Radiology
79. 41-year-old male is in his doctor’s office for a follow up of an abnormality, which was noted, on
an abdominal CT scan. He is to have a chest X-ray due to chest tightness. He otherwise states he
feels well and is here to go over the results of his chest X-ray (PA and Lateral) performed in the
office and the CT scan performed at the diagnostic center. The results of the chest X-ray were
normal. CT scan was sent to the office and the physician interpreted and documented that the CT
scan of the abdomen showed a small mass in his right upper quadrant. What CPT® codes are
reported for the doctor’s office radiological services?
a. 71020-26, 74150-26 c. 71020-26, 74150
b. 71020, 74150 d. 71020, 74150-26

80. A patient has a history of chronic venous embolism in the superior vena cava (SVC) and is having
a radiographic study to visualize any abnormalities. In outpatient surgery the physician accesses
the subclavian vein and the catheter is advanced to the superior vena cava for injection and
imaging. The supervision and interpretation of the images is performed by the physician. What
codes are reported for this procedure?
a. 36010, 75827-26 c. 36000, 75827-26
b. 36000, 75820-26 d. 36010, 75820-26

81. 70-year-old female presents with a complaint of right knee pain with weight bearing activities. She
is also developing pain at rest. She denies any recent injury. There is pain with stair climbing and
start up pain. An AP, Lateral and Sunrise views of the right knee are ordered and interpreted. They
reveal calcification within the vascular structures. There is decreased joint space through the
medial compartment where she has near bone-on-bone contact, flattening of the femoral
 condyles, no fractures noted. The diagnosis is right knee pain secondary to underlying localized
degenerative arthritis. What CPT® and ICD-10-CM codes are reported?
a. 73560, M17.11 c. 73562, M17.9
b. 73562, M17.5 d. 73565, M17.5

82. Myocardial Perfusion Imaging—Office Based

Test Indications: Chest pain.
Procedure: Resting tomographic myocardial perfusion images were obtained following injection
of 10 mCi of intravenous cardiolite. At peak exercise, 30 mCi of intravenous cardiolite was
injected, and post-stress tomographic myocardial perfusion images were obtained. Post stress
gated images of the left ventricle were also acquired. Myocardial perfusion images were
compared in the standard fashion.
Findings: This is a technically fair study. There were no stress induced electrocardiographic changes
noted. There are no significant reversible or fixed perfusion defects noted. Gated images of the left
ventricle reveal normal left ventricular volumes, normal left ventricular wall motion, and an
estimated left ventricular ejection fraction of 50%.
Impression: No evidence of myocardial ischemia or infarction. Normal left ventricular ejection
fraction.
a. 78451 c. 78453
b. 78451, A9500 d. 78451, A9500 x 30

83. After intravenous administration of 5.1 millicuries Tc-99m DTPA, flow imaging of the kidneys
was performed for approximately 30 minutes. Flow imaging demonstrated markedly reduced
flow to both kidneys bilaterally. What CPT® code is reported?
a. 78710 c. 78708
b. 78701 d. 78725

84. An oncology patient is having weekly radiation treatments with a total of seven conventional
fractionated treatments. Two fractionated treatments daily for Monday, Tuesday and Wednesday
and one treatment on Thursday. What radiology code(s) is/are appropriate for the clinical
management of the radiation treatment?
a. 77427 c. 77427 x 2
b. 77427 x 7 d. 77427-22

85. Magnetic resonance imaging of the chest is first done without contrast medium enhancement and
then is performed with an injection of contrast. What CPT® code(s) is/are reported for the
radiological services?
a. 71550, 71551 c. 71555
b. 71552 d. 71275
86. A CT scan confirms improper ossification of cartilages in the upper jawbone and left side of the
face area for a patient with facial defects. The CT is performed with contrast material in the
hospital. What CPT® code is reported by an independent radiologist contracted by the hospital?
a. 70460-26 c. 70487-26
b. 70481-26 d. 70542-26

87. A patient is positioned on the scanning table headfirst with arms at the side for an MRI of the
thoracic spine and spinal canal. A contrast agent is used to improve the quality of the images.
The scan confirms the size and depth of a previously biopsied leiomyosarcoma metastasized to
the thoracic spinal cord. What CPT® and ICD-10-CM codes are reported?
a. 72255, D49.7 c. 72070, C49.9
b. 72157, C72.0 d. 72147, C72.0
88. A young child is taken to the OR to reduce a meconium plug bowel obstruction. A therapeutic
enema is performed with fluoroscopy. The patient is in position and barium is instilled into the
colon through the anus for the reduction. What CPT® code is reported by the independent
radiologist for the radiological service?
a. 74270-26 c. 74283-26
b. 74280-26 d. 74246-26

Laboratory and Pathology

89. What is/are the code(s) for thawing 4 units of fresh frozen plasma?
a. 86927 c. 86931
b. 86927 x 4 d. 86931 x 4

90. The code for sweat collection by iontophoresis can be found in what section of the Pathology
Chapter of CPT®?
a. Cytopathology c. Hematology
b. Chemistry d. Other Procedures

91. A patient will be undergoing a transplant and needs HLA tissue typing with DR/DQ multiple
antigen and lymphocyte mixed culture. How will these services be coded?
a. 86805-26, 86817
b. 86817, 86821
c. 86816-26, 86821
d. 86806-26, 86817

92. A physician orders a quantitative FDP. What CPT® code is reported?

a. 85362 c. 85370
b. 85366 d. 85378
93. A patient’s mother and sister have been treated for breast cancer. She has blood drawn for
cancer gene analysis with molecular pathology testing. She has previously received genetic
counseling. Blood will be tested for full sequence analysis and common duplication or deletion
variants (mutations) in BRCA1, BRCA2 (breast cancer 1 and 2). What CPT® code is reported for this
molecular pathology procedure?
a. 81200 c. 81211
b. 81206 d. 81213

94. A patient with AIDS presents for follow up care. An NK (natural killer cell) total count is ordered.
What CPT® code(s) is/are reported?
a. 86359 c. 86361, 86359
b. 86703 d. 86357

95. A patient has partial removal of his lung. The surgeon also biopsies several lymph nodes in the
patient’s chest which are examined intraoperatively by frozen section and sent with the lung
tissue for Pathologic examination. The pathologist also performs a trichrome stain. What CPT®
codes are reported for the lab tests performed?
a. 88309 x 2, 88313 c. 88307, 88305x2, 88332
b. 88309, 88305, 88313, 88331 d. 88309, 88307, 88313

96. A couple with inability to conceive has fertility testing. The semen specimen is tested for volume,
count, motility and a differential is calculated. The findings indicate infertility due to oligospermia.
What CPT® and ICD-10-CM codes are reported?
a. 89310, 89320, Z31.41 c. 89320, N46.11
b. 89257, N46.11, Z31.41 d. 89264, N46.11

97. In a legal hearing to determine child support there is a dispute about the child’s paternity.
The court orders a paternity test, and a nasal smear is taken from the plaintiff and the child.
The plaintiff is confirmed as the father of the child. Choose the CPT®, ICD-10-CM codes and
modifier for the paternity testing.
a. 89190-32, Z02.81 c.86900, Z02.81
b. 86910-32, Z31.448 d. 86910, Z31.448

98. A virus is identified by observing growth patterns on cultured media. What is this type of
identification is called?
a. Definitive c. Quantitative
b. Qualitative d. Presumptive
 Medicine
99. A female patient fell on the floor as she got out of bed. She has no known head trauma. She
noticed some slight stiffness in her joints and weakness in her lower extremity muscles, with
slight stiffness in her arm joints. The physician decided to test for possible multiple sclerosis (MS).
She was sent to a clinic providing somatosensory studies. The testing included upper and lower
limbs. What CPT® and ICD-10-CM code?
a. 95938, M62.81, M25.60 c. 95926, M62.81, M25.60
b. 95925, 95926, G35 d. 95926, G35

100. 64-year-old patient came to the emergency department complaining of chest pressure. The
physician evaluated the patient and ordered a 12 lead EKG. Findings included signs of acute
cardiac damage. Appropriate initial management was continued by the ED physician who
contacted the cardiologist on call in the hospital. Admission to the cardiac unit was ordered. No
beds were available in the cardiac unit and the patient was held in the ED. The cardiologist left the
ED after completing the evaluation of the patient. Several hours passed and the patient was still in
the ED. During an 80-minute period, the patient experienced acute breathing difficulty, increased
chest pain, arrhythmias, and cardiac arrest. The patient was managed by the ED physician during
this 80-minute period. Included in the physician management were a new 12 lead EKG,
endotracheal intubation and efforts to restore the patient’s breathing and circulation for 20
minutes. CPR was unsuccessful, the patient was pronounced dead after a total of 44 minutes
critical care time, exclusive of other separately billable services. What CPT® codes are reported by
the physician?
a. 99285-25, 93010 x 2, 31500, 92950
b. 99291-25, 31500, 93000, 92950
c. 99291-25, 99292-25, 93005-59 x 2, 31500
d. 99291-25, 31500, 92950

101. A patient with Sickle cell anemia with painful sickle crisis received normal saline IV, 100 cc per
hour to run over 5 hours for hydration in the physician’s office. She will be given Morphine &
Phenergan, prn (as needed). What codes are reported?
a. 96360, 96361 x 4, J7050 x 2, D57.00 c. 96360, 96361 x 3, J7030, D57.00
b. 96360 x 5, J7050, D57.00 d. 96360, J7030, D57.00

102. A patient with bilateral sensory hearing loss is fitted with a digital, binaural, behind the ear
hearing aid. What HCPCS Level II and ICD-10-CM codes should be reported?
a. V5140, H90.3, Z46.1 c. V5140, H90.6
b. V5261, Z46.1, H90.3 d. V5261, Z46.1, H90.6
103. 5-year-old is brought in to see an allergist for generalized urticaria. The family just recently visited
a family member that had a cat and dog. The mother wants to know if her son is allergic to cats
and dogs. The child’s skin was scratched with two different allergens. The physician waited 15
minutes to check the results. There was a flare up reaction to the cat allergen, but there was no
flare up to the dog allergen. The physician included the test interpretation and report in the
record.
a. 95024 x 2 c. 95004 x 2
b. 95027 x 2 d. 95018 x 2

104. 42-year-old patient presented to the urgent care center with complaints of slight dizziness. He
had received services at the clinic about 2 years ago. The patient related this episode happened
once previously and his 51-year-old brother has a pacemaker. A chest X-ray with 2 views and an
EKG with rhythm strip were ordered (equipment owned by the urgent care center). The
physician detected no obvious abnormalities, but the patient was advised to see a cardiologist
within the next 2 - 3 days. The physician interpreted and provided a report for the rhythm strip
and Chest X-ray. What CPT® and ICD- 10-CM codes are reported for the physician employed by
the urgent care center who performed a Level 3 office visit in addition to the ancillary services?
a. 99213-25, 71020, 93040, R42 c. 99283-25, 71010-26, 93010, R42
b. 99213-25, 71020-26, 93042, R42 d. 99203-25, 71010, 93000, R07.9

105. 55-year-old male has had several episodes of tightness in the chest. His physician ordered a
PTCA (percutaneous transluminal coronary angioplasty) of the left anterior descending
coronary artery. The procedure revealed atherosclerosis in the native vessel. It was
determined a stent would be required to keep the artery open. The stent was inserted during
the procedure.
a. 92928-LD, I25.10 c. 92920-LD, 92928, I25.10
b. 92920-LD, 92929-59, I25.811 d. 92920-LD, 92928-59, I25.811

106. A pregnant female is Rh negative and at 28 weeks gestation. The child’s father is Rh positive.
The mother is given an injection of a high-titer Rho (D) immune globulin, 300 mcg, IM. What
CPT® and ICD-10-CM codes are reported?
a. 90384, 96372, O36.0120 c. 90384, 90471, P55.0
b. 90386, 96372, O36.0120 d. 90386, 90471, P55.0

107. A patient with hypertensive end stage renal failure, stage V, and secondary
hyperparathyroidism is evaluated by the physician and receives peritoneal dialysis. The
physician evaluates the patient once before dialysis begins. What CPT® and ICD-10-CM codes
are reported?
a. 90945, I11.0, 18.6, N25.81 c. 90945, I12.0, N18.6, N25.81
b. 90947, I11.0, N25.81 d. 90947, I12.0, N25.81
108. A patient with congestive heart failure and chronic respiratory failure is placed on home
oxygen. Prescribed treatment is 2 L nasal cannula oxygen at all times. A home care nurse
visited the patient to assist with his oxygen management. What CPT® and ICD-10-CM codes
are reported?
a. 99503, I50.9, J96.10 c. 99504, I50.40, J96.10
b. 99503, I50.9, J80 d. 99503, I50.9, J96.10

Medical Terminology
109. The meaning of the root “blephar/o” is:
a. Choroid c. Eyelid
b. Sclera d. Uvea
110. The meaning of heteropsia (or anisometropia) is:
a. Blindness in half the visual field c. Unequal vision in the two eyes
b. Double vision d. Blindness in both eyes
11. The radiology term “fluoroscopy” is described as:
a. Technique using magnetism, radio waves and a computer to produce images
b. An X-ray procedure allowing the visualization of internal organs in motion
c. A scan using an X-ray beam rotating around the patient
d. Use of high-frequency sound waves to image anatomic structures

112. Sialography is an X-ray of :

a. Sinuses c. Salivary glands
b. Liver d. Ventricles of the brain
113. A projection is the path of the X-ray beam. If the projection is front to back it would be:
a. Lateral c. Decubitis
b. Recumbent d. Anteroposterior
114. Cytopathology is the study of:
a. Tissue c. Blood
b. Cells d. Organs
115. The process of preserving cells or whole tissues at extremely low temperatures is known as:
a. Cryotherapy c. Cryalgesia
b. Cryopexy d. Cryopreservation
116. A gonioscopy is an examination of what part of the eye:
a. Anterior chamber of the eye c. lacrimal duct
b. Interior surface of the eye d. Posterior segment

Anatomy
117. Which cells produce hormones to regulate blood sugar?
a. Eosinophils c. Hemoglobin
b. Pancreatic islets d. Target cells
118. Which part of the brain controls blood pressure, heart rate and respiration?
a. Cortex c. Cerebellum
b. Cerebrum d. Medulla
119. What are chemicals which relay amplify and modulate signals between a neuron and another cell?
a. Neurotransmitters c. Interneurons
b. Hormones d. Myelin
120. Which of the following conditions results from an injury to the head? The symptoms include
headache, dizziness and vomiting.
a. Meningitis c. Concussion
b. Parkinson’s disease d. Epilepsy
121. Lacrimal glands are responsible for which of the following?
a. Production of tears c. Production of vitreous
b. Production of zonules d. Production of mydriatic agents
122. Which of the following does NOT contribute to refraction in the eye?
a. Aqueous c. Cornea
b. Macula d. Lens
123. A patient diagnosed with glaucoma has:
a. A lens that is no longer clear c. abnormally high intraocular pressure
b. Bleeding vessels on the retina d. corneal neovascularization

124. Which of the following is true about the tympanic membrane?

a. It separates the middle ear from the inner ear
b. It separates the external ear from the middle ear
c. It sits within the middle ear
d. It sits within the inner ear

ICD-10-CM
125. Use both ____ and ____ when locating and assigning a diagnosis code.
a. Alphabetic Index and Appendix C c. ICD-10-CM code book and Dictionary
b. Alphabetic Index and Tabular List d. Tabular List and Index to Procedures

126. When a patient has a condition that is both acute and chronic and there are separate entries for
both, how is it reported?
a. Code only the acute code
b. Code both sequencing the chronic first
c. Code both sequencing the acute first
d. Code only the chronic code
 127. A patient with chronic back and neck pain developed a drug dependency on oxycodone (opoid).
After being taken off the drug, he was seen in the clinic for withdrawal symptoms. What ICD-10-
CM codes are reported?
a. F11.24, Z79.891 c. F11.23
b. F11.23, Z79.891 d. Z79.891

128. A patient with metastatic bone cancer (primary site unknown) presents to the oncologist’s office
for a chemotherapy treatment. On examination, the oncologist finds the patient to be severely
dehydrated and cancels the chemotherapy. The patient will receive intravenous hydration in the
office and reschedule the chemotherapy treatment. What ICD-10-CM codes are reported?
a. C79.51, E86.0, C80.1 c. C79.51, E86.0
b. E86.0, C79.51, C80.1 d. E86.0, C79.52, C80.1

129. 22-year-old developed sepsis and gas gangrene (gas bacillus infection) and went into septic
shock after a surgical procedure. What ICD-10-CM codes should be reported?
a. T81.12XA, A48.0, R65.21 c. R65.21, T81.12XA, T81.4XXA
b. R65.21, T81.4XXA, A48.0 d. T81.4XXA, T81.12XA, A48.0

130. A patient with hypertensive heart disease is now experiencing accelerated hypertension due to
papillary muscle dysfunction. What ICD-10-CM code(s) should be reported?
a. I11.9, I51.89 c. Z38.00, P07.02, P07.25
b. Z38.30, P07.26, P07.03 d. P07.02, P07.25

131. A three-year-old is brought to the burn unit after pulling a pot of hot soup off the stove spilling
onto to her body. She sustained 18% second degree burns on her legs and 20% third degree burns
on her chest and arms. Total body surface area burned is 38%. What ICD-10-CM codes should be
reported for the burns (do not include External codes for the accident)?
a. T21.31XA, T22.30XA, T24.209A, T31.32 c. T22.20XA, T21.01XA, T24.209A, T31.32
b. T21.31XA, T21.01XA, T24.209A, T31.32 d. T22.00XA, T21.00XA, T24.209A, T31.32

132. Newborn twin girls delivered at 27 weeks, weighing 850 grams for twin A and 900 grams for twin
B. Both were diagnosed with extreme immaturity. What ICD-10-CM codes should be reported for
both twins?
a. P07.03, P07.26, Z38.30 c. Z38.00, P07.30, P07.03
b. Z38.30, P07.03, P07.26 d. Z38.30, P07.03
133. Baby boy is born by cesarean section in the hospital. The mother has a history of diabetes
mellitus, which complicated the management of her pregnancy. In addition, the mother abused
cocaine throughout her pregnancy. The newborn was monitored for drug withdrawal, however
no symptoms were noted and the toxicology report came back negative. ABO incompatibility was
documented, but the Coomb's test was negative. What ICD-10-CM codes should be reported for
the newborn’s record?
a. O24.913, E11.9, O99.343, F14.10, Z38.01 c. Z38.01, P55.1, Z05.8
b. Z38.01, Z05.8 d. P96.1, P55.1, Z28.01

134. The diagnostic statement indicates respiratory failure due to administering incorrect medication.
Valium was administered instead of Xanax. What ICD-10-CM codes should be reported?
a. T42.4X2A, J96.90 c. T42.4X1A, J96.90
b. J96.00, T42.4X1A d. T42.4X2A, J96.00

HCPCS
135. How many days does it take for CMS to implement HCPCS Level II Temporary Codes that have
been reported as added, changed, or deleted?
a. 365 c. 30
b. 90 d. 60
136. What temporary HCPCS Level II codes are required for use by Outpatient Prospective Payment
System (OPPS) Hospitals?
a. C codes c. H codes
b. G codes d. Q codes

137. What agency maintains and distributes HCPCS Level II codes?

a. AMA c. HIPAA
b. CMS d. CPT® Assistant

138. HCPCS Level II includes code ranges which consist of what type of codes?
a. Category II codes, temporary national codes, and miscellaneous codes.
b. Dental codes, morphology codes, miscellaneous codes, and permanent national codes.
c. Permanent national codes, dental codes, category II codes.
d. Permanent national codes, miscellaneous codes, and temporary national codes.

139. How often is HCPCS Level II permanent national codes updated?

a. annually c. bi-annually
b. quarterly d. three times a year
 Coding Guidelines
140. What does “non-facility” describe when calculating Physician Fee Schedule payments?
a. hospitals
b. nursing homes
c. non-hospital owned physician practices
d. hospital owned physician practices

141. What three components are considered when Relative Value Units are established?
a. Physician work, Practice expense, Malpractice Insurance
b. Geographic region, Practice expense, Malpractice Insurance
c. Geographic region, Conversion factor, Physician fee schedule
d. Physician work, Physician fee schedule, Conversion factor

142. CPT® Category III codes are reimbursable at what level of reimbursement?
a. 10 percent
b. 100 percent
c. 85 percent
d. Reimbursement, if any, is determined by the payer

143. The Surgical Global Package applies to services performed in what setting?
a. Hospitals c. Physician’s offices
b. Ambulatory Surgical Centers d. All of the above

144. What surgical status indicator represents the Surgical Global Package for endoscopic procedures
(without an incision)?
a. XXX c. 000
b. 010 d. 090

145. Which statement is TRUE regarding the Instruction for use of the CPT® codebook?
a. Use an unlisted code when a procedure is modified.
b. Parenthetical instructions define each code listed in the codebook.
c. Select the name of the procedure or service that most closely approximates the
procedure or service performed.
d. Select the name of the procedure or service that accurately identifies
the service performed.

Practice Management
146. The Medicare program is made up of several parts. Which part is most significant to coders
working in physician offices and covers physician fees without the use of a private insurer?
a. Part A c. Part C
b. Part B d. Part D
147. If an NCD doesn’t exist for a particular service/procedure performed on a Medicare
patient, who determines coverage?
a. To determine new codes under Current Procedural Terminology (CPT)
b. Centers for Medicare & Medicaid Services (CMS)
c. Medicare Administrative Contractor (MAC)
d. The patient

148. Local Coverage Determinations are administered by ____?

a. Each regional MAC c. LMRP’s
b. NCD’s d. State Law

149. When are providers responsible for obtaining an ABN for a service not considered medically
necessary?
a. After providing a service or item to a beneficiary
b. Prior to providing a service or item to a beneficiary
c. During a procedure or service
d. After a denial has been received from Medicare

150. HIPAA was made into law in what year?

a. 1992 c. 1997
b. 1995 d. 1996