3470 HEALTHCARE TRAINING AND PLACEMENT SOLUTIONS

1. Which types of joints are considered synovial?

a. Suture joint, medial joint, and articulation joint
b. Ball-and-socket joint, hinge joint, and saddle joint
c. Pivot joint, talus joint and cranial joint
d. Ball-and socket joint, nasal joint, and elevation joint

2. A physician applied a cast and also provided all of the subsequent fracture care. The same
physician may report the application of the cast separately from the fracture care.
a. True
b. False

3. A physician designed and prepared prosthesis for palatal lift prosthesis. Howshould you
report the physician’s professional service for this process?
a. 21083
b. 21083-26
c. L9900
d. L8699-26

4. The patient presented for medial meniscal tear left knee. Arthroscopy with partial medial
menisectomy left knee and arthroscopic picking (drilling pick holes) of the lateral femoral
condyle left knee was performed. Code the procedure and diagnosis codes.
a. 29880-LT, 29879-51-LT, S89.212A
b. 29881-LT, 29879-51-LT, S89.212A
c. 29882-LT, 29885-51-LT, S89.219A
d. 29881-RT, 29885-51-LT, S89.219A

5. A 37-year-old patient was previously treated with external fixation for a Grade III left tibia
fracture. There is now nonunion of the left proximal tibia and he isadmitted for open reduction
of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the
iliac crest. The fracture site wasexposed and the area of nonunion was osteotomized, cleaned,
and repositioned. Intrafragmentary compression was applied and three screws and the
harvested bone graft were packed into the fracture site. What are the correct codes for his
diagnosis and procedure?
a. 27724
b. 27758
c. 27722
d. 27759

6. Patient complains of chronic/acute arm and shoulder pain following bilateral carpal tunnel
surgery. Patient is followed by pain management for over a year. Physician finally diagnoses
patient with reflex dystrophy syndrome (RSD). Physician performs six trigger point injections
into four muscle groups. Code the procedure(s).
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a. 20552
b. 20553 x 6
c. 20551 x 6
d. 20553

7. A Grade I, high velocity open right femur shaft fracture was incurred when a
15-year-old female pedestrian was hit by a car. She was taken to the operating room within
four hours of her injury for thorough irrigation and debridement, including excision of
devitalized bone. The patient was then reprepped, redraped, and repositioned. Intramedullary
rodding was then carried out with proximal and distal locking screws. What are the correct
codes for this diagnosis and procedure?
a. 27506, 11044-51
b. 27506, 11012-51
c. 27507, 11012-51
d. 27507, 11044-51

8. Dr. Roy completed a deep transfer of the anterior tibial and flexor digitorumtendons.
Which codes should be used to report this procedure?
a. 27658 x2
b. 27690, 27692-51
c. 27691, 27692
d. 27691, 27692 x2

9. Which codes would you report for an aspiration and injection of ganglion cystto the bone
of the left great toe?
a. 20600
b. 20612
c. 20615
d. 20600, 20612-59
10. Roy is a 25 years old patient who underwent a subcutaneous excision of an 8- cm spongy
tumor on her upper abdominal wall. How should you report thisprocedure?
a.22902
b.22903
c.22900
d.22905

11. A patient presents for a steroid injection into the bilateral SI joint under
fluoroscopic guidance. How should you report this?
a. 27096, 77003-26
b. 27096-50
c. 27096-50, 77003-26
d. 27096
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12. A patient presents for injection of steroid into the right SI joint, as well as trigger points in
the trapezius, iliopsoas, and quadriceps muscles. How will you report this?
a. 20553
b. 20553, 20552-59
c. 20553, 27096
d. 20553, 27096-RT

13. A 56-year-old female undergoes bilateral SI joint injection with ultrasonicguidance.

How should you report this?
a. 20552, 76942
b. 20552-50
c. 27096
d. 27096, 76942

14. Posterior placement of pedicle screws and rods at L2-S1 is reported usingwhich
instrumentation code?
a. +22840
b. +22842
c. +22843
d. +22845

15. A patient suffered a fracture of the femur head. He had an open treatment of the femoral
head with a replacement using a Medicon alloy femoral head and methyl methacrylate cement.
How would you report this procedure?
a. 27236
b. 27235
c. 27238
d. 27275, 27236-59

16. What modifier should you report when the same physician provided arereduction of a
fracture?
a. 76
b. 59
c. 77
d. 54
17. This is a 32-year-old female who presents today with sacroiliitis. On the physical exam,
there was pain on palpation of the left sacroiliac joint and fluoroscopic guidance was done for
the needle positioning. Then 80 mg of Depo- Medrol and 1 Ml of bupivacaine at 0.5% was
injected into the left sacroiliac joint with a 22 gauge needle. The patient was able to walk from
the exam roomwithout difficulty. Follow up will be as needed. The correct CPT® code is:
a. 20610-LT, 77003-26
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b. 27096-LT, 77003-26
c. 27096-LT
d. 20551

18. A 61-year-old gentleman with a history of a fall while intoxicated suffered a blow to the
forehead and imaging revealed a posteriorly displaced odontoid fracture. The patient was taken
into the Operating Room, and placed supine on the operating room table. Under mild sedation,
the patient was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy
was performedto gently try to reduce the fracture. It did reduce partially without any change in
the neurologic examination. More manipulation would be necessary and it was decided to
intubate and use fiberoptic technique. The anterior neck was prepped and draped and an
incision was made in a skin crease overlying the C 4-C5 area. Using hand-held retractors, the
ventral aspect of the spine was identified and the C2-C3 disk space was identified using lateral
fluoroscopy. Using some pressure upon the ventral aspect of the C2 body, we were able to
achieve a satisfactory reduction of the fracture. Under direct AP and lateral fluoroscopic
guidance, a Kirschner wire was advanced into the C2 body through the fracture line and into
the odontoid process. This was then drilled, and a 42 millimeter cannulated lag screw was
advanced through the C2 body into the odontoid process. What procedure code should be
used?
a. 22505
b. Appropriate E&M code
c. 22315
d. 22318
19. 52-year-old female has a mass growing on her right flank for several years. It has finally
gotten significantly larger and is beginning to bother her. She is brought to the Operating
Room for definitive excision. An incision was made directly overlying the mass. The mass was
down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma
approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided
with electrocautery. What CPT® should be reported?
a. 21932
b. 21935
c. 21931
d. 21925

20. 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 havingbeen administered. The right upper
extremity was prepped and draped in a sterilemanner. The limb was elevated, exsanguinated,
and a pneumatic arm tourniquetwas elevated. An incision was made over the dorsal radial
aspect of the rightwrist. Skin flaps were elevated. Cutaneous nerve branches were
identified andvery gently retracted. The interval between the second and third dorsal
compartment tendons was identified and entered. The respective tendons wereretracted. A

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dorsal capsulotomy incision was made, and the fracture wasvisualized. There did not appear to
be any type of significant defect at the fracturesite. A 0.045 Kirschner wire was then used as
a guidewire, extending from theproximal pole of the scaphoid distalward. The guidewire was
positionedappropriately and then measured. A 25- mm Acutrak drill bit was drilled to
25mm. 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 in layers. Sterile dressings were then applied.
The patient tolerated the procedure well and left theoperating room in stable condition. What
code should be used for this procedure?a. 25628-RT
b. 25624-RT
c. 25645-RT
d. 25651-RT

21. The surgeon performs a diagnostic endoscopy on a Medicare patient, followedby a surgical
endoscopy in the same family. How should you code?
a. Report only the diagnostic endoscopy
b. Report only the surgical endoscopy
c. Report both the diagnostic and surgical endoscopy codes, with no modifiers
d. Report both the diagnostic and surgical endoscopy codes, but attachmodifier
51 to the diagnostic scope code
23. Which procedure would be reported when a patient had all five toes on asingle foot
amputated at the metatarsals during the same operative session?
a. 28800
b. 28805
c. 27888
d. 28820

24. Which of the following is a method to treat fractures where a fixation, such asa rod or nail,
is placed across the fracture?
a. Open
b. Closed
c. Endoscopy
d. Percutaneous

25. An 87-year-old man with history of falling presents for repair of fractured proximal ulna
and dislocated radial head. This time he slipped on ice on the walkway in front of his house. He
fell into soft snow and the impact was only on his right elbow. He sustained a Monteggia
fracture. The orthopedic surgeon
performed an ORIF over this site. The correct CPT® and ICD-9-CM codes todescribe this scenario
are:
a. 24635-RT,
b. 24640-RT
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c. 24620-RT
d. 23670-RT

26. A 28-year-old football player fell to his knees upon being tackled. The impactwas so
severe that he suffered a broken left tibia. A medic was called onto thefield and the man
was transported to the nearest ER. Two days later, anorthopedic surgeon repaired the
fracture by placing four screws into the injured area under ultrasonic guidance. The correct
CPT® code for this procedure is:
a. 27750-LT
b. 27752-LT
c. 27756-LT
d. 27758-LT

27. A 41-year-old woman fell off a rickety chair she was standing on and suffered a
trimalleolar fracture of her right ankle. An open treatment was performed. Correct coding for
this scenario is:
a. 27816-RT b. 27822-RT
c. 27818-RT d. 27823-RT

28. Which CPT® code should you report when a physician performs an endoscopic
gastrocnemius recession?
a. 27687
b. 29999
c. 27687-52
d. 29893

29. Which CPT® code should you report when a physician performs manipulationof spine
requiring anesthesia, lumbar region?
a. Appropriate E&M code
b. 22326-52
c. 22505
d. 29893
30. Renny suffered with dislocation of right fourth metacarpal. Dr. Ross completed a closed
manipulation under anesthesia and repaired Renny’s injury. What code should Dr. Ross report
for her service?
a. 26605
b. 26641
c. 26670
d. 26675

31. Christina is a 52-year-old patient who underwent a subcutaneous excision of an 8-cm spongy
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tumor on her upper abdominal wall. How should you report this procedure?
a.22902 b.22903 c.22900 d.22905

32. A 62-year-old female patient was referred to Dr. Stegman for increased right groin pain. The
patient described the pain as worse when sitting and rising from a seated position. The pain was
temporarily relieved with intra-articular corticosteroid injections. Dr. Stegman’s physical exami-
nation on Monday documented loss of hip internal rotation, suspected cam lesion, and referral
for x-ray with arthrography followed by CT with contrast. Both the x-ray and CT scan verified a
cam lesion. Today, one week after the initial consultation, Dr. Stegman completed a surgical right
hip arthroscopy, including a femoroplasty to repair the cam lesion. How should Dr. Stegman
report today’s services?
a. 29860-RT, 73525-26, 73701-26 b.29914-RT, 73525, 73701
c. 29914-RT d.27130-RT

33. A patient underwent an anterior inter body arthrodesis with discectomy, osteophytectomy,
Fusion, and decompression of nerve roots at level C3, C4, and C5. The fusion was explored and
then stabilized with application of anterior instrumentation placed from C3 to C5. Which codes
would you use to report this procedure?
a.22551, 22585 x 2, 22845-51, 22830-59 b.22554, 22585 x 2, 22845, 22830-51
c.22600, 22614, 22842, 22830-59 d.22551, 22552 x 2, 22845, 22830-51

34. Which code(s) would you report for an aspiration and injection of a ganglion cyst to the bone
of the left great toe?
a.20600 b.20612
c.20615 d.20600, 20612-59

35. Dr. Bender completed a therapeutic manipulation of the temporomandibular joint. An

anesthesiologist placed this healthy 54-year-old patient under general anesthesia and monitored
the patient during the procedure. The intra-service time was noted as one hour. The patient
tolerated the procedure well and was returned to the recovery room in good condition. How
would Dr. Bender’s services be reported?
a.21073, 99151, 99152 x 3 b.21480
c.21073 d.21480, 99155, 99156 x 3

36. This 45-year-old male presents to the operating room with a painful mass of the right
upper arm. General anesthesia was induced. Soft tissue dissection was carried down thru
the proximal aspect of the teres minor muscle. Upon further dissection a large mass was
noted just distal of the IGHL(inferior glenohumeral ligament), which appeared to be benign in
nature. With blunt dissection and electrocautery, the 4.5 cm mass was removed en bloc and sent
to pathology. The wound was irrigated, and repair of the teres minor with subcutaneous tissue
was then closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a
subcuticular fashion. What is the correct CPT® code for this service?
A. 23076 B. 23066
C. 23075 D. 23030
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37. The patient presented for medial meniscal tear left knee. Arthroscopy with partial medial
menisectomy left knee and arthroscopic picking (drilling pick holes) of the lateral femoral
condyle left knee was performed. Code the procedure and diagnosis codes.
A. 29880-LT, 29879-LT, S83.241A B. 29881-LT, 29879-LT, S83.241A
C. 29882-LT, 29885-LT, S83.281A D. 29881-RT, 29885-LT, S83.209A

38. This is a 32 year old female who presents today with sacroilitis. On the physical exam there
was pain on palpation of the left sacroiliac joint and imaging confirmation was done for the
needle positioning. Then 80 mg of Depo- Medrol and 1 mL of bupivacaine at 0.5% was
injected into the left sacroiliac joint with a 22 gauge needle. The patient was able to walk
from the exam room without difficulty. Follow up will be as needed. The correct CPT code is:
A. 20610, 77003-26 B. 20551 C. 27096-LT D. 20555

39. Mary tells her physician that she has been having pain in her left wrist for several weeks. The
physician examines the area and palpates a ganglion cyst of the tendon sheath. He marks the
injection sites, sterilizes the area, and injects corticosteroid into two areas.
A.20550-LT X 2, M67.439 B.20551-LT, M67.431
C.20551-LT X 2, M67.432 D.20612-LT, 20612-59-LT, M67.432

40. Mrs. Williams has had a bunion on her right foot for many years and is scheduled for surgery
to correct this condition. The doctor plants to do a double osteotomy of the metatarsal bone.
What procedure code is reported?
A.28296-RT, 28296-RT B. 28299-RT C. 28292-RT D. 28291-RT

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