AAPC-CPCCodingExam2010:TheCertificationStep

FinalExamination

Name:

Date:Time:5.40Minutes

Question1

Indication:Patienthasahypertrophicscarontheposteriorsideoftheleftlegattheleveloftheknee.Thishasbeguntorestricthismobility.Physicaltherapytrialwasunsuccessful.Procedure:Aftertheproperinductionofanesthesia,thesubcutaneoustissueofthepatient’sleftlegbeneaththescarwasinfiltratedwithcrystalloidsolutioncontainingepinephrinetominimizebloodloss.Thescarwasthenexciseddowntoviabledermis.Hemostasiswasobtainedwithepinephrinesoakedpads.Skinwasharvestedfromthepatient’sthighinasplitthicknessfashionandwasusedtocoverthe90sqcmdefectcreatedbythesurgery.Thegraftwassecuredwithskinstaplesandthendressedwithfinemeshgauzefollowedbymedication-soakedgauze.ThedonorsitewasdressedwithmeshfollowedbyAdaptic,followedbyadrydressingandanAcewrap.

A.15110-52,15002B.15100,11406

C.15100,15002D.15110,15002

Question2

Thephysicianiscalledintoperformrepairsfora17-year-oldgirlinvolvedinamotorvehicleaccident.Shesustainedan8.6cmlacerationtoherforehead,a5.5cmlacerationtoherrightcheek,a4cmlacerationtoherleftcheek,a4cmlacerationacrossherchin,anda12.5cmlacerationtoherchest.Thewoundonherchinrequiredalayeredclosure.Allotherwoundsrequiredcomplexclosure.

A.13132,13133x4,13101,12052
B.13132,13133x3,13133-52,13101,13102,12052
C.13132,13133x3,13101,13102,12052
D.13131,13132,13133x3,13101,13102,12052

Question3

A36-year-oldmalepresentstohavemultiplelesionsdestroyed.Threebenignlesionsonhisfacearedestroyedandfiveactinickeratosesonhisleftarmaredestroyed.Codefortheprocedures.

A.17000,17003B.17000,17003x4,17110

C.17110D.17280x5,17000,17003

Question4

Patientishavingongoingbackandhippain.Thephysicianelectstoperformasacroiliacinjectionatanambulatorysurgerycenter.Aftersterileprep,thepatientisplacedproneandunderfluoroscopicguidance;theneedleisplacedintotheSIjointwithamixtureof20mgofCelestoneandMarcaineforpainrelief.Codetheprocedure(s).

A.27096,77003-26B.20610

C.27096,73542-26D.27096

Question5

Patientisseeninthehospital’soutpatientsurgicalareawithadiagnosisofadisplacedcomminutedfractureofthelateralcondyle,rightelbow.AnORIFprocedurewasperformed,whichincludedthefollowingtechniques:Anincisionwasmadeintheareaofthelateralepicondyle.Thiswascarriedthroughsubcutaneoustissue,andthefracturesitewaseasilyexposed.Inspectionrevealedthefragmenttoberotatedintwoplacesabout90degrees.Itwaspossibletomanuallyreducethisquiteeasily,andthemanipulationresultedinanalmostanatomicreduction.Thiswasfixedwithtwopinsdrivenacrossthehumerus.Thepinswerecutoffbelowskinlevel.Thewoundwasclosedwithplaincatgutsubcutaneouslyand5-0nylonfortheskin.Dressingsandalongarmcastwereapplied.WhicharethecorrectICD-9-CMandCPT®codesassignment?

A.24579,29065-51,812.52B.24577,812.42

C.24579,812.42D.24575,812.52

Question6

A35-year-oldfemalepatientpresentswithacuteonsetofseverepainsinceOctober.HerworkuphasrevealedevidenceofdiskherniationwithlossoflordosisattheC5-C6.IntraoperativefindingswereconsistentwithtwolargefragmentsoffreediskfragmentsintheforamenatC5-C6ontherightside.Aftergeneralanesthesia,thepatientwasplacedontheoperativetableinthesupineposition.AllpressurepointswerecushionedandatransverseskinincisionwasfashionedunderfluoroscopicguidanceovertheC5-C6discspace.DissectionthroughtheplatysmaeventuallyallowedforexposureoftheanteriorentrancetothevertebralbodyofC5andC6andretractorswereinsertedtomaintainadequateexposure.Theoperatingmicroscopewasbroughtintothefield.Casparpostswereplacedandslightdistractionallowedexposure.AcompletediscectomywasperformedatC5-C6byusingendplatecuretspituitaryrongeursandKerrisonrongeurs.Theposteriorlongitudinalligamentwasresectedandbeneaththeposteriorlongitudinalligament,twosignificantsizeddiscfragmentswerenotedintheforamenatC5-C6.ThesewereremovedusingpituitaryandDeckerinstruments.TheendplateswerethendecorticatedsothattheywereparalleltoeachotherandamidlinekeelwasperformedonAPandlateralfluoroscopy.Asize#1by5mminterbodyKineflex-Cdevicewasplacedunderfluoroscopicguidance.Satisfiedwiththepositioningofthedevice,thedecisionwasmadetoclose.Whatisthecorrectcodeforthisprocedure?

A.63075B.63081

C.22856D.22554

Question7

Procedure:Dualchamberpacemakerdefibrillatorimplantation.Indications:A67-year-oldwhitegentlemanwhohassignificantunderlyingischemiccardiomyopathywithEFof25percent,priorinfarcts,remotehistoryofsyncopeandathighriskformalignantventriculararrhythmias.HehashadarecentTwavealternanstestwhichwasclearlyabnormal.Hehashadepisodesofrestingbradycardiaalsonoted.HealsomeetsMaditIIcriteriaforICDimplantation.DescriptionofProcedure:Afterinformedconsenthadbeenobtained,thepatientwasbroughttotheoutpatienthospitallabinthefastingstate.Theleftanteriorchestwaspreppedanddrapedinasterilefashion.Intravenoussedationandlocalanestheticweregiven.Afterlocalanesthetic,a5cmincisionwasmadeattheleftdeltopectoralgroove.Withbluntdissectionandcautery,thiswascarrieddownthroughtheprepectoralisfascia.Thecephalicveinwasidentifiedandligateddistally.Throughthevenotomy,asubclavianvenogramwasperformedtoprovidearoadmap.Theatrialandventricularleadswerethenadvancedintothevesseltotheleveloftherightatriumunderfluoroscopicguidance.TheventricularleadwasmaneuveredtotherightventricularoutflowtractandthenthroughtheRVapexwhereitwasactivelyfixed.Goodsensingandpacingthresholdsweredemonstrated.Theleadwasanchoredtothepre-pectoralisfasciawithinterrupted2-0Tycronsutures.10voltpacingdidnotresultindiaphragmaticcapture.Theatrialleadwasmaneuveredtotheanterolateralrightatrialwallwhereitwasactivelyfixed.Goodsensingandpacingthresholdsweredemonstrated.Theleadwasanchoredtothepre-pectoralisfasciawithinterrupted2-0Tycronsutures.10voltpacingdidnotresultindiaphragmaticcapture.Asubcutaneouspocketwascreatedwithgoodhemostasisachieved.ThepocketwassubsequentlyirrigatedwithsolutionofBacitracin.Thegeneratorwasconnectedtotheleadandthenplacedinthepocketwithnotensiononthelead.Thedeepfasciallayerwasclosedwithinterrupted2-0Vicrylsuture.Thesubcutaneousclosurewasmadewithrunning3-0Vicrylsuture.Subcuticularclosurewasmadewithrunning4-0Vicrylsuture.Steri-stripswereapplied.VentricularfibrillationwasinducedwithaTwaveshock.Thiswassuccessfullysensedandterminatedwitha15jouleshocktosinusrhythm.Highvoltageimpedencewas39ohms.Drydressingwasplacedoverthewound.Thepatientreturnedtothefloorinstableconditionwithoutapparentcomplications.Whichofthefollowingcodesaccuratelydescribesthebasicproceduresummarizedinthisreport?

A.33207,71090B.33208,71090-26

C.33240,33208,71090D.33249,71090-26

Question8

ApatientisbroughtfromanMVAtotheERwithmultiplefracturedribs,laboredbreathing,andcomplaintsofchestpainandpalpitations.IntheERthethoracicsurgeonperformsatubethoracostomywithsomereliefofthepatient’smostseveresymptoms.Severaltestsarerunandradiographstaken.Whatisthecorrectcode?

A.32100B.32421

C.32422D.32551

Question9

Asinusendoscopywithtissueremovalfromthesphenoidsinuswasperformed.ThecorrectCPT®codeis:

A.31287B.31288

C.31235D.31050

Question10

A67-year-oldmalepatientwithahistoryofcarcinomaofthesigmoidcolonisreferredforadiagnosticcolorectalcancerscreening.Thepatientcompletedalltreatmentforhiscancerin2004.Thephysicianperformedadiagnosticflexsigmoidoscopyexamtoscreenforrecurrentcoloncancerandexaminetheanatomicsite.Duringtheexam,thephysicianfoundthreepolypsintherectosigmoidjunction.Theywereremovedbyhotbiopsyforceps.Thepathreportindicatedthepolypswerebenign.Codetheencounter.

A.45333,V10.05,211.3B.45331,V12.72,211.3

C.45338,V10.05D.45339,211.3,V12.72

Question11

PostoperativeDiagnosis:CalculiofthegallbladderProcedure:RemovalofgallbladderIndications:Thepatientisa40-year-oldwomanwhohasasixmonthhistoryofRUQpain,whichultrasoundrevealedtobemultiplegallstones.Shepresentsforremovalofhergallbladder.Procedure:ThepatientwasbroughttotheORandpreppedanddrapedinanormalsterilefashion.Afteradequategeneralendotrachealanesthesiawasobtained,atrocarwasplacedandCO2wasinsufflatedintotheabdomenuntilanadequatepneumoperitoneumwasachieved.Acamerawasplacedattheumbilicusandthegallbladderandliverbedwerevisualized.Thegallbladderwasenlargedandthickened,andtherewasevidenceofchronicinflammatorychanges.Twoadditionalportswereplacedandgrasperswereusedtofreethegallbladderfromtheliverbedwithacombinationofsharpdissectionandelectrocautery.SeveralattemptsweremadebeforeitwasdecidedthatadditionalexposurewasneededandIconvertedtoanopenapproach.Thetrocarswereremovedandamidlineincisionwasmade.Atthistime,itwasclearthatthereweremultipleadhesionsinthearea,andoncethesewerecarefullytakendown,wewereabletograspthegallbladder.Thecysticductwascarefullyligatedandthegallbladdercarefullyremovedfromthefield.Theareawascopiouslyirrigated,andaneedlebiopsyoftheliverwastaken.Thentheskinwasreapproximatedinlayers.Spongesandneedlecountswerecorrect,andthepatientwastakentotherecoveryroomingoodcondition.

A.47600-22B.47600-22,47001

C.47562,47600-22,47001D.47562-22,47000

Question12

Apatientwithrectalbleedingundergoesaproctosigmoidoscopy.Duringtheproctosigmoidoscopy,thephysicianidentifiesinternalhemorrhoids.Theproctoscopewaswithdrawn,andtheanuswaspreppedanddraped.AfieldblockwithMarcaine0.25%wasthenplaced.Anoscopewasinserted.Therewasaprolapsinghemorrhoidintheanteriormidline.Thiswasrubberbandligatedbyapplyingtwobands.Intheposteriormidline,therewasanotherhemorrhoidthatwasbandedinthesamemanner.Codetheprocedures.

A.46221,45300-51,46600-51B.46221,45300-51

C.46945,45300D.46934,45300-51,46600-51

Question13

Apregnantpatientdeliverstwinsat30weeksgestation.Thefirstbabyisdeliveredvaginally,butduringthisdelivery,thesecondbabyhasturnedintothetransversepositionduringlabor.Thedecisionismadetoperformacesareantodeliverthesecondbaby.TheOBphysicianwhoperformedthedeliveryalsoperformedtheprenatalcare.Thestandardcodingforthisis:

A.59400,59514-51,651.01,652.31B.59510,59409-51,651.01,652.31

C.59510-22,651.01,660.01,652.31D.59510,59409-51,651.01,660.30

Question14

A30-year-olddisabledMedicarepatientisscheduledforsurgeryduetothefindingofwhatlookslikeanovarianmassontherightovary.Onenteringtheabdomen,thesurgeonfindsanenlargedovariancystontheright,buttheovaryisotherwisenormal.Theleftovaryisnecroticlooking.Thedecisionismade,basedonthepatient’sage,toremovethecystfromtherightovary,butperformsaleftsalpingo-oophorectomy.Codethisencounter.

A.58720-RT,58925-LTB.58925-RT,58720-51-LT

C.58925,58720-50D.58720,58925-51

Question15

A35-year-oldmalepatientpresentedtoanurologistbecausehewashavingcontinuousyeastinfectionsandirritationonhispenis.Thephysicianrecommendedhehaveacircumcision.Thephysicianperformedthecircumcisionusingaclampwithregionalblock.Codethisprocedure.

A.54150B.54160

C.54161D.54150-52

Question16

A55-year-oldmanwithcomplaintsofanelevatedPSAof6.5presentstotheoutpatientsurgicalfacilityforprostatebiopsies.Thepatientisplacedinthelateralposition.Somecalcificationswerefoundintherightlobe,withnoobvioushypoechogenicabnormality.Thebaseoftheprostatewasinfiltratedandunderultrasonicguidancerandomneedlebiopsieswereperformed.

A.55700,76872-26B.55706

C.55700,76942-26D.55700

Question17

ThepatientwastakentotheprocedureroomandplacedproneandtheL4–L5interspacewasidentifiedusingfluoroscopytodeterminetheinjectionsite.ThepatientwaspreppedinroutinesterilefashionwithBetadineandcoveredinsteriledrape.1%lidocainewasusedtoanesthetizetheskin,subcutaneoustissue,andmuscle.Oncetheproperanesthesiawasobtained,a3inch,20gaugeTuohyneedlewasinsertedandslowlyadvancedtowardstheL4-L5interspace.Usinga6ccglasssyringeandtheloss-of-resistancetechniquetheepiduralspacewasidentified.Afteraspirationrevealednobloodorcerebrospinalfluidreturn,thesyringeswerethenchangedand80mg/mlpreservative-freeDepoMedroland2ccof1%methylparabenfreelidocainewereinjectedinslowincrementalfashion.Afteraspiration,allneedleswereremovedintact,theskinwascleanedandaBand-Aidwasapplied.Codethisencounter.

A.62311B.62311,77003-26

C.62310,77003-26D.62319,77003-26

Question18

A65-year-oldpatientpresentedwithectropionoftherightlowereyelid.Repairwithtarsalwedgeexcisionisperformedforcorrection.Attentionwasthendirectedtothelefteye.Thepatientalsohadanectropionoftheleftlowerlidwhichwasrepairedbysuturerepair.Codethisprocedure.

A.67916-50B.67916-E4,67914-E2

C.67914-50D.67923-E4,67921-E2

Question19

A42-year-oldpatientreturnstothehospitalneurologyclinicforfollow-up.Hewascheckedthreedayspriortothisvisitwherealumbarpuncturewasdonetofindtheetologyofthepatient’sheadaches.Theheadacheshaveincreasedinintensityoverthepastthreedays.TheneurologistexaminesthepatientandfindsaCSFleakfromthelumbarpuncture.Abloodpatchbyepiduralinjectionisperformedtorepairtheleak.Codetheservicesfortoday’svisit.

A.62272B.62273

C.62270,62273D.62270,62287

Question20

A63-year-oldwomanpresentedtotheeyeclinicasanewpatientwithsymptomsofflashinglightsandfloatersintherighteyefortwodaysduration.Theophthalmologistdoesageneralevaluationofthecompletevisualsystem,includingdilatinghereyesandcheckingherwiththeindirectophthalmoscope,revealingperipheralretinaltear.Thephysicianexplainstothepatientthatifleftuntreated,thereisahighlikelihoodofretinaldetachment.Thepatientagreestotheprocedure.Thephysicianlaserstheretinaltearandtellsthepatienttocomebackin24hoursforfollow-up.Codethisvisit.

A.67210,92004-25B.67145,92004-25

C.66821D.67145

Question21

42-year-oldwomanisbeingdischargedtoday,2/5/XX.Shewasadmittedtothehospital2/2/XXforacutediverticulitis.Refertodictatednotesforadetaileddescriptionofthehistory,exam,andassessmentandtreatmentprotocol.PatientwasalsoseeninconsultationbyDrZ.Shewasplacedonintravenousantibioticsandhasmadeslowsteadyprogress.Todayhasnoabdominalpain.LabsarenormalandCToftheabdomenandpelvisshowedchangesconsistentwithdiverticulitisintheleftsideofcolon.Shewasgivenfollowupinstructionsofhermedications,whatdiettohaveandtofollowupwithPCPin10to14daysorreturnifpainresumes.Totaltimespentwithpatient40minutes.WhatCPT®code(s)shouldbereported?

A.99233,99239B.99217

C.99252,99238D.99239

Question22

63-year-oldmaniscominginforasecondopinionforhissleepapnea.Hehashaditforthepastfivemonths.Sleepisdisruptedbyfrequentawakeningsandgettingworseduetoanxietyandsnoring.Hefeelstiredallthetime,hassomejointstiffnessandnightsweats;allothersystemswerenegative.Heisgoingthroughadivorcewhichiscausinghimanxietyandhadaherniarepairtwomonthago.Doctorperformsacomprehensiveexamandorderslabsandasleepstudytest.Prescriptionwasgiventohelpwiththeanxiety.WhatCPT®codeshouldbereported?

A.99203B.99204

C.99244D.99214

Question23

A55-year-oldestablishedpatientiscominginforapre-opvisit;heisgettingalivertransplantduetocirrhosis.Thephysicianperformsanexpandedproblemfocusedhistory,detailedexamination,andmoderateMDM.Patientagreeswithhisphysician’srecommendationsandthetransplantationwilltakeplaceasscheduled.Aftertheevaluation,thepatientexpressesanumberofconcernsandquestionsfortheprospectivelivertransplant.Physicianspendsanadditional30minutes,excludingthetimespentindoingtheE/Mservice,incounselingandansweringquestionsregardingthesurgeryanddiscussingpossibleoutcomes.WhatCPT®codesshouldbereported?

A.99213,99354B.99214,99358

C.99213,99358D.99214,99354

Question24

A56-year-oldreceivesgeneralanesthesiaforanopenpleurabiopsy.Ananesthesiologistmedicallydirectingtwoothercases,andmedicallydirectsaCRNAonthiscase.Whataretheappropriatecodesforbothproviders?

A.00540-AA,00540-QZB.00540-QK,00540-QX

C.00541-AA,00540-QZD.00541-QK,00541-QX

Question25

Theanesthesiologistperformsanaxillaryblockforpostoperativepainmanagement.Thepatientreceivesgeneralanesthesiaforacarpaltunnelrelease.Whataretheappropriatecodes?

A.01810B.01810,64417

C.01810,64417-59D.01830,64417-59

Question26

Ahealthy45-year-oldishavinganeedlethyroidbiopsy.Theanesthesiologistbeginstopreparethepatientforsurgeryat0900.Thesurgerybeginsat0915andendsat0945.Theanesthesiologistturnsoverthecareofthepatienttotherecoveryroomnurseat1000.Whatistheappropriateanesthesiacodeandwhatistheanesthesiatime?

A.00320,onehourB.00320,45minutes

C.00322,45minutesD.00322,onehour

Question27

Thephysicianrequestsadualenergyabsorptiometryofthefoot.Whichcodeshouldbereportedforthisdiagnostictest?

A.77080B.77081

C.77079D.77077

Question28

Thephysicianperformsanabdominalaortographywithselectiveinjectionoftherightrenalarteryandrenalangiography.Thepuncturesitewastherightfemoralartery.

A.36215-RT,75722-26B.36245-RT,36200,75722,75625

C.36245-RT,75722,75625D.36245-RT,75722-26

Question29

Apatientwithcoloncancerreceivessevenradiationtreatments.Duringthecourseofthetreatments,thephysicianviewstheportfilms,reviewsthetreatmentparameters,andassessesthepatient’sresponsetothetreatment.Codefortheradiationtreatmentmanagement.

A.77427B.77431x4

C.77427x2D.77427,77431

Question30

Asurgicalspecimenwasremovedfromtheproximaljejunumduringaresectionforadenocarcinomaandwassubmittedtosurgicalpathologyforgrossandmicroscopicexamination.Thecorrectcodeforthisserviceis:

A.88300B.88309

C.88304D.88305

Question31

Thephysicianperformsthefollowingtestsonherautomatedequipment:HDL,totalserumcholesterol,triglyceridesandaquantitativeglucose.Thecorrectcodesfortheseproceduresare:

A.83718,82465,84478,82947B.83721,82465,82951

C.80061,82947D.80061,82950

Question32

Apatientwithrheumatoidarthritisisbeingtreatedwithgold.Thephysicianordersatherapeuticdrugtesttomeasurethelevelofgold.Whatisthecorrectcode?

A.80172B.80100

C.80102D.80299

Question33

Apatientpresentstoheroncologist’sofficeforschedulechemotherapy.Thepatientisseverelydehydrated.Thephysiciandecidestoschedulethechemotherapyforanotherdayandordershydrationtherapytobeperformedtodayinsteadofthechemotherapy.Thetherapyisorderedandadministeredforonehourand10minutes.Selectthecode(s).

A.96413-53,96360B.96360

C.96360,96361D.96413,96361

Question34

Leftheartcatheterizationretrogradefromthefemoralarterywithinjectionproceduresforselectivecoronaryangiographyandselectiveleftventriculography,includingimagingsupervisionandinterpretationwithreport,areperformed.Thecardiologistperformedalloftheservicesatthehospital.TheCPT®codesare:

A.93458C.93452,93454

C.93452,93563D.93458,93565

Question35

35.ThecorrectcodeforOMTperformedonthecervical,thoracicandsacralregionswouldbe:

A.97110B.98941

C.98926D.97124

Question36

ThepatientisadmittedtothehospitalforaneightchannelEEGtodeterminethefocusofhercerebralseizures.TheEEGisperformedfor24hours.Selecttheappropriatecode.

A.95813B.95824

C.95827D.95950

Question37

Whatisorchitis?

A.InnerearimbalanceB.Lacrimalinfection

C.InflammationoftestisD.Inflammationofanilioinguinalhernia

Question38

Thewoundwasdebrided.Whatwasdonetothewound?

A.Itwasclosedwithlayeredsuturesanddressed
B.Itwasmedicatedandleftopentoheal
C.Itwascleansedofforeignmaterialsordeadtissue
D.Itwasexaminedradiographicallyfordefects

Question39

Whichofthefollowingpatientsmightbedocumentedashavingmeconiumstaining?

A.WomanwithrenalfailureB.Teenageboywithsicklecellanemia

C.NewbornwithpneumoniaD.Manwithalcoholiccirrhosisofliver

Question40

Whichofthefollowinganatomicalsiteshaveseptums?

A.Nose,heartB.Kidney,lung

C.Sternum,coccyxD.Orbit,ovary

Question41

Lordosisisadisorderofwhichanatomicalsite?

A.SpineB.Integument

C.MalegenitaliaD.Nasalsinus

Question42

ThenewbornhasbeenplacedinNICUtotreatherpeticvesiclesonhertorsoandlowerextremities.Testshavebeenorderedtoruleoutherpeticencephalitis,chorioretinitis,andsepsis,andprophylacticprotocolswillbeputinplacetopreventspreadoftheinfectionfromrupturinglesions.Codethepatient’sdiagnosis.

A.054.9B.771.2

C.646.92D.054.0

Question43

FollowingtheMUGAscan,thephysiciandocumentsthatthepatienthasdevelopedcongestiveheartfailureassociatedwiththetrastuzumabshereceivedasatreatmentforherbreastcancer.Thetrastuzumabantineoplasticantibiotictherapyisbeingdiscontinuedwhileheattemptstomanagetheheartfailurepharmaceutically.Codethediagnosis.

A.428.0,960.7,V10.3,E930.7B.428.0,963.1,174.9,E930.7

C.428.0,174.9,E930.7D.428.0,174.9,E933.1

Question44

ThepatienthasahistoryofsymptomaticHIV.

A.V08B.042

C.V12.2D.795.71

Question45

Themother,38-weeksgestation,advancestoseverepre-eclampsiaduringlabor.Fetaldecelerationsduringcontractionsarenotimprovedwiththeadministrationofoxygen,soalowtraversecesareansectionisperformed.Thereisevidenceofintrauterinegrowthretardation,andtheplacentaisnotedtobesmall.Themaleinfantweighs1587gmandhasApgarsof3and5.Selectthebestcodesequencefortheinfant’schart.

A.760.0,763.81,V27.0B.760.0,763.82,764.16,763.4,V30.01

C.760.0,763.82,764.16,765.29,V30.01D.760.0,763.81,764.15,765.29,V27.1

Question46

Thephysicianperformedamedialmeniscectomyandremovalofloosebodiesfromthelateralcompartment.SelecttheappropriatecodesforaMedicarepatient.

A.29881B.29881,G0289

C.29880,29874D.G0289

Question47

WhichofthefollowingVcodescanbereportedasafirstlistedcode?

A.V27.0B.V07.4

C.V13.61D.V20.2

Question48

WhatisthefullCPT®codedescriptionfor61535?

A.Craniotomywithelevationofboneflap;forsubduralimplantationofanelectrodearray,forlong-termseizuremonitoring;forremovalofepiduralorsubduralelectrodearray,withoutexcisionofcerebraltissue(separateprocedure)
B.Craniotomywithelevationofboneflap;forremovalofepiduralorsubduralelectrodearray,withoutexcisionofcerebraltissue(separateprocedure)
C.Forremovalofepiduralorsubduralelectrodearray,withoutexcisionofcerebraltissue(separateprocedure)
D.Forexcisionofepileptogenicfocuswithoutelectrocorticographyduringsurgery;;forremovalofepiduralorsubduralelectrodearray,withoutexcisionofcerebraltissue(separateprocedure)

Question49

Whichofthefollowingplaceofservicecodesisreportedforfracturecareperformedbyanorthopedicphysicianintheemergencydepartment?

A.11B.20

C.22D.23

Question50

Whichofthefollowingisanexampleoffraud?

A.Reportingthecodeforultrasoundguidancewhenusedtoperformaliverbiopsy.
B.Reportingabiopsyandexcisionperformedonthesameskinlesionduringthesameencounter.
C.Failingtoappendmodifier26onanX-raythatisperformedinthephysician’soffice.
D.Failuretoappendmodifier57ontheEMserviceperformedthedaypriortoaminorprocedure.

Question51

A15-year-oldboywasburnedinafireandassessedtohavereceivedburnsto75percentofhistotalbodysurfacearea.Hewastransferredtoaburncenterfordefinitivetreatment.Oncestable,hewasbroughttotheOR.Procedure:Duetoextentofthepatient’sburnsandlackofsufficientdonorsites,hisfull-thicknessburnswillbeexcisedandcoveredwithporcinegrafts,andasplit-thicknessskinbiopsywillbeharvestedforpreparationofautologousgraftstobeappliedinthecomingweeks,whenavailable.Afterinductionofanesthesia,extensivedebridementofthefull-thicknessburnswasundertaken.Attentionwasfirstdirectedtothepatient’sface,neck,andscalp.Atotalof500sqcminthisareareceivedfull-thicknessburns.Theescharinvolvingthisareawasexciseddowntoviabletissue.Hemostasiswasachievedusingelectrocautery.Attentionwasthenturnedtothetrunk.Atotalof950sqcminthisareareceivedfull-thicknessburns.Theescharinvolvingthisareawasexciseddowntoviabletissue.Hemostasiswasachieved.Attentionwasthenturnedtothearmsandlegs.Atotalof725sqcmreceivedfull-thicknessburns.Theescharinvolvingthisareawasexciseddowntoviabletissue.Hemostasiswasachieved.Attentionwasthenturnedtothehandsandfeet.Atotalof300sqcminthisareareceivedfull-thicknessburns.Theescharinvolvingthisareawasexciseddowntoviabletissue.Allinvolvedareaswerethencoveredwithporcinegraft.Finallyasplitthicknessskingraftof0.015inchesindepthwasharvestedusingadermatomefromaseparatedonorsite.Atotalof85sqcmwasrecovered.Whatprocedurescodeswouldbereportedservice?

A.15300,15301x10,15320,15321x10,15004,15005,15002,15003
B.15420,15421x7,15400,15401x16,15004,15005x16,15002,15003x7
C.15420,15421x7,15400,15401x16,15004,15005x7,15002,15003x16,15040
D.15420,15421x7,15400,15401x16,15004,15005x7,15002,15003x16

Question52

Theleftbreastwaspreppedanddrapedinasterilefashion.Anincisionfromthe3aroundtothe9o’clockpositionontheareolarborderonitsinferioraspectwasmadeintheskinandextendedtothesubcutaneoustissue.Thebreastmasswasexcisedbysharpdissection.Themasswasfoundtobeapproximately1.5-2cminmaximumdimension.Frozensectionrevealedclearmargins.HemostasiswasmadeadequateusingelectrocauteryandtheArgonbeamcoagulator.Afterthiswasaccomplished,theskinmarginswerereapproximatedwithrunninginverted3-0Vicrylsubcuticularsuture.Selecttheprocedureanddiagnosiscodes.

A.19120,611.72B.19301,611.72

C.19125,217D.19101,611.79

Question53

This37-year-oldparaplegichasdevelopedasacraldecubitusulcer.HeisbroughttotheORtodayfordebridementofthepressureulcerwithasplit-thicknessskingrafttocoverthedefect.Thepatientwasplacedproneontheoperativetableafterinductionofadequateendotrachealanesthesia.Thesacralareawaspreppedanddrapedsterilely,andtheulcerisinspected.Theareaisdebridedextensivelytohealthytissue.Involvedbone,includingpartofthecoccyx,wasalsoremoved.Oncetheareawasclearofnecrotictissue,thesitewaspreparedforaskingraft.Asplit-thicknessskingraftwasharvestedfromthethighwithadermatome.Totalgraftsizewas25sq.cm.Thegraftwassuturedinplaceusing6-0Vicryl.Theharvestsitewasclosedprimarilywithskinstaples.Dressingswereapplied.Needlecountswerecorrectx2.Thepatienttoleratedtheprocedurewell.Codetheprocedure(s).

A.15002,15100-51B.15937,15100-51

C.15937D.15937,15100-51,15002

Question54

A17-year-oldmalepresentstotheemergencydepartmentafterbeinginvolvedinacaraccident.Thepatient’sprimaryphysiciancallstheorthopedicsurgeontotheemergencydepartment.Theorthopedistdiagnosesasprainedkneeligament.Heplacesalonglegwalkingcastandinstructsthepatienttoreturntohisofficeforfollow-upcare.Whataretheprocedureanddiagnosiscodes?

A.29358,844.8B.29355,844.9

C.27520-54,844.0D.29345,844.9

Question55

Patientcomplainsofchronic/acutearmandshoulderpainfollowingbilateralcarpaltunnelsurgery.Patientisfollowedbypainmanagementforoverayear.Physicianfinallydiagnosespatientwithreflexdystrophysyndrome(RSD).Physicianperformssixtriggerpointinjectionsintofourmusclegroups.Codetheprocedure(s).

A.20552B.20610x6

C.20552x5D.20553

Question56

AGradeI,highvelocityopenrightfemurshaftfracturewasincurredwhena15-year-oldfemalepedestrianwashitbyacar.Shewastakentotheoperatingroomwithinfourhoursofherinjuryforthoroughirrigationanddebridement,includingexcisionofdevitalizedbone.Thepatientwasthenreprepped,redraped,andrepositioned.Intramedullaryroddingwasthencarriedoutwithproximalanddistallockingscrews.Whatarethecorrectcodesforthisdiagnosisandprocedure?

A.27506,11044-51,821.11B.27506,11012-51,821.11

C.27507,11012-51,821.01D.27507,11044-51,821.10

Question57

This25-year-oldmalepresentswithdeviatednasalseptum.Afterintubation,alefthemitransfixionincisionwasmadewithelevationofthemucoperichondrium.Cartilagefromthebonyseptumwasdetachedandthenasoseptumwasrealignedandremovedinapiecemealfashionfromtheobstructedperpendicularplateoftheethmoid.Thereafter,4-0chronicwasusedtoapproximatemucousmembranes.Next,submucousresectionofthemiddleandinferiorturbinateswashandledintheusualfashionbyremovingtheanteriorthirdofthebonyturbinateandlateralmucosalfollowedbybipolarcauterizationoftheposteriorenlargedtipoftheinferiorturbinateaswellasoutfracturing.Asmallamountofsilvernitratecauterywasusedtoachievehemostasis.AdressingconsistedofafoldofTelfawithaventilatingtubefornasalairwayoneachsideachievedgoodhemostasis,patientwenttorecoveryingoodcondition.Whatisthecorrectcodeforthisprocedure?

A.30520B.30420

C.30620D.30450

Question58

Atthepatient’sbedsideinthehospital,aPICClineisinserted.UsingXylocainelocalanesthesia,aseptictechniqueandultrasoundguidance,a21gaugeneedlewasusedtoaspiratetherightcephalicveinofa72-year-oldpatient.Whenbloodwasobtained,a0.018inchplatinumtipguidewirewasadvancedtothecentralvenouscirculation.A6FrenchduallumenPICCwasintroducedthrougha6Frenchpeel-awaysheathtotheSVARAjunctionandafterremovalofthesheath,thecatheterwasattachedtotheskinwithaSTAT-LOCKdeviceandflushedwith500unitsofHeparinineachlumen.Asteriledressingwasappliedandthepatientwasdischargedinimprovedcondition.Codetheprocedure(s).

A.36565B.36556,76942-26

C.36561,76942-26D.36569,76942-26

Question59

Thepatienthadbeenhoarseforamonth.Hissurgeonscheduledadirectlaryngoscopywithinjectionofhisvocalcords.Duringthesurgeryitbecamenecessarytouseanoperatingmicroscope.Howshouldtheseservicesbereported?

A.31571B.31561

C.31571,69990D.31545

Question60

A62-yearoldfemalewiththree-vesseldiseaseandsupraventriculartachycardia,whichhasbeenrefractorytoothermanagement.Shepreviouslyhadpacemakerplacementandstentingofthecoronaryarterystenosis,whichhasfailedtosolvetheproblem.ShewillundergoCABGwithautologoussaphenousveinandamodifiedMAZEproceduretotreatthetachycardia.Therisksandbenefitshavebeendiscussedandthepatientwishestoproceed.SheisbroughttothecardiacORandplacedsupineontheORtable.Sheispreppedanddrapedandadequateendotrachealanesthesiaisassured.Amediansternotomyincisionismadeandcardiopulmonarybypassisinitiated.Theendoscopeisusedtoharvestanadequatelengthofsaphenousveinfromherleftleg.Thisisuneventfulandbleedingiseasilycontrolled.Theveingraftispreparedandcuttotheappropriatelengthsforanatomosis.Threebypassesareperformed,onetotheLAD,onetothecircumflexandanotherdistallyonthecircumflex.Amodifiedmazeprocedurewasthenperformedandthepatientwasweanedfrombypass.Oncetheheartwasonceagainbeatingonitsownagain,weattemptedtoinduceanarrhythmiaandthiscouldnotbedone.Atthispoint,thesternumwasclosedwithwiresandtheskinreapproximatedwithstaples.ThepatienttoleratedtheprocedurewithoutdifficultyandwastakentothePACU.Choosetheprocedurecode(s)forthisservice.

A.33519,33508,33254-51B.33512,33508,33999-51

C.33512,33508,33254-51D.33512,33508-51,33254-51

Question61

ApatientdiagnosedwithGERDpresentstothesamedaysurgerydepartmentforanupperGIendoscopy.TheprocedureisdoneinordertotreattheGERDbydeliveringthermalenergytothemuscleofthegastriccardiaandloweresophagealsphincter.Anesthesiawasadministeredandasthephysicianbeginstheprocedure,thepatient’sbloodpressuredropstoadangerouslylowlevel.Thephysiciandecidesnottofinishtheprocedureduetotheriskitmaycausethepatient.Whatarethecodesforthisprocedureanddiagnosis?

A.43257-73,530.7,458.8B.43499,530.81,458.9

C.43257-74,530.81,458.29D.43257-53,530.81,458.29,V64.1

Question62

Preoperativediagnosis:HistoryofpriorcolonpolypsPostoperativediagnosis:Colonpolyps,diverticulosis,hemorrhoidsProcedure:Arectalexamwasperformedandrevealedsmallexternalhemorrhoids.Thevideocolonoscopewaspassedwithoutdifficultyfromanustocecum.Thecolonwaswellprepped.Theinstrumentwasslowlywithdrawnwithgoodviewsobtainedthroughout.Therewasa3mmpolypintheproximalascendingcolon.Thispolypwasremovedwithhotbiopsyforcepsandretrieved.Therewasa4mmrectalpolyplocated10cmfromtheanusintheproximalrectum.Thepolypwasremovedbyhotbiopsyforceps.Therewasalsomoderatediverticulosisextendingfromthehepaticflexuretothedistalsigmoidcolon.CodetheCPT®procedure(s).

A.45384B.45384,45384-51

C.45380,45384D.45383

Question63

ApatientwithesophagealcancerisbroughttotheORforsubtotalesophagectomy.Athoracotomyincisionismadeandtheesophagusisidentified.Thetumoriscarefullydissectedfreeofthesurroundingstructures.NoinvasionoftheaortaorIVCisidentified.Thecervicalesophagusiscontrolledwithpursestringsuturesandthentransectedabovethesternalnotch.Theesophagusisthendissectedfreeofthestomachandtheentirespecimenisremovedfromthechestcavityandsenttopathology.Thestomachisthenpulledintothechestcavityandanastomosedtotheremainingcervicalesophagealstump.Theanastomosisistestedforpatencyandnoleaksarefound.Hemostasisisassured.Thechestisexaminedforanysignsofadditionaldiseasebutisgrosslyfreeofcancer.Thechestisclosedinlayersandachesttubeisplacethroughaseparatestabincision.ThepatienttoleratedtheprocedurewellandwastakentothePACUinstablecondition.

A.43101B.43117

C.43107D.43112

Question64

PatientwithRUQpainandnauseasuspectedofhavingastoneorotherobstructioninthebiliarytractisbroughtinforERCPunderradiologicguidance.Procedure:Thepatientwasbroughttothehospitaloutpatientendoscopysuiteandplacedsupineonthetable.Themouthandthroatwereanesthetized.Underradiologicguidance,thescopewasinsertedthroughtheoropharynx,esophagus,stomachandintothesmallintestine.TheampullaofVaterwascannulatedandfilledwithcontrast.Itwasclearthattherewasanobstructioninthecommonbileduct.Theendoscopewasadvancedretrogradetothepointoftheobstruction,whichwasfoundtobeastonethatwasremovedwithastonebasket.Therestofthebiliarytractwasvisualizedandnootherobstructionsoranomalieswerefound.Thescopewasremovedwithoutdifficulty.Thepatienttoleratedtheprocedurewell.

A.43260,74328-26B.43264,74328-26

C.43265D.43269,74329

Question65

Acolposcopewasintroducedintothepatient’svaginaandunderdirectvisualizationthroughabinocularmicroscopeexcessivelesionswererevealedinandaroundthevagina.Electrocauteryandlaservaporizationwereusedtodestroytheextensivenumberofvaginallesions.Whataretheprocedureanddiagnosiscodes?

A.57061,623.8B.57065,623.8

C.57000,621.9D.57120,621.9

Question66

Apregnantpatientisdiagnosedwithanincompetentcervix.Thephysicianperformsacervicalcerclagetopreventamissedabortion.Afterinsertingaspeculumintothevaginatoviewthecervix,thephysicianthreadsheavysuturematerialaroundthecervixusingpurse-stringsutures.Thesuturesarepulledtighttomaketheopeningsmallerandpreventspontaneousabortion.Whataretheprocedureanddiagnosiscodes?

A.57700,654.50B.59320,654.53

C.59325,622.5D.59899,622.5

Question67

Apatientisdiagnosedwithabladdertumor.Thephysicianperformsacystourethroscopywithfulgurationandresectsa7cmbladdertumor.WhichCPT®code(s)wouldyouuseforthisservice?

A.52000,52235B.52000,52240

C.52240D.52204,52240

Question68

PostoperativeDiagnosis:CarpaltunnelsyndromerightwristThepatientwasbroughttotheoperatingroomandsedatedbyanesthesia.Aftersterilepreppinganddrapingoftherighthand,wristandarmthepatient’sareaofincisionwasinfiltratedwithXylocaine/Marcaineinfiltration.AftersatisfactoryanesthesiaanEsmarchbandagewasusedtoexsanguinatetherighthandandwristandusedaboutthedistalforearmasatourniquet.Acurvilinearincisionwasmadeonthepalmaraspectoftherightwrist.Dissectionwascarriedoutthroughtheskinandsubcutaneoustissue.Bleedingwascontrolled.Themediannerveanditbrancheswereidentified,retracted,andprotectedatalltimes.Theligamentwasincisedfromproximaltodistal.Athoroughdecompressionwascarriedout.Aneurolysiswascarriedout.Thenervewasfoundtobeflattenedandischemicunderneaththetransversecarpalligament.Thefasciawasclosed,thetourniquetwasreleased.Adressingwasappliedandpatientwastransferredtorecoveryroom.Codethisprocedure.

A.64721-RTB.64450-RT

C.64614-RTD.29848-RT

Question69

A35-year-oldmanpresentstotheurgentcarecenterwithsevereneckpain.Thephysicianexaminesthepatientandmakesthediagnosisofcervicalnerveimpingementandinjectsananestheticagentintothecervicalplexususingthreeinjections.Selecttheprocedureanddiagnosiscodes.

A.64400x3B.64405

C.64413D.64413x3

Question70

Afour-year-oldwithchronicotitismediaandfluidbuildupinbothearswasadmittedbyherotolaryngologistforabilateraltympanostomy.Theprocedurewasperformedwithplacementofventilatingtubes.Theprocedurerequiredgeneralanestheticduetothepatient’sage.Selecttheprocedurecodeforthisprocedure.

A.69420-50B.69421-50

C.69433-50D.69436-50

Question71

Physicianperformsamedicalreviewanddocumentationonan83-year-oldpatientstillhospitalizedforconfusionforthelasttwodays.Sheisalertandorientedx3today.Reviewingherlabsfromyesterday,herBNPwaselevatedsuspectingherconfusionisduetocongestiveheartfailure.Anechocardiogramisorderedandtreatmentwillbeforcongestiveheartfailure.Patientisnotsafetoreturnhome.WhatCPT®codeshouldbereported?

A.99231B.99221

C.99218D.99232

Question72

AplasticsurgeoniscalledtotheEDattherequestoftheemergencydepartmentphysiciantoevaluateapatientthatarrivedwithmultiplefacialfracturesafterbeinginanautomobileaccidentforheropinionontheneedforreconstructivesurgery.TheplasticsurgeonarrivesattheED,obtainsahistoryofpresentillnessincludinganextendedhistoryofpresentillness;asystemreview,includingconstitutional,musculoskeletal,integumentary,neurologic,andEENMT;andthepatient’ssocialhistoryandpastmedicalhistory.Theplasticsurgeonthenperformsaphysicalexamincludingrespiratory,cardiovascular,andanextendedexaminationoftheskinandbonystructuresofthepatient’sface.Theplasticsurgeonperformsmoderatemedicaldecisionmaking,includingdecidingthepatientneedsmajorsurgerytorepairtheinjuries.TheplasticsurgeonschedulesthepatientforsurgerythenextdayanddocumentsherfullnotewithfindingsintheEDchart.

A.99284-57B.99244

C.99243-57D.99221

Question73

Attherequestofthemother’sobstetrician,thephysicianwascalledtoattendthebirthofaninfantbeingdeliveredat29weeksgestation.Duringdelivery,theneonatewaspaleandbradycardic.Suctioningandbagventilationonthis1000gramneonatewasperformedwith100percentoxygen.Brachycardiaworsened;endotrachealintubationwasperformedandinsertionofanumbilicallineforfluidresuscitation.LaterthiscriticallyillneonatewasmovedfromthedeliveryroomandadmittedtotheNICUwithsevererespiratorydistressandcontinuedhypotension.Whataretheappropriateprocedurecodes?

A.99465,99468B.99465,99464,99468-25,31500,36510-51

C.99468,99464D.99465,99468-25,31500-59,36510-59

Question74

Patientisadmittedinlaborfordelivery.Shereceivedalaborneuraxialepiduralforavaginaldelivery.Thebabygoesintofetaldistressandacesareansectionisperformed.Followingdeliverythepatientstartstohemorrhage.Thephysiciandecides,withfamilyapproval,toperformahysterectomy.Codetheanesthesiaservices.

A.01967,00840B.01962

C.01968D.01967,01969

Question75

Angiogramsrevealthreearteryblockages.ThepatienthasCOPD,whichisaseveresystemicdisease.ThepatientundergoesaCABGX3venousgraftsoncardiopulmonarybypassandcellsaver.Codetheanesthesiaservice.

A.00562-P3B.00560-P4

C.00567-P3D.00566-P4

Question76

Ahealthy11-month-oldpatientwithbilateralcleftlipandpalateundergoessurgery.Thesurgeonperformsabilateralcleftliprepair,singlestage.Codetheanesthesiaservice.

A.00170-P1,99100B.00102-P1

C.00102-P1,99100D.00170-P1

Question77

A78-year-oldwithlowerbackpainandlegpainisscheduledforanMRIoflumbarspinewithoutcontrast.FollowingtheMRI,thepatientisdiagnosedwithspinalstenosisofthelumbarregion.Whataretheprocedureanddiagnosiscodes?

A.72020,724.2,729.5,724.00B.72149,724.5

C.72148,724.02D.72158,724.2,729.5

Question78

A46-year-oldfemalewithhistoryofcervicalcarcinoma.Sheunderwentplacementofanilealconduit,withsubsequentdevelopmentoflefthydronephrosis.Aretrogradeureteralcatheterwasrecentlyplaced.Shereturnstodayforcatheterexchange.Patientwasplacedinthesupineposition.Theilealconduitwasaccessed.Theexistingcatheterwasremovedoveraguidewireandreplacedwithasimilar10French50cmlonglockingpigtailcatheter.Contrastwasinjected,confirminggoodposition.IMPRESSION:Leftretrogradeureteralcatheterexchangeviatheilealconduit.

A.50398,75984B.50393,74480

C.50385D.50688,75984

Question79

Thephysicianordersanultrasoundonapatient25weekspregnantwithtwinstoaccessfetalheartrateandfetalposition.Selectthecode(s).

A.76805,76810B.76811,76812

C.76816x2D.76815

Question80

ApatientpresentstotheEDwithcrushingchestpainradiatingdowntheleftarmandupunderthechin.ThereareelevatedS-TsegmentsonEKG.ThecardiologistseesandadmitsthepatienttoCCU.HeordersthreeserialCPKenzymeslevelswithinstructionsthatthetestsarealsotobedonewithisoenzymesiftheinitialtestsareelevatedforthatdateofservice.TheCPKenzymelevelswereelevated,thelabcodeswouldbe:

A.82550,82552,82550-76x2,82552-76x2B.82550,82552,82552-91x2

C.82550,82550-91x2,82552,82552-91x2D.82550x3,82554x3

Question81

WhichofthefollowingpanelsdoesNOTincludechloride?

A.80061B.80050

C.80053D.80047

Question82

Thepatientpresentswithburningurinationandfrequency.ThephysicianperformsaUAdipstick,whichshowselevatedWBC.Heordersaurineculturewithidentificationforeachisolatetodeterminewhichantibiotictogivetothepatientfortheinfection.Whataretheappropriatelabcodes?

A.81000,81007B.81002,87088

C.81001,87086D.87086,87088

Question83

Whichofthefollowingcodingcombinationsisanexampleofunbundling?

A.80048,80061B.80076,80100

C.80061,83718,84478D.82310,82355,82374

Question84

Apediatricianismanagingthecareofapatientwhoisathomeonaventilatorunderthecareofahomehealthagency.Thepatienthascysticfibrosisandissufferingfromrecurrentpneumonia.TheMDdidtheinitialplanofcareforthehomehealthagencyandnowisfollowingthismonitorventmanagementoversightonday20.Theproviderhasatotal45minutesforthismonthhowshouldhecode?

A.94002B.94003

C.94005D.94004

Question85

Atwo-month-oldcomesinforawellcheckupandseveralshots(Rota,DTaP-Hib,PCV)withherpediatrician.Heofferssuggestionstothemom,completestheexam,andcounselsheronthevaccinations.Howshouldthisbecoded?

A.99391-25,90471,90472x2,90680,90721,90669
B.99381-25,90460,90461x2,90680,90700,90648,90669
C.99381-25,90471,90472x3,90680,90700,90645,90669
D.99391-25,90460,90461x2,90680,90721,90669

Question86

Mary,whohasfoodallergies,cametoherphysicianforherweeklyallergenimmunetherapythatconsistsoftwoinjectionspreparedandprovidedbythephysician.Thecorrectcodeis:

A.95125B.95117

C.95131D.95146

Question87

Whatoccursinangiography?

A.TheveinsorarteriesareviewedbyX-rayB.Thepatientischeckedforangina

C.TheheartisviewedusingultrasonographyD.Theelectricalcurrentoftheheartismapped

Question88

Meatusdescribes:

A.SeptumB.Muscle

C.PassagewayD.Nutrient

Question89

Whichofthefollowingisnotliketheotherthree?

A.RadiusB.Femur

C.TibiaD.Calcaneus

Question90

Whatisthefunctionoftheesophagus?

A.Tocarryairfromthepharynxintothelungs
B.Tocarrynutrientsfromthepharynxintothelarynx
C.Tocarryairfromthenoseintothelarynx
D.Tocarrynutrientsfromthepharynxintothestomach

Question91

PreschoolvisiontestingdiscoveredthatMatthascongenitaltritanopia,justlikehismother.

A.743.59B.368.52

C.368.53D.743.8

Question92

Mr.Jonesisheretodaytoreceiveanintercostalnerveblocktomitigatethedebilitatingpainofhismalignancy.Hiscancerhasmetastatizedtohislungs.

A.338.3,197.0B.338.3,162.9

C.338.12,162.9D.338.12,197.0

Question93

ThepatientcametodaytodiscussLapbandsurgery.Heisengagedtobemarriednextspring,andisreadytochangehislife.HeismorbidlyobeseandhisBMIcalculatesto41.Hisdiabetesiscontrolledwithpreprandialtabletsof120mgStarlix.Hehasbilateralosteoarthriticchangesinhisknees.Overall,heisagoodcandidatefortheprocedure,andIhavereferredhimtoDr.Mast,generalsurgeon.

A.250.00,278.00,715.96,V84.89B.278.01,250.00,715.96,V85.41

C.250.80,713.06,278.00,V85.41D.278.01,250.80,715.96,V85.41

Question94

Patientpresentswithsternalchestpain,possibleangina.Physicianrulesoutanginaanddocumentsprobablecostochondritis.Codethediagnosis.

A.786.50B.733.6

C.786.51D.413.9

Question95

WhatistheHCPCSLevelIIcodeforwoundclosureusingtissueadhesive(s)only?

A.A6250B.G0168

C.A4452D.A4450

Question96

Apatienthasaninsulinpumpof100units.Thepumpisfilled.Whichcodereportsthesupply?

A.J1817B.J1815x20

C.J1817x2D.J1835

Question97

Whencodingforapatientwhohashadaprimarymalignancyofthethyroidcartilagethatwascompletelyexcisedayearago,whichofthefollowingstatementsisTRUE?

A.Whennofurthertreatmentisprovidedandthereisnoevidenceofanyexistingprimarymalignancy,codeV10.87.
B.Whenfurthertreatmentisprovidedandthereisevidenceofanexistingmetastasis,codefirstV10.87andthen161.3.
C.Anymentionofextension,invasion,ormetastasistoanothersiteiscodedasa239.1.
D.Whenfurthertreatmentisprovidedandthereisevidenceofanexistingmetastasis,codefirst197.3

Question98

Inordertousethecriticalcarecodes,whichofthefollowingstatementsisTRUE?

A.Criticalcareservicescanbeprovidedinaninternist’soffice
B.Criticalcareservicesprovidedformorethan15minutesbutlessthan30minutesshouldbebilledwith99291andmodifier52.
C.Timespentreviewinglaboratorytestresultsordiscussingthecriticallyillpatient’scarewithothermedicalstaffintheunitoratthenursingstationonthefloorcannotbeincludedinthedeterminationofcriticalcaretime.
D.Criticalcareservicescanonlybebilledifthepatientisinalicensedemergencyroomorintensivecaretypeunit(i.e.,cardiac,surgical,respiratory).

Question99

Whichofthefollowingstatementsregardingadvancedbeneficiarynotices(ABN)isTRUE?

A.ABNmustspecifyonlytheCPT®codethatMedicareisexpectedtodeny.
B.GenericABNwhichstatesthataMedicaredenialofpaymentispossibleortheinternistisunawarewhetherMedicarewilldenypaymentornotisacceptable.
C.AnABNmustbecompletedbeforedeliveryofitemsorservicesareprovided.
D.AnABNmustbeobtainedfromapatienteveninamedicalemergencywhentheservicestobeprovidedarenotcovered.

Question100

WhichofthefollowingservicesarecoveredbyMedicarePartB?

A.Inpatientchemotherapy
B.Minorsurgeryperformedinaphysician’soffice
C.Routinedentalcare
D.Assistedlivingfacility

Question101

Thepatientisa32-year-oldfemalewhowasdiscoveredtohavebreastcancerontherightside.Shewastreatedwithmastectomyfollowedbychemotherapyandradiationtherapy.ShenowelectstoproceedwithreconstructionbyTRAMflap.Codeforthereconstruction.

A.19364B.19361

C.19316D.19367

Question102

A55-year-oldmalepresentsintheofficewithaningrowntoenailontherightandleftfoot.Theprocedurewasdiscussedindetailandthepatientelectedtohaveitperformed.Therightfootwaspreppedanddrapedinsterilefashion.Therightgreattoewasanesthetizedwith50/50solutionof2percentlidocaineand.05percentMarcaine.Amini-tourniquetwasplacedaroundthetoeforhemostasis.Thelateralborderwasincisedandexcisedintotal.Phenolwasthenapplied,thetoewasthenflushed.Tourniquetwasreleasedanddressingapplied.Atthistimethepatientelectedtoonlyhaveoneperformedandwillreturnintwoweeksfortheleftfoot.Codetheprocedure.

A.11765B.11750

C.11752D.11740

Question103

Pre-ProcedureDiagnosis:Basalcellcarcinoma,leftchin.Procedure:Widelocalexcisionof3.0cmwith0.3cmmarginbasalcellcarcinomaoftheleftchinwitha4cmclosure.Procedure:Thepatient’sleftchinwasexamined.Thesiteofintendedexcisionwasmarkedout.Thesitewasthenprepped.Thepatientwasthenpreppedanddrapedintheusualfashion.A15bladescalpelwasthenusedtomakeanincisioninthepreviouslymarkedsite.Itwascarrieddowntothesubcuticularfat.Thelesionwasthensharplydissectedoffunderlyingtissuebedusinga15-bladescalpel.Itwastaggedforpathologicorientation.Thehyfrecatorwasusedforhemostasis.Thewoundedgeswerethenundermined.Thewoundwasthenclosedbyadvancingthetissuesurroundingthelesionandclosinginlayerswith3-0Vicrylforthedeeplayer,followedby5-0Prolenefortheskin.Theskinclosurewasinarunningsubcuticularfashion.Steri-Stripswerethenapplied.Whataretheprocedureanddiagnosiscodes?

A.11644,12052-51,173.3B.11643,12013-51,173.3

C.11444,12052-51,239.2D.11443,12013-51,239.2

Question104

Thephysicianremovesatumorfromthepatient’sneckusingtheMohsmicrographicsurgerytechnique.Duringthefirststage,thephysiciantakesfourtissueblocksandreviewsthemunderamicroscope.Theexamofthetissueblocksrevealsasecondstageisnecessarytoremoveareaswherethetumorisstillpresent.Thephysicianremovestwoadditionaltissueblocks.WhataretheappropriateCPT®codesforreportingtheprocedure?

A.17311,17312,17315B.17313,17315

C.17313,17314,17315D.17311,17312

Question105

This45-year-oldmalepresentstotheoperatingroomwithapainfulmassoftherightupperarm.Generalanesthesiawasinduced.Softtissuedissectionwascarrieddownthrutheproximalaspectoftheteresminormuscle.UponfurtherdissectionalargemasswasnotedjustdistaloftheIGHL(inferiorglenohumeralligament),whichappearedtobebenigninnature.Withbluntdissectionandelectrocautery,the4.5cmmasswasremovedenblocandsenttopathology.Thewoundwasirrigated,andrepairoftheteresminorwithsubcutaneoustissuewasthenclosedwithtriple-0Vicryl.Skinwasclosedwithdouble-0Proleneinasubcuticularfashion.WhatisthecorrectCPT®codeforthisservice?

A.23076B.23066

C.23075D.23030

Question106

PostoperativeDiagnosis:1.Impingementsyndromeleftshoulder.2.ACsynovitisleftshoulderProcedure:ArthroscopywithsubacromialdecompressionandACresectionleftshoulder.Thepatientwasplacedsupineontheoperatingtablepreppedanddrapedinusualsterilefashion.Thescopewasintroducedfromaposteriorportalandthejointwasinspected.Therotatorcufflookedingoodcondition.Thearticularsurfaceslookedgood.Thebicepalsowasingoodcondition.Wewentsubacromiallyandtherewasafairamountofbursalinflammationencountered.Wedidathoroughbursectomy.Aligamentchiselwasusedtotakedownthecoracoacromialligament.Ahigh-speedburwasusedtodoasubacromialdecompressiongoingfromlateraltomedial.Wetookoffabout2cmofboneanteriorly.NextweopenedtheACjointthroughananterosuperiorportal.Wegroundoffabout10mmofdistalclaviclebecausetherewasalargesubchondralcystandwewantedtogetthistotallygroundout,whichwedid.Thenthewoundswereirrigatedout,Nylonsuturewasplacedinourportals.Thepatientwasplacedinabulkydressingandanarmslingandsenttotherecoveryroominstablecondition.Codetheprocedure.

A.29826-LT,29824-LTB.29825-RT,29824-RT

C.23120-LT,23130-LTD.29826-LT,29824-LT,29825-LT

Question107

Thepatientpresentedformedialmeniscaltearleftknee.Arthroscopywithpartialmedialmenisectomyleftkneeandarthroscopicpicking(drillingpickholes)ofthelateralfemoralcondyleleftkneewasperformed.Codetheprocedureanddiagnosiscodes.

A.29880-LT,29879-LT,836.0B.29881-LT,29879-LT,836.0

C.29882-LT,29885-LT,836.1D.29881-RT,29885-LT,836.2

Question108

A47-year-oldpatientwaspreviouslytreatedwithexternalfixationforaGradeIIIlefttibiafracture.Thereisnownonunionoftheleftproximaltibiaandheisadmittedforopenreductionoftibiawithbonegrafting.Approximately30gramsofcancellousbonewasharvestedfromtheiliaccrest.Thefracturesitewasexposedandtheareaofnonunionwasosteotomized,cleaned,andrepositioned.Intrafragmentarycompressionwasappliedandthreescrewsandtheharvestedbonegraftwerepackedintothefracturesite.Whatarethecorrectcodesforthisdiagnosisandprocedure?

A.27724,733.82,905.4B.27722,733.82

C.27722,733.81,905.4D.27724,733.82

Question109

Thepatientisathree-year-oldboywhoattemptedtoswallowahalf-dollar.Theboy’smotherimmediatelybroughtthechildtotheED,whichwasonlyashortdistancefromthehouse,andthethoracicteamwascalledemergently.ThepatientwasinacuterespiratorydistresswhenwearrivedintheED.Atemporarytracheostomywasaccomplished,allowingoxygenexchange.X-rayrevealedthecointobedeeplywedgedinthetrachea.SeveralattemptsweremadetoremovethecoinintheEDwiththeuseofforceps,withoutsuccess.ThepatientwasgivenamildsedativeandtakentotheORwhereascopewasusedtosuccessfullyremovethecoin.Thetrachwasdiscontinued.Thepatientwasadmittedforovernightobservationanddischargedthenextdayinsatisfactorycondition.

A.31530,31603-51,934.0B.31635,31603-59,934.0,E912,E849.0

C.31603,31530-59,934.0,E912,E849.0D.31635,934.0

Question110

Thepatienthadtroublebreathingforthreedays.HerurgentcarephysicianreferredhertoanENTphysician.TheENTperformedadiagnosticmaxillarysinusoscopy.Howshouldthesinusoscopybereported?

A.31237B.31256

C.31233D.31256-LT

Question111

Diagnosis:RightlungmassIndications:PatientwithamassintherightlungmassidentifiedonroutineX-raypresentsforbronchoscopyandbiopsy.Procedure:Thepatientwasbroughttotheendoscopysuiteandthemouthandthroatwereanesthetized.Thebronchoscopewasinsertedandadvancedthroughthelarynxtothebronchus.Theleftsidewasexaminedfirstandnoabnormalitieswereappreciated.Thebronchoscopewasthenintroducedintotherightbronchus.Usingfluoroscopicguidance,thetipofthebronchoscopewasmaneuveredintotheareaofthemass.Aclosedbiopsyforcepswaspassedthroughthechannelinthebronchoscopeandthenthroughthebronchialwall.Atissuesamplewasobtained.Therewerenootherabnormalitiesappreciatedintherightsideandthebronchoscopewasremoved.Thespecimenwaslabeledandsenttopathologyfortesting.Thepatienttoleratedtheprocedurewell.Pathologyindicatesthatthemassiscancer.Whataretheprocedureanddiagnosiscodes?

A.31628,786.6B.31628,162.9

C.31628,31622-51,162.9D.31625,786.6

Question112

PreoperativeDiagnosis:LowerleftinguinalpainPostoperativeDiagnosis:InguinalherniaProcedure:This30-year-oldpatientpresentedwithlowerleftinguinalpainandonexaminationwasfoundtohavealeftinguinalhernia.Thedecisiontoperformaleftinguinalherniarepairwasmade.Theprocedurewasperformedintheoutpatienthospitalsurgerycenter.Risksandbenefitsofthesurgerywerediscussedwiththepatientandthepatientdecidedtoproceedwiththesurgery.Askinincisionwasplacedattheumbilicuswheretheleftrectusfasciawasincisedanteriorly.Therectusmusclewasretractedlaterally.Balloondissectorwaspassedbelowthemuscleandabovetheperitoneum.Insufflationanddeinsufflationweredonewiththeballoonremoved.Thestructuralballoonwasplacedinthepreperitonealspaceandinsufflatedto10mmHgcarbondioxide.Theothertrocarswereplacedinthelowermidlinetimestwo.Theherniasacwaseasilyidentifiedandwaswell-defined.Itwasdissectedoffthecordanteromedially.Itwasanindirectsac.Itwastakenbackdownandreducedintotheperitonealcavity.Meshwasthentailoredandplacedoverlyingthedefect,coveringthefemoral,indirect,anddirectspaces,tackedintoplace.Afterthiswascompleted,therewasgoodhemostasis.Thecord,structures,andvaswereleftintact.Thetrocarswereremoved.Thewoundswereclosedwith0Vicrylforthefascia,4-0fortheskin.Steri-Stripswereapplied.Thepatientwasawakenedandcarriedtotherecoveryroomingoodcondition,havingtoleratedtheprocedurewell.Whatarethecorrectprocedureanddiagnosticcodes?

A.49505-LT,550.90B.49505-LT,49568,550.90

C.49507-LT,550.92D.49501-LT,49568,550.92

Question113

PreoperativeDiagnosis:Chronictonsillitis.Chronicadenoiditis.PostoperativeDiagnosis:Same.Procedure:Tonsillectomyandadenoidectomy.Patientisa24-yearoldmalewhowastakentotheoperatingroomandputunderIVsedationbytheanesthesiadepartment.Aninitialcurettageofadenoidswasdoneandpackingwasplaced.Thelefttonsilwasthenidentifiedanddissectedoutextracapsularandremovedwithscissors.Hemostasiswasmaintainedbypackingthelefttonsil.Next,therighttonsilwasidentifiedandincisionwasmade.Dissectionwasdoneextracapsularandtherighttonsilwasthenremoved.Boththerightandlefttonsilweresentasspecimensaswellasadenoidtissue.Whataretheprocedureanddiagnosiscodes.

A.42826,42831-59,474.01B.42826,42831-51-59,42809,474.02

C.42821-50,42809-59,474.00,474.01D.42821,474.02

Question114

DiagnosticupperGIendoscopyoftheesophagus,stomach,andduodenumwasperformedafteresophagealballoondilation(lessthan30mmdiameter)wasdoneatthesameoperativesession.Codetheprocedure(s).

A.43235B.43249

C.43226,43200D.43220,43235

Question115

Thepatienthasapositivepregnancytest,butultrasounddoesnotconfirmagestationalsacinthefirsttrimester.ThephysiciandiagnosesablightedovumandperformsasuctionD&C.Whataretheprocedureanddiagnosiscodes?

A.59870,631B.59820,631

C.58120,631D.59840,631

Question116

Thephysicianperformsacystoscopy,bilateralretrogradepyelograms,removalofstent,andureteroscopyontheleftsideatahospital.DESCRIPTION:Aftersatisfactorygeneralanesthesia,andafterroutinepreparationanddrapinginthelithotomyposition.Theurethraseemedtobefreeoflesions.Therewasnoprostatictissue.Thebladderhadtwodiverticula,onerightendoneleftinferolateralwall,nolesionswerenoted,andtherightwaslarger.UrineforcytologyandFISHwassent.Residualurinewasapproximately100mL.Ureteralstentwasseenintheleftureter.Rightretrogradeureterogramrevealednolesions.Thebladderwasfreeoflesions.Thestentwasremovedeasilyontheleftside,andureteroscopywascarriedoutintotherenalpelviswithnolesionsnoted.RightretrogradepyelogramthenrevealedgradeII-IIIdilatationoftheureter,gradeIdilatationofthecalicesontheleftside,andnootherlesions.Itwasdecidednottoreplacethedouble-Jstent.ThepatienttoleratedtheprocedurewellandwassenttotheRRingoodcondition.Howwouldyoucodetheprocedure?

A.52310,74420-26B.52332,52000-59,74420-26

C.52310,52000,74425-26D.52332,52310,74425-26

Question117

Alaparoscopicremovalofthepatient’slefttesticlewasperformedona34-year-oldpatientwhowasdiagnosedwithtesticularcancer.Codetheencounter.

A.54522,186.0B.58671,257.8

C.54640,257.8D.54690,186.9

Question118

Apatientpresentstotheemergencydepartmentwithcomplaintofpainfuleye.Thepatientstatesthatherrighteyeisconstantlytearingandissensitivetolight.Thephysicianperformsanexamandidentifiesacornealforeignbodyintherighteye.Utilizingaslitlamp,theforeignbodyisremoved.Codetheencounter.

A.65205-RTB.65220-RT

C.65222-RTD.65435-RT

Question119

Thephysicianperformsarightthyroidlobectomy.Thepatientwaspreppedanddraped.Afteradequategeneralanesthesia,theneckwasincisedontherightsideandsharpdissectionwasthenusedtocutdownontothestrapmusclesandsternodcleidomastoidmuscles.Thestrapmuscleswereseparatedandtransectedontherightside.Asmallthyroidlobewasvisualizedanddissectedfree.Therewasnoevidenceofatumor.Thewoundwasclosedwith3-0interruptedVicrylfortheplatysma,4-0Vicrylforthedeeptissuesand6-0fastabsorbinggutfortheskin.Codetheencounter.

A.60252-RTB.60210-RT

C.60220-RTD.60260-RT

Question120

PROCEDURE:BilaterallumbarmedialbranchblockunderfluoroscopyfortheL3,L4,L5medialbranchesfortheL4-L5,L5-S/1facetsfordiagnosticandtherapeuticpurposes.PROCEDURE:Thepatientwasplacedinthepronepositiononthefluoroscopytableandautomatedbloodpressurecuffandpulseoximeterapplied.TheskinentrypointsforapproachingtheanatomictargetpointsofthebilateralsegmentalmedialbranchesordorsalramusofL3,L4,L5wereidentifiedwitha22.5degreefromperpendicularlateralobliquefluoroscopyviewandmarked.FollowingthoroughChlorapreppreparationoftheskinanddrapingand1%lidocaineinfiltrationoftheskinentrypointsandsubcutaneoustissues,a22gauge6"spinalneedlewasplacedunderfluoroscopicguidancedownonthetargetpointforeachrespectivesegmentalmedialbranchordorsalramus.Ateachpoint1mLconsistingof0.5%bupivacaineandDepo-Medrolwasinjected.Atotalof80mgofDepo-Medrolwasdividedbetweenallsixspots.Codetheprocedure(s).

A.64483,64484,77003-26B.64493-50,64494-50,64495-50

C.64493,64494,63395x4,77003-26D.64493-50,64494-50

Question121

38-year-oldfemaleinitialvisit,justmovedfromoutofstate,hasneckandbackpainforthelastyearandisgettingworse.Painisexacerbatedwhenshedrives,bends,orchangespositions,andmoderatelyalleviatedwithibuprofen.Positiveforachesandweaknessinhermusclesandtinglingandnumbnessofthearmsandhands,aswellasheadaches.Allothersystemsarereviewedandarenegative.Shehashadapartialhysterectomyandisdivorced.Hermotherhasahistoryofbreastcancer.Thephysicianperformsanexamonthefollowingsystems:constitutional,eyes,ENT,respiratory,cardiovascular,gastrointestinal,musculoskeletal,andneurologic.X-raysofthecervicalandlumbarspineweretaken.WillbesendinghertogetaMRIandtostartphysicaltherapy.Prescriptionwasgivenformusclerelaxer.SelecttheappropriateCPT®codeforthisvisit?

A.99203B.99204

C.99214D.99244

Question122

Afour-year-oldpatientpresentswithpainintheleftforearmfollowingafallfromachair.Theinjuryoccurredonehourago.Hermomappliedicetotheinjurybutitdoesnotappeartohelp.TheEDphysicianperformsafoursystemROS.Thepatientlivesathomewithbothparentsandattendspre-Kclasses.Thepatienthasnoknowndrugallergies.TheEDphysicianperformsanextendedsixsystemexam.AnX-rayisordered,whichshowsafractureofthedistalendoftheradiusasreadbytheradiologist.TheEDphysicianperformsmoderateconscioussedationwithketaminefor30minutes.ThefractureisreducedandcastappliedbyanorthopedicsurgeonfollowingconsultationwiththeEDphysician.Thechildwasmonitoredwithpulseoxymetry,cardiacmonitorandfrequentphysicianevaluation.Thepatientwasdischargedwithaslingandrequestedtofollowupwiththeorthopedicsurgeon.CodetheservicesperformedbytheEDphysician.

A.99284,99143B.99284-25,99148

C.99283-25,99143D.99283

Question123

Dr.Xperformsafollow-upconsultationoncertainteststhatwerenotavailableinanursingfacilityfora75-year-old-malethatwashavingchestpain.TodaythepatientisfeelingbetterafteraGIcocktailwithMaaloxandXylocaine.TheEKGshowedanarrhythmiaandthechestX-raycamebacknormal.Dr.Xperformsaproblemfocusedhistory.Helistenstothepatient’sheartandlungs.Dr.XmakestherecommendationofrepeatcardiacenzymesandEKGandtohaveaGIevaluation.ThePCPacceptstherecommendationsandimplementstheplanofcare.WhatCPT®codeshouldbereportedforDr.X?

A.99241B.99232

C.99308D.99251

Question124

Physicianwascalledtothefloortoevaluatea94-year-oldthathadsuddenweakness,hypotension,anddiaphoresis.Physicianfoundthepatientinmilddistressanddyspenic.HerBP101/60,pulse85.Herheartwaspositiveforasystolicmurmur.EKGcamebackwithSTelevationV2-V6.Labswerestillpending.ShewasadmittedtoCCUforAcuteAntero-lateralMIandhypotension.Physicianspenttotalcriticalcaretimeof48minutes.SelecttheappropriateCPT®codeforthisvisit:

A.99253B.99233

C.99291D.99236

Question125

TheanesthesiologistperformedMAC(monitoredanesthesiacare)forapatientundergoinganarthroscopyoftherightknee.Codetheanesthesiaservice.

A.01382-AAB.01382-AA-QS

C.01400-AAD.01400-AA-QS

Question126

Generalanesthesiaisadministeredtoa9-month-oldundergoingatracheostomy.Codetheanesthesiaservice.

A.00320,99100B.00320

C.00326D.00326,99100

Question127

Usingultrasoundguidance,thephysicianperformedapercutaneousneedlecorebiopsyonasuspiciouslumponthepatient’srightbreast.Thisprocedurewasperformedinthephysician’soffice.Codethisencounter.

A.10022-RTB.19101-RT,76942

C.19102-RT,76942D.19102-RT

Question128

DuetoanelevatedCEAleveltwoyearsfollowingacolonresection,thepatient’soncologistorderedadiagnosticliverultrasound.Codethisencounter.

A.76700B.78220

C.76705D.76970

Question129

ThephysicianordersaheartCTwithoutcontrast.Thetestswillevaluatetheamountofcoronarycalcium.Whatisthecorrectcode?

A.75571B.75572

C.75574D.75557

Question130

A42-year-oldhasalesiononhispancreas.Thephysicianpassesthebiopsyneedlethroughtheskinandremovestissuetobesenttopathology.Fluoroscopicguidanceisusedtoobtainthebiopsy.Codethisencounter.

A.48100,77002B.48102,77002

C.48120,76942D.48102,76942

Question131

Patientisundergoinginvitrofertilizationtogetpregnant.Followingtheretrievaloffollicularfluidfromthepatient,thephysicianusesamicroscopetoexaminethefluidtoidentifytheooctyes.Whatisthecodeforthelaboratoryservice?

A.89250B.89254

C.89255D.89258

Question132

Apatienthasaniliaccrestbonemarrowbiopsy.Thephysiciansuspectsthepatienthasmyelofibrosis.Thebonemarrowspecimenissenttopathologyforgrossandmicroscopicexam.Whatistheappropriatecodeforthepathologist’sservice?

A.88304B.88305

C.88309D.88307

Question133

Apathologistperformsacomprehensiveconsultationandreportafterreviewingapatient’srecords,specimensandofficialfindingsfromothersources.Whatisthecorrectcode?

A.88325B.99244

C.80502D.88329

Question134

Photodynamictherapyinvolvingapplicationoflightexternallytodestroypremalignantlesionsonthelowerlipwasprovidedtoa63-year-oldpatient.Codetheencounter.

A.96570B.96999

C.96567D.96913

Question135

ThepatientpresentstoseethenurseforhisscheduledvitaminB12injection.Thephysicianorderedtheinjectionatthepatient’slastvisit.Thephysicianisintheofficeseeingotherpatients.Thenurseadministersthe1000mcgofvitaminB12intramuscularly.Sheschedulesthepatientforhisnextappointment.

A.99211-25,96372,J3420B.99211-25,J3420

C.96372,J3420D.96401,J3420

Question136

Intheinpatientsetting,thepsychiatristprovidespsychotherapyfor30minutestoaffectachangeinthepatient’smaladaptivebehavior.Whatistheprocedurecode?

A.90804B.90816

C.90845D.90801

Question137

WhatistheapproachinPTCA?

A.Thepancreaticandcommonbileductsareaccessedviathestomachandduodenum.
B.Acatheteristhreadedthroughanextremityveinandintotheheart.
C.Abronchoscopeisthreadeddownthethroatandintothealveoliofthelung.
D.Throughawide,openincision,theanklefractureisreducedandinternalfixationplaced.

Question138

Apatientwithacontralateralfracturehaswhat?

A.AsecondfractureonthesamesideB.Multipleandcompletebonefractures

C.AfractureofonlythesurfaceoftheboneD.Afractureontheoppositeside

Question139

Whatisascites?

A.FluidintheabdomenB.Enlargedliverandspleen

C.AbdominalmalignancyD.Abdominaltenderness

Question140

Whichofthefollowingisadisorderofthefacialnerve?

A.ExotropiaB.Tarsaltunnelsyndrome

C.BrachialplexislesionsD.Bell’spalsy

Question141

Whichofthefollowingdescribesfunctionsofthelymphaticsystem?

A.Removeexcessfluidfromtissueandtransportsandprotectthebodyagainstdisease
B.Maintainbloodpressureandcirculatehormonesthroughoutthebody
C.Returncarbondioxidetothelungsandprotectthebodyagainstdisease
D.Circulatehormonesthroughoutbodyandreturncarbondioxidetothelungs

Question142

IsletsofLangerhansarefoundinwhichorgan?

A.KidneyB.Parathyroidgland

C.PancreasD.Liver

Question143

Whichofthefollowingconditionswouldmostlikelybeattributedtohyperlipidemia?

A.AtherosclerosisB.Multiplemyeloma

C.KwashiorkorD.Perniciousanemia

Question144

Thepatientisseentodayforradiationtherapyfortreatmentofbreastcancerfollowingalumpectomythatremovedalesiononthecentralportionoftherightbreast.Whichofthefollowingdiagnosiscodeswouldbelistedfirstforthisencounter?

A.174.1B.V10.3

C.233.0D.V58.0

Question145

Thepatientisa75-year-oldwomanwhoishereforfollow-upafteranincidentlastweekinwhichshehadanFBlodgedinherthroatduetoanarrowinginheresophagus.Anemergencyesophagoscopywasperformedandthepieceofhamburgermeatremovedandbiopsyperformed.SheispositiveforBarrett’sesophagus.ShehasahistoryofGERDandisheretodaytobeevaluatedforphotodynamictherapy.

A.530.81,530.85,V41.6B.935.1,530.3,V41.6

C.935.1,530.3,530.81D.530.3,530.85,530.81

Question146

A78-year-oldpatient,withknownarrhythmia,presentedtoanoutpatientclinicfortheinsertionofacardiaceventrecorder.WhatistheproperHCPCSLevelIIcodeforthisdevice?

A.C1767B.C1764

C.C1777D.C1785

Question147

Thephysicianperformedmanipulationofaclosedfractureofthedistalradiusona12-year-oldmale.Heplacedashortarmfiberglasscast.WhatistheHCPCSLevelIIcodeforthesupply?

A.Q4012B.Q4011

C.Q4010D.Q4009

Question148

WhichofthefollowingstatementsregardingtheICD-9-CMcodingconventionsisTRUE?

A.IfthesameconditionisdescribedasbothacuteandchronicandseparatesubentriesexistintheAlphabeticIndexatthesameindentationlevel,codeonlytheacutecondition.
B.OnlyassignacombinationcodewhentheAlphabeticIndexexplanationdirectsthecodertouseit.
C.AnICD-9-CMcodeisstillvalidevenifithasnotbeencodedtothefullnumberofdigitsrequiredforthatcode.
D.Signsandsymptomsthatareintegraltothediseaseprocessshouldnotbeassignedasadditionalcodes,unlessotherwiseinstructed.

Question149

WhichmodifiershouldbeappendtoaCPT®,forwhichtheproviderhadapatientsignanABNformbecausethereisapossibilitytheservicemaybedeniedbecausethepatient’sdiagnosismightnotmeetmedicalnecessityforthecoveredservice?

A.GJB.GA

C.GBD.GY

Question150

Whatisthepatient’srightwhenitinvolvesmakingchangesinthepersonalmedicalrecord?

A.Patientmustworkthroughanattorneytoreviseanyportionofthepersonalmedicalinformation.
B.Theyshouldbeabletoobtaincopiesofthemedicalrecordandrequestcorrectionsoferrorsandmistakes.
C.Itisaviolationoffederalhealthcarelawtoreviseapatientmedicalrecord.
D.Revisionofthepatientmedicalrecorddependssolelyonthefacility’scomplianceprogrampolicy.