MOCK 2

10,000 SERIES – INTEGUMENTARY SYSTEM(6 Questions)

1.A splinter is removed from the subcutaneous tissue of a patient’s index

finger through an incision made by the physician. The medical record
states that this was a complicated procedure. How should the physician
code this procedure?

a.10121 b.10120 c.11010 d.11011

2.A patient has a pressure ulcer requiring the surgeon to debride all the
necrotic muscle, subcutaneous tissue, and skin. The size of the ulcer
before the debridement was 3 cm x 5 cm. When the debridement was
complete, the size of the ulcer was 4 cm x 6 cm. Which is the
propercoding?

a.11043,11046 b. 11043 c.11046 d. 11042,11043

3.Multiple wound debridements by different depth with different sites are

done on same day, useModifier?

a.Modifier58 b.Modifier59 c.Modifier78 d. Modifier XE

4.On January 31st, Barbara had a two cm malignant lesion excised from
her left foot. During a postoperative check-up on February 2nd, a residual
tumor was noted at the margin of the original excision and the margins
were re-excised. The re-excision included a three cm excised diameter.
How would the same physician code there-excision?

a.11622,11623-59 b. 11626 c.11623-59 d.11623-58

5.A 42-year old male present with Keloid Scar with more than 8 rubbery
lesions and can vary from pink to the color of the person's skin. Provider
administered the IntralesionalKenalog 10mg injections to the patient. What
is correct CPTService?
a. 96406, J3301,L91.0
b. 11900, J3301,L90.5
c. 11901, J3301,L91.0
d. J3301, L90.5

6.Dr. Shars took skin biopsies of three lesions from Laura’s back. How
would you report Dr. Shars’ services?

a. 11100, 11101-51
b. 11056, 11100, 11101-51
c. 11100, 11101 x 2
d. Biopsy codes are not reported unless the lesions are removed

20,000 SERIES - MUSCULOSKELETAL SYSTEM(6 Questions)

7.A 25 year old male with right side thoracic pain and has metastatic lung
cancer. Physician performed Trigger point injection into the right-sided
thoracic spine musculature, into the rhomboid major, rhomboid minor, and
levator scapular muscles. Five spots were marked into the right-sided
thoracic paraspinal musculature. I then cleaned off his back with
chlorhexidine x2. Then a 25 gauge 1.5 inch needle on a 10 cc controlled
syringe with Depo- Medrol, 40 mg/mL was used. After negative aspiration,
1 cc was injected into each point. A total of four points were injected. A total
of 4 cc (160 mg) was used. The patient tolerated the procedure well. Band-
Aids were not placed. The patient was notbleeding.

a.20552,J1030 b. 20553, J1030x4

c. 20610,J1030x4 d. 20553, 76942, J1030x4

8.How would you code for the provider done two injections on the right
shoulder and one injection on the rightknee?

a. 20610-RT,20610-RT-59x2 b. 20610 x2 c.20610-RTx3 d. 20610x3

9.A 45-year old male patient is with Rheumatoid arthritis in both shoulders.
Providers performed an injection of 40 mg of Depo-Medrol to eachshoulder.
a. 20610-RT, 20610-LT-59, J1030 x2, M05.711, M05.712
b. 20610-50, J1030 x2, M06.811,M06.812
c. 20610-50, J1030 x2, M06.011,M06.012
d. 20610-50, J1030 x2, M05.711,M05.712

10.A 45-year-old male patient is with Osteoarthritis in right knee and left
shoulder. Providers performed an injection of 40 mg of Depo-Medrol to
right knee and leftshoulder.

a. 20610-RT, 20610-LT-59, J1030 x2, M17.11, M19.012

b. 20610-50, J1030 x2, M17.11,M19.012
c. 20611-50, J1030 x2, M17.11,M19.012
d. 20610-RT, 20610-LT-51, J1030 x2, M17.10, M19.019

11.A 48-year-old male has right ankle joint effusion with pain. The cause of
an effusion is unclear hence physician done arthrocentesis with
fluoroscopic guidance allows synovial fluid analysis which can assist in
confirming or ruling out a pathologic diagnosis. Physician also inject the
corticosteroid drug for relieve pain on the same joint.

a.20605-RT,77002 b. 20605-RT x2,77002

c.20605-50 d. 20606-RT,77002

12.An established patient is seen for periodic follow-up for hypertension

and diabetes. During the visit, the patient asked the physician to address
right knee pain which developed after recent yard work. The physician
performed a problem-focused history and exam of the patient’s
hypertension and diabetes, and adjusted medications.Then the physician
evaluated the knee and performed arthrocentesis.

a.99212-25 b.20610 c.99212-25,20610 d. 99212-25,20611

30000 SERIES – RESPIRATORY, HEMIC, LYMPHATIC, MEDIASTINUM,

DIAPHRAGM &CARDIOVASCULAR SYSTEMS(6 Questions)

13.Assign the cpt code for endovascular repair of aneurysm of the visceral
and infra renal aorta using fenestrated visceral endograft , an infra renal
aortic endograft with the placement of endoprosthesis into four
visceralarteries

a. 34844 b. 34848 c. 34845, 34848 d. 34800

14.A patient’s nose was hit with a baseball during high school baseball
game. At that time reconstruction was performed with local grafts. Patient
returns now as an adult , discontent with the bony prominence along the
bony pyramid and flat look of the tip of the nose. He underwent major repair
with osteotomies and nasal tip work. What cpt code isreported

a.30410 b. 30435 c. 30450 d. 30462

15.Beverly had been hoarse for two weeks. Her surgeon scheduled a direct
laryngoscopy with injection of her vocal cords. During the surgery it
became necessary for the surgeon to use an operating microscope. How
should the physician’s services bereported?

a. 31571
b. 31570, 69990
c. 31513-50
d.31541-50

16.This 52-year-old male has undergone several attempts at extubation, all

of which failed. He also has morbid obesity and significant subcutaneous
fat in his neck. The patient is now in for a flap tracheostomy and cervical
lipectomy. The cervical lipectomy is necessary for adequate exposure and
access to the trachea and also to secure tracheotomy tubeplacement.

a. 31610 b. 31610, 15839 c. 31603, 15839-51 d. 31610,15839-51

17.A 20 year old patient is seen for 5 transbronchial lung biopsy is taken in
one lobe and 4 biopsies in another lobe. What cpt code isreported?

a.31628 b.31628, 31632 c.31629,31632 d. 31628,31632x2

18.Which of the following is NOT bundled into 37217 and37218?

a.Imaging performed of the head/neck vessels on the contralateral side
where a stent is not placed

b.Ipsilateral cervical and cerebral diagnosticimaging

c.Closure ofvessel

d.Open vessel exposure

40,000 Series – Digestive System(6 Questions)

19.The patient has a unilateral incomplete cleft lip. Repair was

accomplished of the alveolar ridge, which included a bone graft to the
alveolar ridge. Which is the proper CPT®code?

a. 42205 b. 42220 c. 42210 d. 42200

20.A patient has a secondary cleft deformity of hard and soft palate
repaired by elevating the adjacent mucosa for coverage and suturing in
layers. Which is the proper CPT®code?

a.42235 b. 42215 c. 42225 d. 42227

21.A patient is admitted with acute gastric ulcer with hemorrhage. An

esophagogastroduodenoscopy EGD is performed for control of the
hemorrhage with band ligation.

a.43244,K25.3 b. 43243,K25.0
c.43255,K25.0 d. 43255, 43244-59,K25.0

22.Preoperative diagnosis: History of Rectal carcinoma Postoperative

diagnosis: History of Rectal Carcinoma Procedure performed: Closure of
loop ileostomy with small bowel resection and
enteroenterostomy with intraoperative flexible sigmoidoscopy.Description of
procedure: After induction of adequate general endotracheal anesthesia,
the patient was carefully positioned in the supine modified lithotomy
position in Allen stirrups. Great care was taken to carefully pad and protect
all areas of potential bodily injury. Digital rectal examination revealed a
widely patent circumferentially intact pouch anal anastomosis within 1 cm
of the dentate line. Flexible sigmoidoscopy was performed revealing
healthy pink mucosa. The abdomen was prepped and draped in the usual
sterile manner and a parastomal incision was made and carried down
sharply into the peritoneal cavity. Meticulous hemostasis was obtained with
electrocautery. A 360 degree subfascial mobilization was undertaken until
approximately 40 cm of each the afferent and efferent limb reached above
the skin in a tension-free manner. Betadine was insufflated down each limb
to verify that no enterotomies or seromyotomies were made. The
mesentery was scored and vessels divided with a 10 mm LigaSure Impact.
The bowel was circumferentially cleared of fat proximally and distally and
each end divided with a GIA 100 mm stapling device with blue cartridge.
The field was protected with blue towels and the antimesenteric border of
each staple line was excised. A side-to-side functional end- to-end
anastomosis was fashioned with a GIA 100 mm stapling device. The staple
line was reinforced for hemostasis with 3-0 PDS 2 suture where necessary
and the afferent limb was secured to the efferent limb with 3-0 PDS 2
seromuscularLembert type sutures. After verification of the meticulous
hemostasis, the apical enterotomy was secured with a GIA 100 mm
stapling device. The anastomosis was healthy pink and widely patent and
circumferentially intact and easily returned into the peritoneal cavity. After
copious irrigation and verification of meticulous hemostasis. What are the
CPT® and ICD-10-CM codesreported?

a. 44625, Z43.2, Z85.048

b. 44620, Z43.1, Z85.048
c. 44626,Z43.2,C20
d. 44227,Z43.2

23.A 56-year-old patient complains of occasional rectal bleeding. His

physician decides to perform a rigid proctosigmoidoscopy. During the
procedure, one polyp and single tumor are found in the rectum. The polyp
is removed by a snare, tumor removed by hot biopsy forceps and bleeding
occurs as a result of an endoscopic procedure, physician performed control
of bleeding by unipolar cauterizationtechnique.

a.45317,45315 b. 45308,45315
c.45308,45309 d. 45308, 45309,45317
24.The surgeon is removing the gallbladder, and happens to notice the
appendix looks abnormal; therefore the surgeon decides to go ahead and
removed the appendix during that surgery.

a.44955 b. 47600, 44950 c.47600,44955 d. 47600,44970

50,000 Series - Genito-Urinary System(6 Questions)

25.A Percutaneous needle biopsy for preoperative diagnosis is complex

cystic renal mass. The patient was prepped and draped in a sterile manner.
Sonographic examination of the right flank demonstrated a large cyst in the
lower pole of the rightkidney.

a.50390,76942 b. 10022,76942
c.50200,76942 d. 50200, 10022,76942

26.Radiologist did a CT-guided drainage of a renal cyst with contrast

injection via an existing drainagecatheter.

a. 50200, 77012 b. 50390, 77012 c.50542,77012 d. 10022,77012

27.Preoperative diagnosis: Gross Hematuria Postoperative diagnosis:

Bladder/prostatetumor

Operation: Transurethral resection bladder tumor (TURBT) large (5.3 cm)

Anesthesia: GeneralFindings: The patient had extensive involvement of the
bladder with solid and edematous- appearing hemorrhagic tumor
completely replacing the trigone and extending into the bladder neck and
prostatic tissue. The ureteral orifices were not identifiable. Digital rectal
examination revealed nodular, firm mass per rectum.Procedure description:
The patient was placed on the operating room table in the supine position,
and general anesthesia was induced. He was then placed in the lithotomy
position and prepped and draped appropriately. Cystoscopy was done
which showed evidence of the urethral trauma due to the traumatic removal
of the Foley catheter (patient stepped on the tubing and the catheter was
pulled out). The bladder itself showed extensive clot retention. Papillary
and necrotic-appearing nodular tissue mass extensively involving the
trigone and the bladder neck and the prostate area. The ureteral orifices
were not identified. After consulting with the patient’s wife and obtaining an
adjustment to the surgical consent,the tumor was resected from the trigone,
bladder neck and prostate. Obvious edematous and hemorrhagic tissue
was removed. Extensive electrocauterization was done of bleeding vessels.
Several areas of necrotic-appearing tissue were evacuated. Care was
taken to avoid extending resection into the area of the external sphincter.
Digital rectal examination revealed the firm, nodular mass in the anterior
rectum. No impacted stool was identified. At the end of the procedure
hemostasis appeared good. Tissue chips were evacuated from the bladder.
Foley catheter was inserted. Patient was taken to the recovery room in
satisfactory condition.Addendum: The patient has had a previous partial
prostatectomy and had been found to have T2b N0 MX prostate cancer. On
the physical examination today and on the endoscopic exam it was unclear
as to whether the tumor mass was related to the bladder or recurrent
prostate cancer. Pathology revealed bladder carcinoma in the trigone and
bladder neck and recurrent prostate cancer.
a.52235 b.52224 c.52240 d.52214

28.What is the correct coding for 52630 as per the CPTguidelines?

a.Forresectionofresidualprostatetissueperformedwithinthepostoperativeperi
odof a related procedure performed by the same physician, append
modifier78

b.For transurethral waterjet ablation of prostate, use 0421T instead of

52630

c.Both a &b

d.None of the above

29.Which circumstance use 54150 with append modifier-52?

a.Circumcision using dorsal penile or ringblock

b.Circumcision performed without dorsal penile or ringblock

c.Circumcision using dorsalslit

d.Repair incomplete circumcision

30.When will you report 38770 conjunctions with55840?

a.If 55845 carried out on separate days; use 38770-50 and55840

b.If 55842 carried out on separate days, use 38770-50 and55840

c.If 55845 carried out on separate days; use 38770 and55840

d.If 55845 carried out on same days; use 38770-50 and55840

60,000 SERIES – NERVOUS SYSTEM(6 Questions)

31.What is the correct CPT code for Right-sided hemicraniectomy with

duraplasty?

a.61320 b.61314 c.61322 d.61323

32.Preoperative diagnosis: Spinal stenosis at L3–L5 Postoperative

diagnosis: Spinal stenosis atL3–L5

Operation performed: Right L3–L5 laminotomy, foraminotomy,

decompression, bilateral decompression of the lateral recess
a.63030-50
b.63030-RT,63035-RT
c.63030-RT
d.0275T

33.Select the appropriate codes to report a supratentorial craniotomy for

excision of a meningioma and implantation of brain intracavitary
chemotherapy agent.

a.61510,61517 b.61512, 61517 c.61512,77770 d. 61510,77770

34.Using an intradural approach, a physician excised an intradural lesion at
the base of the anterior cranial fossa. How should the physician’s services
be reported?

a.61583,61601 b. 61583, 61601-51 c. 61581, 61608-51 d. 61583,61601-

59

35.Preoperative diagnoses: 1. Low Back Pain. 2. Degenerative lumbar disc.

Postoperative diagnosis: 1. Low back pain.2. Degenerative lumbar
disc.Procedure performed: Bilateral facet joint injection of steroid at the L4–
L5 and L5–S1 with fluoroscopic guidance.

a.64493,64494
b. 0216T,0217T
c.64493-50,64494-50
d. 0216T-50,0217T-50

36.Which is the proper modifier to report a return to the operating room

during the postoperative period to treat a complication of the prior
procedure?

a.Modifier 24 b.Modifier 59 c.Modifier 78 d. Modifier79

99,000 SERIES EVALUATION AND MANAGEMENT(6 Questions)

37.When reporting an approved telehealth service, you must append

modifier:

a.GA b.PT c.33 d.GT

38.In an inpatient setting, the physician provides a consultative service for

a Medicare patient; the service meets all requirements of a consultation as
defined by CPT®. The documentation supports a comprehensive history,
comprehensive exam, and MDM of moderate complexity. Which is the
correct code to report thisservice?

a. 99222 b. 99223 c. 99244 d. 99254

39.Which procedure code may be billed in addition to critical care codes
99291 and 99292?

a. 94002 b. 43752 c. 36000 d. 92950

40.When reporting an E/M service using time as the key component, what
percentage of the visit must be spent on counseling and/or coordination
ofcare?

a. 25 percent
b. 50 percent
c. 100 percent
d. CPT® does not specify a requirement.

41.The provider spends 45 minutes of a 60-minute visit with an established

patient in the office, counseling and coordinating care for a new diagnosis
of diabetes. If reporting this visit based on time, what is the appropriate E/M
servicecode?

a. 99204 b. 99213 c. 99214 d. 99215

42.True or False: When calculating time for outpatient and office E/M
services, the time must be face to face.

a.True b.False

00,100 SERIES ANESTHESIA(4 Questions)

43.A Medicare patient undergoes general anesthesia for knee replacement

surgery, with a total anesthesia time of 224 minutes. Which is the correct
way to report the anesthesia service, excluding the physical status
modifiers, performed by both the CRNA and the anesthesiologist?

a.01402-QX x 15 units and 01402-QK x 15units

b.01402-AA x 224minutes

c.01402-QX x 224 minutes and 01402-QK x 224minutes

d.01402-QX x 14.9 units and 01402-QK x 14.9units

44.Which service is not included with anesthesia services?

a.Swan-Ganz Monitoring b. Administration of blood

c.Blood Pressure d. Mass Spectrometry

45.A patient undergoes an amputation of his left foot due to gangrene.

Which anesthesia code best fits thisprocedure

a.01462 b.01520 c 01480 d.01482

46.A patient with an enlarged prostate undergoes a transurethral resection

procedure.

Choose the anesthesia code

a.00920 b.00908 c.00914 d.00902

70,000 SERIES RADIOLOGY(6 Questions)

47.A primary care physician took a two view chest x-ray (frontal and lateral
views) in his office. The films were sent to a radiologist (who was not
affiliated with the primary care physician) to be interpreted. The radiologist
billed separately for her services. How should the radiology-related
services provided by the primary care physician’s office be reported?
a.71020-TC b.71021-TC c.71022-TC d.71030-TC

48.A radiologist interpreted a head CT scan taken by the hospital. The

study was performed without contrast material. How should the radiologist’s
professional services be reported?

a.70450 b.70450-26 c.70450-TC d. 70450-26,-TC

49.A radiologist interpreted a head CT scan taken by the hospital. The

study included both films taken without contrast and films taken with IV
contrast material. How should the radiologist’s professional services
bereported?

a.70470-26 b.70450-26 c.70460-26 d.70460-TC

50.A physician interpreted a CT study of cervical spine (C2-C4 area) with

IV contrast. How should the physician’s professional services bereported?

a.70491-26 b. 70492-26 c. 72126-26 d. 72126-26, 62284

51.A radiology tech (employed by the hospital) took CT images of the

patient’s lower cervical spine (C5-C7) without contrast. The radiologist then
administered intrathecal contrast by injection in the area of C5-C7. The
radiology tech then took additional images of the same area. The
radiologist interpreted all of the images. All services were furnished at the
hospital. How should the radiologist’s professional services bereported?

a. 72127-26, 62284 b. 72127-26, 61055 c. 72127 d. 72127-

TC

52.A radiologist administered IV contrast material and a radiology tech

(employed by the hospital) then took images of the patient’s left leg using
computerized axial tomography. The radiologist interpreted the images. All
services were furnished at the hospital. How should the radiologist’s
professional services be reported?

a.73700-26 b.73701-26 c.73702-26 d.76376

80,000 SERIES - LAB/PATHOLOGY(6 Questions)

53.A physician ordered an “electrolyte panel” from a local laboratory

company. The order form supplied by this company indicates the following
tests are always included whenever an electrolyte panel is ordered: carbon
dioxide, chloride, glucose, potassium and sodium. The lab company
performed all of these tests. How should the lab company report these
services?

a. 82374, 82435, 84132, 84295, 82947

b. 80051, 82374, 82435, 84132, 84295, 82947
c. 80051
d. 80051, 82947

54.A patient uses Clonazepam to control his seizures. He comes in every

two months to have a definitive drug testing performed to assess serum
plasma levels of this medication. What lab code is reported for thistesting?

a.80345 b.80346 c.80347 d.80375

55.A lab performed a calcitonin stimulation panel consisting of three

separate calcitonin tests. How should these lab services be reported?

a. 80410, 82308x 3 b. 82308x3 c.80410 d. 82308, 82308-91 x3

56.A 58-year-old male patient with abdominal pain and episodes of bright
red blood in his stool reports to his physician’s office for a check-up. His
physician performs a digital rectal exam and tests for occult blood. Dr.
Smith documents this blood occult test was done for purposes other than
colorectal cancer screening. How would you report the occult blood test?

a.82270 b.82274 c.82271 d.82272

57.Patient that is a borderline diabetic has been sent to the laboratory to

have an oral glucose tolerance test. Patient drank the glucose and six
blood specimens were taken every 30 to 60 minutes up to three hours to
determine how quickly the glucose is cleared from the blood. What code(s)
should be reported for thistest?

a.82951,82952 b. 82951x3,82952x3
c.82951,82952x3 d.82952x3

58.CPT Code for RSV Ag by immunofluorescence technique

a.87290 b.87280 c. 87420 d.87631

90,000 SERIES – MEDICINE(6 Questions)

59.Dr. Cardiologist at Cardio Clinic Outpatient Hospital reviews the ECG he

ordered (Electrocardiogram, routine ECG with at least 12 leads,
interpretation and report only) and documents it in the medical record,
along with a separate interpretation and report for a ne

w patient he saw earlier that day. The E/M level is 99204. What is the
correct coding for ECG component of thevisit?

a. There is no additional coding beyondtheE/M

b.93010-26
c.93010
d. 99204,93010-26

60.A patient who is a singer has been hoarse for a few months following an
upper respiratory infection. She is in a voice laboratory to have a laryngeal
function study performed by an otolaryngologist. She starts off with the
acoustic testing first. Before she moves on to the aerodynamic testing she
complains of throat pain and is rescheduled to come back to have the other
test performed. What CPT® code(s) should be reported?

a. 99211, 92520 b. 92700 c.92520-52 d. 99211,92700-52

61.Colin had a comprehensive audiometry threshold evaluation and speech

recognition testing to the left ear. What code(s) capture this procedure?

a. 92557-52 b. 92553, 92556 c. 92557 d. 92700-

59

62.Which is proper coding for a combined left- and right-heart

catheterization with coronary angiography?

a. 93453 b. 93453-22 c. 93460 d. 93461

63.Which is the correct hierarchy to determine the most extensive

procedure?

a.Stent with atherectomy (lowest), atherectomy, stent, angioplasty(highest)

b.Atherectomy (lowest), stent with atherectomy, angioplasty, stent(highest)

c.Angioplasty (lowest), stent, atherectomy, stent with atherectomy(highest)

d.Stent (lowest), angioplasty, atherectomy, stent with atherectomy(highest)

64.Sally suffered from dehydration after running a marathon. She was
taken into her primary care doctor’s office. Dr. Small checked Sally and
ordered hydration therapy with normal saline. The hydration lasted 45
minutes. How would you report thisservice?

a.96365,96361 b. 96369 c. 96360 d. 96360,96361

ANATOMY AND MEDICAL TERMINOLOGY(8 Questions)

65.The most common surgical position is:

a. Supine
b.Lithotomy
c.ReverseTrendelenberg
d.Prone

66.The wrist, or carpus,contains carpal bones.

a.3 b.5 c.8 d.12

67.A surgical procedure for repair/reconstruction of the nose is called:

a.Palatoplasty b.Rhinoplasty c. Blepharoplasty d.Rhytidectomy

68.Appendix is present in which quadrant

a.RLQ b.RUQ c.LLQ d.LUQ

69.Gallbladder is present in which quadrant

a.RLQ b.RUQ c.LLQ d.LUQ

70.Front side of the body

a.Anterior b.Ventral c.Dorsal d.Both a & b

71.Back side of the body

a.Anterior b.Posterior c.Dorsal d.Both b &c

72.The patellar tendon harvested for use in the graft normally joins:
a. muscle to muscle
b. muscle to bone
c. bone to ligament
d. bone to bone

ICD 10 CM(5 Questions)

73.What is the ICD-10-CM code for reporting MRSA of a known site?

a.A49.02 b.B95.62 c.A41.02 d.J15.212

74.What is the ICD-10-CM code for reporting sepsis due toMRSA?

a.A49.02 b.B95.62 c.A41.02 d.J15.212

75.Which is the proper code to report malignant melanoma oflip?

a.C43 b.C43.0 c.C43.3 d.C00.0

76.A 56-year-old female presents to the clinic today for a five-month

recheck on her type II diabetes mellitus. She states that she checks her
blood sugars in the morning, which have all been ranging less than 100.
She has not been checking after meals. Which is the correct ICD-10-
CMcode?

a.E11.6 b.E11.69 c.E11.8 d.E11.9

77.The patient has type 1 diabetes mellitus with bilateral diabetic cataracts.
Which is the correct ICD-10-CMcode?

a.E10.36 b.E10.37 c.E11.36 d.E13.36

HCPCS Level II(3 Questions)

78.What HCPCS Level II supply code would be reported for a 2 mg oral

administration of Tacrolimus?

a. J7525 b. J7507 x 2 c. J7599 d. J7507

79.Jennifer is diabetic and must check her blood sugar regularly. Her
primary care physician supplied two boxes of Lancets to her for use in
checking her blood sugar. Each box contained 100 Lancets. What HCPCS
Level II code would be reported for the supply of these Lancets?

a. A4259 b. A4258 c. A4259x 2 d. A4258 x2

80.A physician administers 12 cc of IM gamma globulin immunization in his

office. What HCPCS Level II supply code(s) would be used in reporting
thisdrug?

a.J1550,J1470 b. J1460x12 c.J1560 d. J1510 x2

CODING GUIDELINES(7 Questions)

81.A physician performs venipuncture on a 5-year-old patient after a

previous attempt by an RN to access the vessel was unsuccessful. Code
36410 should be used to identify this service. Is this statement true or
false?

a.True b.False

82.When selecting a code for a preventive medicine visit, the provider

should

a.Select the code based on the patient’s age,only

b.Select the code based on the how much time was spent with the patient

c.Select the code based on the patient’s age and status (new or
established)

d.Ask the patient what code they would like reported to his or her insurance

83.True or False: Documentation stating, “trimming of skin fragments

surrounding wound” is sufficient to support coding for excisional
debridement.
a.True b.False

84.For a provider to bill an office E/M code based on time, the

documentation must include:

a.Amount of total face-to-face time spent with the patient at the encounter.

b.A statement that at least 50 percent of the visit was engaged in

counseling and/or coordination ofcare.

c.A description of the counseling and/or care coordination activities

performed at that encounter.

d.All of theabove

85.How many vertebral segments are there in the span C6-T2? How many
interspaces?

a. Three and two b. Three and three c. Four And three d. Four and four

86.An E/M service leads to the decision to perform a major surgical

procedure later that same day. When reporting the E/M service, you must
append which modifier?

a.25 b.57 c.79 d. No modifier is necessary.

87. Paraumbilical hernias are asubcategoryof hernias.

A.Femoral B.Umbilical C.Ventral D.Inguinal

COMPLIANCE AND REGULATORY(3 Questions)

88.Medical Insurance) covers most medically necessary doctors' services,

preventive care, durable medical equipment, hospital outpatient services,
laboratory tests, x rays, mental health care, and some home health and
ambulance services. You pay a monthly premium for this coverage.

a. Medicare Part A b. MedicarePartB c. Medicare Part C d.

Medicare Part D
89.Document that acknowledges patient responsibility for payment if
Medicare denies the claim.

a.ABN b.EOB c.GEP d.IEP

90.Covers inpatient hospital care as well as care provided in skilled nursing

facilities hospice care and home health care

a. MedicarePartA b.Medicare PartB

c. MedicarePartC d. Medicare Part D

CODING CASES-10 CASES

91.Procedure Note:
A pulmonology provider urgently attends to a COVID-19 patient who is
found to be in acute hypoxic respiratory failure and in need of ventilation
management and documents 62 minutes of critical care. The same
provider returns and documents an additional 55 minutes of critical care.
On the same day, the endocrinology staff manages the patient’s diabetes
and stage III
sacral ulcer and documents their time as 29 minutes. What is the
appropriate code assignment?

A. 99291, 99292 x 2, 99233

B. 99291, 99292 x 3
C. 99291, 99292 x 3, 99291
D. 99291, 99292 x 2, 99232

92.OPERATIVE REPORT OPERATIVE PROCEDURE: Excision of back

lesion.

INDICATIONS FOR SURGERY: The patient has an enlarging lesion on the

upper mid back.
FINDINGS AT SURGERY: There was a 5-cm, upper mid back 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-cm transverse skin incision, the lesion was excised. Hemostasis was
ensured. The incision was closed using 3-0 Vicryl for the deep layers and
running 3-0 Prolene.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.
A. 11406, 12002
B. 11424
C. 11406, 12032
D. 11606

93.EMERGENCY DEPARTMENT REPORT CHIEF COMPLAINT: Nasal

bridge laceration.

SUBJECTIVE: The patient is a 74-year-old male who presents to the

emergency department with a laceration to the bridge of his nose. He fell
in the bathroom tonight. He recalls the incident. He just sort of lost his
balance. He denies any vertigo. He denies any chest pain or shortness of
breath. He denies any head pain or neck pain.
There was no loss of consciousness. He slipped on a wet floor in the
bathroom and lost his balance; that is how it happened. He has not had
any blood from the nose or mouth.

PAST MEDICAL HISTORY:

Parkinson's
Back pain
Constipation

MEDICATIONS: See the patient record for a complete list of medications.

ALLERGIES: NKDA.

REVIEW OF SYSTEMS: Per HPI. Otherwise, negative.

PHYSICAL EXAMINATION: The exam showed a 74-year-old male in no

acute distress. Examination of the HEAD showed no obvious trauma other
than the bridge of the nose, where there is approximately a 1.5- to 2-cm
laceration. He had no bony tenderness under this. Pupils were equal,
round, and reactive. EARS and NOSE: OROPHARYNX was
unremarkable. NECK was soft and supple. HEART was regular. LUNGS
were clear but slightly diminished in the bases.
 PROCEDURE: The wound was draped in a sterile fashion and
anesthetized with 1% Xylocaine with sodium bicarbonate. It was cleansed
with sterile saline and then repaired using interrupted 6-0 Ethilon sutures
ASSESSMENT: Nasal bridge laceration, status post fall.
Plan: Keep clean. Sutures out in 5 to 7 days. Watch for signs of infection.

A. 12051, S01.20XA
B. 12011, S01.20XA
C. 12011, S01.23XA
D. 12011, 11000, S01.23XA

94. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Open fracture, left humerus, with possible

loss of left radial pulse.

PROCEDURE PERFORMED: Open reduction internal fixation, left open

humerus fracture.

PROCEDURE: While under a general anesthetic, the patient's left

arm was prepped with Betadine and draped in sterile fashion. We then
created a longitudinal incision over the anterolateral aspect of his left arm
and carried the dissection through the subcutaneous tissue. We attempted
to identify the lateral intermuscular septum and progressed to the fracture
site, which was actually fairly easy to do because there was some
significant tearing and rupturing of the biceps and brachialis muscles.
These were partial ruptures, but the bone was relatively easy to expose
through this.

We then identified the fracture site and thoroughly irrigated it with several
liters of saline. We also noted that the radial nerve was easily visible,
crossing along the posterolateral aspect of the fracture site. It was intact.
We carefully detected it throughout the remainder of the procedure. We
then were able to strip the periosteum away from the lateral side of the
shaft of the humerus both proximally and distally from the fracture site. We
did this just enough to apply a 6-hole plate, which we eventually held in
place with six cortical screws. We did attempt to compress the fracture site.
Due to some comminution, the fracture was not quite anatomically aligned,
but certainly it was felt to be very acceptable. Once we had applied the
plate, we then checked the radial pulse with a Doppler. We found that the
radial pulse was present using the Doppler, but not with palpation. We then
applied Xeroform dressings to the wounds and the incision. After padding
the arm thoroughly, we applied a long-arm splint with the elbow flexed
about 75 degrees. He tolerated the procedure well, and the radial pulse
was again present on Doppler examination at the end of the procedure.

A.24515-RT,
B.24500-LT,
C.24515-LT,
D.24505-LT,

95.OPERATIVE REPORT
Code only the operative procedure and diagnosis(es).
PREOPERATIVE DIAGNOSIS:

Hypoxia
Pneumothorax

POSTOPERATIVE DIAGNOSIS:
1. Hypoxia
2. Pneumothorax

PROCEDURE: Chest tube placement

DESCRIPTION OF PROCEDURE: The patient was previously sedated
with Versed and paralyzed with Nimbex. Lidocaine was used to numb the
incision area in the midlateral left chest at about nipple level. After the
 lidocaine, an incision was made, and we bluntly dissected to the area of
the pleural space, making sure we were superior to the rib. On entrance to
the pleural space, there was immediate release of air noted. An 18-gauge
chest tube was subsequently placed and sutured to the skin. There were
no complications for the procedure, and blood loss was minimal.
DISPOSITION: Follow-up, single-view, chest x-ray showed significant
resolution of the pneumothorax except for a small apical pneumothorax
that was noted.

A. 32505, R09.2, J93.9

B. 32551, 71001, R09.01, J93.9
C. 32551, J93.9, R09.02
D. 32505, R09.01

96.OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Leaking from intestinal anastomosis.

POSTOPERATIVE DIAGNOSIS: Leaking from intestinal anastomosis.

PROCEDURE PERFORMED: Proximal ileostomy for diversion of colon.
Oversew of right colonic fistula.

OPERATIVE NOTE: This patient was taken back to the operating room
from the intensive care unit. She was having acute signs of leakage from
an anastomosis I performed 3 days previously. We took down some of the
sutures holding the wound together. We basically exposed all of this
patient's intestine. It was evident that she was leaking from the small bowel
as well as from the right colon. I thought the only thing we could do would
be to repair the right colon. This was done in two layers, and then we freed
up enough bowel to try to make an ileostomy proximal to the area of
leakage. We were able to do this with great difficulty, and there was only a
small amount of bowel to be brought out. We brought this out as an
ileostomy stoma, realizing that it was of questionable viability and that it
should be watched closely. With that accomplished, we then packed the
wound and returned the patient to the intensive care unit.
A.44310
B.44310-78
C.45136
D.45136-78

97. OPERATIVE REPORT

 PREOPERATIVE DIAGNOSIS: Missed abortion with fetal demise, 11
weeks.
POSTOPERATIVE DIAGNOSIS: Missed abortion with fetal demise, 11
weeks.
PROCEDURE: Suction D&C.

The patient was prepped and draped in a lithotomy position under general
mask anesthesia, and the bladder was straight catheterized; a weighted
speculum was placed in the vagina. The anterior lip of the cervix was
grasped with a single-tooth tenaculum. The uterus was then sounded to a
depth of 8 cm. The cervical os was then serially dilated to allow passage
of a size 10 curved suction curette. A size 10 curved suction curette was
then used to evacuate the intrauterine contents. Sharp curette was used
to gently palpate the uterine wall with negative return of tissue, and the
suction curette was again used with negative return of tissue. The
tenaculum was removed from the cervix. The speculum was removed
from the vagina. All sponges and needles were accounted for at
completion of the procedure. The patient left the operating room in
apparent good condition having tolerated the procedure well.

A. 59812, O03.1 B. 59812, O03.0

C. 59820, O02.1 D. 59856, O02.1

98.EXAMINATION OF: Brain.

CLINICAL FINDING: Headache.

COMPUTED TOMOGRAPHY OF THE BRAIN was performed without

contrast material.

FINDINGS: There is blood within the third ventricle. The lateral ventricles
show mild dilatation with small amounts of blood.

IMPRESSION: Acute subarachnoid hemorrhage.

A. 70460-26, R51.0
B. 70250, R51.9
C. 70450-26, I60.9
D. 70450-26, R51.9

99. CHIEF COMPLAINT

  Right earache and ear pain.

HISTORY

 This 20 year old male is an established patient and well known to me.
He is a full-time college student, and presents with a right sided ear
pain, noted 8/10. The symptoms started yesterday and continue to
worsen with no pain relief using acetaminophen. Denies discharge,
hearing loss, or ringing/roaring. He denies trauma or recent
barotrauma to ear. He denies fever, sore throat, and cough today. He
reports recently having an URI that resolved with OTC medications.
 He is up to date on his influenza, HPV, Tdap, and meningococcal
immunizations.
 Patient does not use tobacco, alcohol, or illicit drugs. He denies
exposure to second hand smoke.
 Medical history includes major depressive disorder with recurrent
episodes of mild severity, and bipolar II disorder. His current
medications include aripiprazole, and duloxetine.
 No known allergies.
 16 point review of systems negative except for notations above.

EXAM

 Healthy appearing male. A&Ox3. He appears calm and is

cooperative.
 Vital signs: BP: 130/78 HR: 70 bpm T: 99.8 °F Wt: 235 lbs Ht: 5’ 10”.
 ENT: auricle and external canals normal bilaterally. Right ear:
erythematous membrane, bulging, with loss of landmarks. Pharynx,
teeth, and nose exam normal. No cervical adenopathy bilaterally.
 Integumentary: Skin is flushed, warm, and dry with no edema.
Mucous membranes are moist.
 Respiratory: Lungs clear CTA with normal respiratory effort.
 Abdomen: non-tender, no organomegely.

ASSESSMENT AND PLAN

 New onset AOM, suppurative, with pain unrelieved by

acetaminophen.
 Prescriptions: amoxicillin for AOM; ibuprofen for pain.
 Return in one week if symptoms persist.
CODE THE ICD 10 CM?

A. H66.001
B. H66.002
C. H66.10
D. H66.007

100. CC: Shortness of breath

History: A 62-year-old female returns to a family practice having shortness

of breath for the last week. It has been two years since her last visit to the
practice. She also has nausea, diaphoresis, chest pressure.
Past History: Celebrex® for her arthritis.
Hysterectomy 1 year ago.
Social History: Smoker-No Alcohol-No
Allergies: Penicillin
PHYSICAL EXAM
Vital Signs: BP 195/95 sitting, left arm
General/Constitutional: Mild distress. Some diaphoresis.
Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No
mucosal lesions.
Neck/Thyroid: Supple, without adenopathy or enlarged thyroid.
Respiratory: Shallow breathing, no wheezing.
Cardiovascular: Unequal pulses in both arms. Abnormal heart sounds
heard.
EKG ordered.
Assessment/Plan
Severe exacerbation of congestive heart failure
Patient is sent to the hospital to be admitted. Will send hospital orders to
start her on IV, order chest X-ray and CBC.
A. 99202
B. 99215
C. 99204
D. 99214