MOCK - 2

1.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
2. 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

3. 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

4. Operative Report
Diagnosis: Basal Cell Carcinoma
Procedure: Mohs 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 Mohs 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, followup 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
5. 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 reported?
a. 14020 c. 14040, 14060
b.14060 d. 11643
6.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
7. 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
8. 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. c. 20670-LT
b.20680-LT, 20680-59-LT d. 20680-LT, 20670-59-LT
9. 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
10. 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 palmarislongus 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*4. c.20526,J3301
b.20551,J3301*4. d 20550,J3301
11. 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-LT,28090-51-LT c. 28045-LT, 28090-51-LT
b. 28111-LT, 28092-51-LT d. 28100-LT, 28092-51-LT
12. 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

13. 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

14. 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
15. 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
16. 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
17. 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. 35870 c.35820-78
b.35870-78 d. 35241
18. 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
40000 Series
19. 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, 38115-5
b. 43622 , 38102 d. 43634, 38102-51

20. 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, I85.10 c.43400, K70.30, I85.10
 b.43244 , K74.60, I85.10 d.43235, K74.60, I85.10
21. 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
22. 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,l10
b. I10, K80.21, Z01.810 d. I10, K80.20, Z01.810
23. 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
24. 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

50000 Series
25. 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
26. 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
27.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
28 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-
9-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
29. 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

30. 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

31. 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
32. 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. 6 6983-58 d. 66985
33. 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
34. OPERATIVE REPORTPREOPERATIVE DIAGNOSIS: Fever. PROCEDURE
PERFORMED: Lumbar puncture. DESCRIPTION OF PROCEDURE: The patient was
placed in the lateral decubitus position with the left side up. The legs and hips were flexed into
the fetal position The lumbosacral area was sterilely prepped. It was then numbed with 1%
Xylocaine. I then placed a 22-gauge spinal needle on the first pass into the intrathecal space
between the L4 and L5 spinous processes. The fluid was minimal lyxanthochromic. I sent the
fluid for cell count for differential, protein, glucose, Gram stain, and culture. The patient
tolerated the procedure well without apparent complication. The needle was removed at the
end of the procedure. The area was cleansed, and a Band-Aid was placed.
1 point
a. 62272, R68.12 c.62272, R60.9, R50.9
b.62268, R50.9 d. 62270, R50.9
35. OPERATIVE REPORTDIAGNOSIS: Malignant tumor, thyroid
PROCEDURE: Thyroidectomy, total. The patient was prepped and draped. The neck area was
opened. With careful radical dissection of the neck completed, one could visualize the size of
the tumor. The decision was made to do a total thyroidectomy.
Note: The pathology report later indicated that the tumor was malignant.
1 point
a. 60254, C73
b. 60240, C73
c. 60271, C73
d. 60220, C37

36. Postoperative Diagnosis: Carpal tunnel syndrome right wrist. The patient was brought to
the operating room and sedated by anesthesia. After sterile prepping and draping of the right
hand, wrist and arm the patient's area of incision was infiltrated with Xylocaine/Marcaine
infiltration. After satisfactory anesthesia an Esmarch bandage was used to exsanguinate the
right hand and wrist and used about the distal forearm as a tourniquet. Acurvilinear incision
was made on the palmar aspect of the right wrist. Dissection was carried out through the skin
and subcutaneous tissue. Bleeding was controlled. The median nerve and it branches were
identified, retracted, and protected at all times. The ligament was incised from proximal to
distal. A thorough decompression was carried out. A neurolysis was carried out. The nerve was
found to be flattened and ischemic underneath the transverse carpal ligament. The fascia was
closed, the tourniquet was released. A dressing was applied and patient was transferred to
recovery room. Code this procedure.
1 point
a. 64721-RT c. 64642-RT
b. 64450-RT d.29848
Evaluation & Management
37. 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 45minutes 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
38. Patient comes in today at four months of age for a check-up. 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.
ASSESSMEN: 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
39.28-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-10-CM codes for this encounter?
a .99214,K37,R12. c.99213, K37
b. 99202, K37 d. 99203, R50.9, R12, R10.31, K37
40. 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
41. 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
42. 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. Counselling and education was done for 20 minutes of the 30 minute
visit. Prescription 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. 99204. d. 99214, 99354
Anaesthesia
43. A pre-anaesthesia assessment was performed and signed at 10:21 a.m. Anaesthesia 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
anaesthesia time. What is the anaesthesia time reported?
a.10:21 am to 15:12 pm (291 minutes) c. 12:26 pm to 15:12 pm (146 minutes)
b.12:26 pm to 15:26 pm (180 minutes) d. 12:37 pm to 15:26 pm (169 minutes)
44. 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
anaesthesia service?
a.00300-P2 c. 00322-P3
b. 00300-P3 d. 00350-P3
45. 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 anaesthesia code?
a. 99100 c. 99140
b. 99116 d. 99100,99140
46. 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
anaesthesia?
a.00560 c. 00561
b.00560, 36620 d. 00562

Radiology
47. 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

48. 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. 78709 c. 78708
b. 78701 d. 78725
49. 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
50. 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
51. 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
52. 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. 4270-26 c.74283-26
b.74280-26 d. 74246-26
Laboratory and Pathology
53. 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

54. 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
counselling. 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. 81162
 b.81206 d. 81213
55. 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
56. 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
57. 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
58. 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
59. 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. 9291-25,31500,92950

60. 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
61. 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. 95004x 4
b. 95027 x 2 d. 95018 x 2
62. 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
63. 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
64. 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
65. The meaning of the root “blephar/o” is:
a Choroid c. eyelid
b. Sclera d. Uvea

66.Sialography is an X-ray of :
a. Sinuses. c. Salivary glands
 b. Liver d. Ventricles of the brain

67. Cytopathology is the study of:

a. Tissue. c. Blood
b. cells d. Organs

68. The process of preserving cells or whole tissues at extremely low temperatures is known
as:
a Cryotherapy c. Cryalgesia
b. Cryopexy d. Cryopreservation
Anatomy
69. 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

70. 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
71. Which of the following does NOT contribute to refraction in the eye?
a. Aqueous c. Cornea
b Macula d. Lens
72. Which of the following is true about tympanic membrane?
a. It separates the middle ear from the inner ear
b. It separates the external ear from the inner ear
c. It sits within the middle ear
d. It sits within the inner ear

ICD-10-CM
73. 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.
74. 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 c. Code both sequencing the acute first.
b. Code both sequencing the chronic first d. Code only the chronic code
75. 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
76. 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. l11.9,I51.89 c. I11.0, I51.89
b.I10, I51.89 d.I10, I51.9, I51.89
77. 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
78. 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
79. 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

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

a. AMA c. HIPAA
b. CMS d. CPT® Assistant
Coding Guidelines
81. What does “non-facility” describe when calculating Physician Fee Schedule payments?
a. hospitals
b. nursing homes
c. non- hospital owned physician practise
d. hospital owned physician practices

82. 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

83. 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
84. What surgical status indicator represents the Surgical Global Package for endoscopic
procedures (without an incision)?
a. XXX c. 000
b. 010 d. 090
85. Which statement is TRUE regarding the Instruction for use of the CPT® codebook?
a. 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
86. 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
87. 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
88.Local Coverage Determinations are administered by _?
a. Each regional MAC c. LMRP’s
b. NCD’s d. State Law
89. 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

90. HIPAA was made into law in what year?

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

Case 1
91. OPERATIVE REPORTDIAGNOSIS: Large bladder neck obstruction PROCEDURE
PERFORMED: Cystoscopy and trans urethral resection of the prostate.The patient is a 76-
year-old male with obstructive symptoms and subsequent urinary retention. The patient
underwent the usual spinal anesthetic, was put in the dorso lithotomy position, prepped, and
draped in the usual fashion. Cystoscopic visualization showed a marked high-riding bladder.
Median lobe enlargement was such that it was difficult even to get the cystoscope over. Inside
the bladder, marked trabeculation was noted. No stones were present. The urethra was well
lubricated and dilated. The resectoscopic sheath was passed with the aid of an obturator with
some difficulty because of the median lobe. TURP of the median lobe was performed, getting
several big loops of tissue, which helped to improve visualization. Anterior resection of the
roof was carried out from the bladder neck. Bladder-wall resection was taken from the 10 to 8
o'clock position. This eliminated the rest of the median lobe tissue as well. The patient tolerated
the procedure well. Code the procedure(s) performed and the diagnosis.
1 point

a. 52450, 52001-51, N32.0

b. 52450, 52000, Q64.31
c. 52450, 52001, Q64.31
d. 52450, 52000-59, N32.0

Case 2
92.OPERATIVE REPORT DIAGNOSIS: Malignant tumor, thyroid
PROCEDURE: Thyroidectomy, total. The patient was prepped and draped. The neck area was
opened. With careful radical dissection of the neck completed, one could visualize the size of
the tumor. The decision was made to do a total thyroidectomy. Note: The pathology report later
indicated that the tumor was malignant.
1 point
a. 60254, C73
b. 60240, C73
c. 60271, C73
d. 60220, C37

Case 3
93. PRE OP DIAGNOSIS: Left Breast Abnormal MMX or Palpable Mass; Other Disorders Of
Breast PROCEDURE: Automated Stereotactic Biopsy Left Breast FINDINGS: Lesion is
located in the lateral region, just at or below the level of the nipple on the 90 degree lateral
view. There is a sub glandular implant in place. I discussed the procedure with the patient today
including risks, benefits and alternatives. Specifically discussed was the fact that the implant
would be displaced out of the way during this biopsy procedure. Possibility of injury to the
implant was discussed The patient was placed prone on the stereotactic table; the left breast
was then imaged from the inferior approach. The lesion of interest is in the anterior portion of
the breast away from the implant which was displaced back toward the chest wall. After
imaging was obtained and stereotactic guidance used to target coordinates for the biopsy, the
left breast was prepped with Betadine. 1% lidocaine was injected subcutaneously for local
anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling
needle. The SenoRx needle was then placed into the area of interest. Under stereotactic
guidance we obtained 9 core biopsy samples using vacuum and cutting technique. The
specimen radiograph confirmed representative sample of calcification was removed. The
tissue marking clip was deployed into the biopsy cavity successfully. This was confirmed by
final stereotactic digital image and confirmed by post core biopsy mammogram left breast. The
clip is visualized projecting over the lateral anterior left breast in satisfactory position. No
obvious calcium is visible on the final post core biopsy image in the area of interest. The patient
tolerated the procedure well. There were no apparent complications. The biopsy site was
dressed with Steri-Strips, bandage and ice pack in the usual manner. The patient did receive
written and verbal post-biopsy instructions. The patient left our department in good condition.

IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OFLEFT BREAST

CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP
INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD
CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT
IS PENDING;
ANAD DENDUM WILL BE ISSUED AFTER WE RECEIVE THE PATHOLOGY REPORT.
What are the codes for the procedures? 1 point
A. 19081
B. 19101
C. 19083, 76942-26
D. 19081, 77012-26

Case 4

94. PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open

reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, anesthesia having been administered. The right
upper extremity was prepped and draped in a sterile manner. The limb was elevated,
exsanguinated, and apneumatic arm tourniquet was elevated. An incision was made over the
dorsal radial aspect oft he right wrist. Skin flaps were elevated. Cutaneous nerve branches were
identified and very gently retracted. The interval between the second and third dorsal
compartment tendons was identified and entered. The respective tendons were retracted. A
dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear
to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used
as a guidewire, extending from the proximal pole of the scaphoid distal ward. The guidewire
was positioned appropriately and then measured. A 25-mm Acutrak drill bit was drilled to 25
mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished
in this fashion. This was visualized under the OEC imaging device in multiple projections. The
wound was irrigated and closed inlayers. Sterile dressings were then applied. The patient
tolerated the procedure well and left the operating room in stable condition. What code should
be used for this procedure?
1 point
A. 25628-RT
B. 25624-RT
C. 25645-RT
D. 25651-RT

Case 5
95. PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and
ulna.POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius
and ulna.
OPERATIVE PROCEDURE:
Reduction with application external fixator, left wrist fracture
FINDINGS: The patient is a 46-year-old right-hand-dominant female who fell off stairs 4 to 5
days ago sustaining an impacted distal radius fracture with possible intraarticular component
and an associated ulnar styloid fracture. Today in surgery, fracture was reduced anatomically
and an external fixator was applied. PROCEDURE: Under satisfactory general anesthesia, the
fracture was manipulated and C-arm images were checked. The left upper extremity was
prepped and draped in the usual sterile orthopedic fashion. Two small incisions were made
over the second metacarpal and after removing soft tissues including tendinous structures out
of the way, drawing was carried out and blunt-tipped pins were placed for the EBI external
fixator. The frame was next placed and the site for the proximal pins was chosen. Small incision
was made. Subcutaneous tissues were carried out of the way. The pin guide was placed and 2
holes were drilled and blunt-tipped pins placed. Fixator was assembled. C-arm images were
checked.Fracture reduction appeared to be anatomic. Suturing was carried out where needed
with 4-0 Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings
were applied. Vascular supply was noted to be satisfactory. Final frame tightening was carried
out.What CPT and ICD-10-CM codes should be reported?
1 point
A. 25600-LT, 20692-51
B. 25605- LT, 20690-51
C. 25606-LT
D. 25607-LT

Case 6
96. PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE
DIAGNOSIS Medial meniscus tear, extensive synovitis with an impingement medial synovial
plica, right knee. TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial
meniscectomy and synovectomy, right knee The patent was brought to the operating room,
placed in the supine position after which he underwent general anesthesia. The right knee was
then prepped and draped in the usual sterile fashion. The arthroscope was introduced through
an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was
inspected. The findings on the patella and the femoral groove were as noted above. An intra-
articular shaver was introduced to debride the loose fibrillated articular cartilage from the
medial patellar facet.The hypertrophic synovial scarring between the patella and the femoral
groove was debrided. The hypertrophic impinging medial synovial plica was resected. The
hypertrophic synovials carring overlying the inter condylar notch and lateral compartment was
debrided. The medial compartment was inspected. An up biting basket was introduced to
transect the base of the degenerative posterior horn flap tear. This was removed with a grasper.
The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed
and found to be stable.The cruciate ligaments were probed, palpated and found to be intact.
The lateral compartment was then inspected. The lateral meniscus was probed and found to be
intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with
the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope.
The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile
dressing was applied.The patient was then awakened and sent to the recovery room in stable
condition. What CPT and ICD-10-CM codes should be reported?
1 point
A. 29880-RT, M23.205, M65.9, M94.20, M22.40
B. 29881-RT, M23.321, M65.80, M94.20, M22.40
C. 29881-RT, 29822-59-RT, M23.311, M65.80, M94.20, M22.40
D. 29880-RT, 29822-59-RT, M23.329, M65.80, M94.20, M22.40

Case 7
97.PREOPERATIVE DIAGNOSIS: Left breast carcinoma.
POSTOPERATIVE DIAGNOSIS: Left breast carcinoma. NAME OF PROCEDURE: Left
lumpectomy and sentinel node biopsy. DESCRIPTION OF PROCEDURE: The patient is a 65-
year female admitted with a diagnosis of left breast carcinoma. Risks and benefits of the
procedure had been discussed preoperatively including risks of bleeding, infection, deformity
in the breast, chronic pain, numbness, chronic lymph edema associated with the lymph node
biopsy as well as other possible complications. The patient agreed to proceed. Because the wire
was located in the upper outer quadrant of the breast over the lesion and the length of the wire
was 10 cm, it was felt that it would be best to approach the node biopsy as well as the
lumpectomy through the same incision in the upper outer quadrant of the left breast. Incision
was made with a 15-blade through skin and subcutaneous.Homeostasis achieved with Bovie
electrocautery. Flaps were formed in the usual manner. A wire was brought out through the
incision. We then circumferentially removed all the tissue around the wire down to the tip. We
marked the specimen with a long lateral stitch, short superior stitch, 2 lateral clips, and 1
superior clip. We were able to identify a hot node in the axilla and at least 2 lymph nodes that
were blue-dyed within the sentinel nodes. We did perform lymphoscintigraphy and injected 2
cc of methylene blue dye in the periareolar area preoperatively and massaged the breast for 5
minutes. The lymph nodes were excised and a biopsy was performed on the axillary node. At
this point, we copiously irrigated the area to assure good homeostasis. We placed clips
throughout the entire cavity. We then closed the deep dermal tissue with interrupted 3-0 Vicryl
sutures and then closed the skin with a fine 5-0nylon. The patient tolerated the procedure well.
Sponge count was correct. Blood loss was minimal. The patient was sent to the recovery room
in stable condition. What are the codes for these procedures?
1 point

A. 19120, 38530-51-LT
B. 19301, 38525-52-51-LT, 38792-51-LT
C. 19302, 38520-51-LT
D. 19120, 38510-51-LT, 38792-51-LT

Case 8
98. DIAGNOSIS: Diverticulitis, perforated diverticula
POST OPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula PROCEDURE:
Hartman procedure, which is a sigmoid resection with Hartman pouch and colostomy.
DESCRIPTION OF THE PROCEDURE: Patient was prepped and draped in the supine
position under general anesthesia. Prior to surgery patient was given 4.5 grams of Zosyn and
Rocephin IV piggyback. A lower midline incision was made, abdomen was entered. Upon
entry into the abdomen, there was an inflammatory mass in the pelvis and there was a large
abscessed cavity, but no feces. The abscess cavity was drained and irrigated out. The left colon
was immobilized, taken down the lateral perineal attachments. The sigmoid colon was
mobilized. There was an inflammatory mass right at the area of the sigmoid colon consistent
with a divertiliculitis or perforation with infection. Proximal to this in the distal left colon, the
colon was divided using a GIA stapler with 3.5 mm staples. The sigmoid colon was then
mobilized using blunt dissection. The proximal rectum just distal to the inflammatory mass
was divided using a GIA stapler with 3.5 mm staples. The mesentary of the sigmoid colon was
then taken down and tied using two 0 Vicryl ties. Irrigation was again performed and the
sigmoid colon was removed with inflammatory mass. The wall of the abscessed cavity that
was next to the sigmoid colon where the inflammatory mass was, showed no leakage of stool,
no gross perforation, most likely there is a small perforation in one of the diverticula in this
region.Irrigation was again performed throughout the abdomen until totally clear. All excess
fluid was removed. The distal descending colon was then brought out through a separate
incision in the lower left quadrant area and a large 10 mm 10 French JP drain was placed into
the abscessed cavity. The sigmoid colon or the colostomy site was sutured on the inside using
interrupted 3-0Vicryl to the peritoneum and then two sheets of film were placed into the intra-
abdominal cavity. The fascia was closed using a running #1 double loop PDS suture and
intermittently a #2nylon retention suture was placed. The colostomy was matured using
interrupted 3-0 chromic sutures. I palpated the colostomy; it was completely patent with no
obstructions. Dressings were applied. Colostomy bag was applied. Which CPT code should be
used?
1 point
A. 44140
B. 44143
C. 44160
D. 44208

Case 9
99. PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE
DIAGNOSIS: Multivessel coronary artery disease.
NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to
the LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal.
The patient is placed on heart and lung bypass during the procedure. Anesthesia time: 6:00 PM
to 12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and
anesthesia time?
1 point
A. 00567, 6 hours
B. 00566, 6 hours
C. 00567, 5 hours and 30 minutes
D. 00566, 5 hours and 30 minutes Case 10

100. OPERATIVE REPORT OPERATIVE PROCEDURE: Excision of back lesion.

INDICATIONS FOR SURGERY: The patient has an enlarging lesion on the upper midback.
FINDINGS AT SURGERY: There was a 5-cm, upper midback lesion.
OPERATIVE PROCEDURE: With the patient prone, the back was prepped and draped in the
usual sterile fashion. The skin and underlying tissues were anesthetized with 30 mL of 1%
lidocaine with epinephrine. Through a 5-cmtransverse skin incision, the lesion was excised.
Hemostasis was ensured. The incision was closed using 3-0 Vicryl for the deep layers and
running 3-0Prolene subcuticular stitch with Steri-Strips for the skin. The patient was returned
to the same-day surgery center in stable postoperative condition. All sponge, needle, and
instrument counts were correct. Estimated blood loss is 0 mL. PATHOLOGY REPORT
LATER INDICATED: Follicular cyst, infundibular type, skin of back.
1 point
A. 11406, 12002
B. 11424
C. 11406, 12032
D. 11606