2014 Final with Answers

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

What CPT® and ICD-9-CM codes are reported?

a. 10121, 709.4, V90.10 c. 10121, 729.6, V90.10
b. 11010, 873.52, V90.10 d. 11010, 729.6, V90.10

2. The patient is here because the cyst in her chest has come to a head and is still painful even though she has
been on antibiotics for a week. I offered to drain it for her. After obtaining consent, we infiltrated the area
with 1 cc of 1% lidocaine with epinephrine, prepped the area with Betadine and incised opened the cyst in
the relaxed skin tension lines of her chest, and removed the cystic material. There was no obvious
purulence. We are going to have her clean this with a Q-tip. We will let it heal on its own and eventually
excise it. I will have her come back a week from Tuesday to reschedule surgery. What CPT® and ICD9-
CM codes are reported?
a. 10140, 706.1 c. 10061, 706.2
b. 10060, 706.2 d. 10160, 786.6

3. Patient has returned to the operating room to aspirate a seroma that has developed from a surgical procedure
that was performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-cloudy
serosanguinous fluid. What codes are reported?
a. 10160-78, 998.13 c. 10140-78, 906.3
b. 10180-58, 998.12 d. 10140-58, 729.91
4. Operative Report
PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp.
POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp.
PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin-Yang flap repair

ANESTHESIA: Local, using 4 cc of 1% lidocaine with epinephrine.

COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 5 cc.
SPECIMENS: Squamous cell carcinoma, scalp sutured at 12 o’clock, anterior tip

INDICATIONS FOR SURGERY: The patient is a 43-year-old white man with a biopsy-proven
basosquamous cell carcinoma of his scalp measuring 2.1 cm. I marked the area for excision with gross
normal margins of 4 mm and I drew my planned Yin-Yang flap closure. The patient observed these
markings in two mirrors, so he can understand the surgery and agreed on the location and we proceeded.

DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The patient was placed
prone, his scalp and face were prepped and draped in sterile fashion. I excised the lesion as drawn to
include the galea. Hemostasis was achieved with the Bovie cautery. Pathologic analysis showed the
margins to be clear. I incised the Yin-Yang flaps and elevated them with the underlying galea. Hemostasis
was achieved in the donor site using Bovie cautery. The flap rotated into the defect with total
measurements of 2.9 cm x 3.2 cm. The donor sites were closed and the flaps inset in layers using 4-0
Monocryl and the skin stapler. Loupe magnification was used. The patient tolerated the procedure well.

What CPT® and ICD-9-CM codes are reported?

a. 14060, 172.3 c. 14041, 172.40
b. 14040, 173.42 d. 14020, 173.42

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

6. Operative Report
PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration.
POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration.
OPERATION PERFORMED: Debridement and split thickness autografting of left foot
 ANESTHESIA: General endotracheal.

INDICATIONS FOR PROCEDURE: This patient with multiple complications from Type II diabetes has
developed ulcerations which were debrided and homografted last week. The homograft is taking quite
nicely; the wounds appear to be fairly clean; he is ready for autografting.

DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the operating room
and placed in the supine position on the operating table. Anesthetic monitoring was instituted, internal
anesthesia was induced. The left lower extremity is prepped and draped in a sterile fashion. Staples were
removed and the homograft was debrided from the surface of the wounds. One wound appeared to have
healed; the remaining two appeared to be relatively clean. We debrided this sharply with good bleeding in
all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked sponges. With
good hemostasis a donor site was then obtained on the left anterior thigh, measuring less than 100 cm2.
The wounds were then grafted with a split-thickness autograft that was harvested with a patch of Brown
dermatome set at 12,000 of an inch thick. This was meshed 1.5:1. The donor site was infiltrated with
bupivacaine and dressed. The skin graft was then applied over the wound, measured approximately 60
cm2 in dimension on the left foot. This was secured into place with skin staples and was then dressed with
Acticoat 18's, Kerlix incorporating a catheter, and gel pad. The patient tolerated the procedure well. The
right foot was redressed with skin lubricant sterile gauze and Ace wrap. Anesthesia was reversed. The
patient was brought back to the ICU in satisfactory condition.

What CPT® and ICD-9-CM codes are reported? a.

15220-58, 15004-58, 707.15, 250.80
b. 15120-58, 15004-58, 250.80, 707.15
c. 15950-78, 15004-78, 250.00, 707.14
d. 11044-78, 15120-78, 15004-78, 250.80, 707.15

7. Operative Report
Diagnosis: Basal Cell Carcinoma
Procedure: Mohs micrographic excision of skin cancer.
Site: face left lateral canthus eyelid
Pre-operative size: 0.8 cm
Indications for surgery: Area of high recurrence, area of functional and/or cosmetic importance Discussed
procedure including alternative therapy, expectations, complications, and the possibility of a larger or
deeper defect than expected requiring significant reconstruction. Patient’s questions were answered.

Local anesthesia 1:1 marcaine and 1% lidocaine with epinephrine. Sterile prep and drape.

Stage 1: The clinically apparent lesion was marked out with a small rim of normal appearing tissue and
excised down to subcutaneous fat level with a defect size of 1.2 cm. Hemostasis was obtained and a
pressure bandage placed. The tissue was sent for slide preparation. Review of the slides show clear
margins for the site.

Repair: Complex repair.

 Repair of Mohs micrographic surgical defect. Wound margins were extensively undermined in order to
mobilize tissue for closure. Hemostasis was achieved. Repair length 3.4 cm. Narrative: Burrows triangles
removed anteriorly (medial) and posteriorly (lateral). A layered closure was performed. Multiple buried
absorbable sutures were placed to re-oppose deep fat. The epidermis and dermis were re-opposed using
monofilament sutures. There were no complications; the patient tolerated the procedure well.
Postprocedure expectations (including discomfort management), wound care and activity restrictions
were reviewed. Written Instructions with urgent contact numbers given, follow-up visit and suture
removal in 3-5 days

What CPT® and ICD-9-CM codes are reported?

a. 13152, 11642-51, 173.31 c. 17313, 13152-51, 173.11
b. 13152, 11442-51, 173.31 d. 17311, 13152-51, 173.11

8. PREOPERATIVE & POSTOPERATIVE DIAGNOSES:

1. Macromastia.
2. Back pain.
3. Neck pain.
4. Shoulder pain.
5. Shoulder grooving 6. Intertrigo.

NAME OF PROCEDURE:
1. Right breast reduction of 1950 g.
2. Right free-nipple graft.
3. Left breast reduction of 1915 g.
4. Left free-nipple graft.

INDICATIONS FOR SURGERY: The patient is a 43-year-old female with macromastia and associated
back pain, neck pain, shoulder pain, shoulder grooving and intertrigo. She desired a breast reduction.
Because of the extreme ptotic nature of her breasts, we felt she would need a free-nipple graft technique.
In the preoperative holding area, we marked her for this free-nipple graft technique of breast reduction.
The patient observed these markings so she could understand the surgery and agree on the location, and
we proceeded. The patient also was morbidly obese with a body mass index of 54. Because of this, we felt
she met the criteria for DVT prophylaxis, which included Lovenox injection. The patient understood this
would increase her risk of bleeding. She also made it known she is a Jehovah's Witness and refused blood
products, but she did understand her risk of bleeding would significantly increase and we proceeded.

DESCRIPTION OF PROCEDURE: The patient was given 40 mg of subcutaneous Lovenox in the

preoperative holding area. She was then taken to the operating room. Bilateral thigh-high TED hose, in
addition to bilateral pneumatic compression stockings were used throughout the procedure. IV Ancef 1 g
was given. Anesthesia was induced. Both arms were secured on padded arm boards using Kerlix rolls. A
similar body bear hugger was placed. The chest and abdomen were prepped and draped in sterile fashion.
I began by circumscribing around each nipple-areolar complex using a 42-mm areolar marker. On each
side the free-nipple grafts were harvested. They were marked to be side specific and were stored on the
back table in moistened lap sponges. Meticulous hemostasis was achieved using Bovie cautery. The tail
of the apex of each breast was deepithelialized using the scalpel. I amputated the inferior portion of the
 breast from the right side. Again, meticulous hemostasis was achieved using the Bovie cautery. There
were also large feeder vessels divided and ligated using either a medium Ligaclip or 3-0 silk tie sutures. I
then moved to the left and again amputated the inferior portion of the breast. Meticulous hemostasis was
achieved using the Bovie cautery. Each of these wounds were temporarily closed using the skin stapler.
The patient was then sat up. I felt we had achieved a very symmetrical result. The new positions for the
nipple-areolar complexes were marked with a 42-mm areolar marker and methylene blue. The patient was
then placed in the supine position and the new positions for the nipple-areolar complexes were
deepithelialized using the scalpel. Meticulous hemostasis was then achieved again using the Bovie
cautery. The free-nipple grafts were then retrieved from the back table. They were each defatted using
scissors and were placed in an onlay fashion on the appropriate side, and each was inset using 5-0 plain
sutures. Vents were made in the skin graft to allow for the egress of fluid on each side. A vertical mattress
suture was used, tied over a piece of Xeroform in critical areas of each of the nipple-areolar complexes. A
Xeroform bolster wrapped over a mineral oil-moistened sponge was affixed to each of the nipple-areolar
complexes using 5-0 nylon suture. The vertical and transverse incisions were closed using 3-0 Monocryl,
both interrupted and running suture, and 5-0 Prolene. The patient tolerated the procedure well. Again,
meticulous hemostasis was achieved using the Bovie cautery. She was given another 1 g of Ancef at the
2-hour mark by our anesthesiologist, and was taken to the recovery room in good condition. What CPT®
codes are reported?
a. 19316-50, 19355-59-50 c. 19318-50, 19355-59-50
b. 19318-50, 19350-59-50 d. 19340-50, 19350-59-50

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

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

20000 Series
11. A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture while on
vacation. The patient was put under general anesthesia and the elbow was reduced and was stable. The
medial elbow was held in the appropriate position and was reduced in acceptable position and elevated to
treat non-surgically. A long arm splint was applied. The patient is referred to an orthopedist when she
returns to her home state in a few days. What CPT® code(s) are reported?
a. 24575-54-RT, 24615-54-51-RT c. 24577-54-RT, 24600-54-51-RT
b. 24576-54-RT, 24620-54-51-RT d. 24565-54-RT, 24605-54-51-RT

12. A 45-year-old presents to the operating room with a right index trigger finger and left shoulder bursitis. The
left shoulder was injected with 1 cc of Xylocaine, 1 cc of Celestone, and 1 cc of Marcaine. An incision was
made over the A1 pulley in the distal transverse palmar crease, about an inch in length. This incision was
taken through skin and subcutaneous tissue. The Al pulley was identified and released in its entirety. The
wound was irrigated with antibiotic saline solution. The subcutaneous tissue was injected with Marcaine
without epinephrine. The skin was closed with 4-0 Ethilon suture. Clean dressing was applied. What CPT®
codes are reported?
a. 26055-F6, 20610-76-LT c. 26055-F6, 20610-51-LT
b. 20552-F6, 20605-52-LT d. 20553-F6, 20610-51-LT

13. A patient presents with a healed fracture of the left ankle. The patient was placed on the OR table in the
supine position. After satisfactory induction of general anesthesia, the patient’s left ankle was prepped and
draped. A small incision about 1 cm long was made in the previous incision. The lower screws were
removed. Another small incision was made just lateral about 1 cm long. The upper screws were removed
from the plate. Both wounds were thoroughly irrigated with copious amounts of antibiotic containing saline.
Skin was closed in a layered fashion and sterile dressing applied. What CPT® code(s) should be reported?
a. 20680-LT c. 20670-LT
b. 20680-LT, 20680-59-LT d. 20680-LT, 20670-59-LT

14. A patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced comminuted
fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was performed and
included the following techniques: An incision was made in the area of the lateral epicondyle. This was
 carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the
fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily,
and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across
the humerus. The pins were cut off below skin level. The wound was closed with plain catgut
subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. What CPT® and
ICD-9-CM codes are reported?
a. 24579-RT, 29065-51-RT, 812.52 c. 24579-RT, 812.42
b. 24577-RT, 812.42 d. 24575-RT, 812.52

15. A 47-year-old patient was previously treated with external fixation for a Grade III left tibial fracture. There
is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting.
Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was
exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Intrafragmentary
compression was applied with three screws. The harvested bone graft was packed into the fracture site.
What CPT® and ICD-9-CM codes are reported?
a. 27724-LT, 733.82, 905.4 c. 27722-LT, 733.81, 905.4
b. 27722-LT, 733.82 d. 27724-LT, 733.82

16. A Grade I, high velocity open right femur shaft fracture was incurred when a 15-year-old female pedestrian
was hit by a car. She was taken to the operating room within four hours of her injury for thorough irrigation
and debridement, including excision of devitalized bone. The patient was prepped, draped, and positioned.
Intramedullary rodding was carried out with proximal and distal locking screws.
What CPT® and ICD-9-CM codes should be reported?
a. 27506-RT, 11044-51-RT, 821.11, E814.7 c. 27507-RT, 11012-51-RT, 821.01, E814.7
b. 27506-RT, 11012-51-RT, 821.11, E814.7 d. 27507-RT, 11044-51-RT, 821.10, E814.7

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

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

19. An elderly female presented with increasing pain in her left dorsal foot. The patient was brought to the
operating room, and placed under general anesthesia. A curvilinear incision was centered over the lesion
itself. Soft tissue dissection was carried through to the ganglion. The ganglion was clearly identified as a
gelatinous material. It was excised directly off the bone and sent to pathology. There was noted to be a large
bony spur at the level of the head of the 1st metatarsal. Using double action rongeurs, the spur itself was
removed and sequestrectomy was performed. A rasp was utilized to smooth the bone surface. The
eburnated bony surface was then covered, utilizing bone wax. The wound was irrigated and closed in
layers. What CPT® codes are reported?
a. 28122-LT2, 28090-51-LT c. 28045-LT, 28090-51-LT
b. 28111-LT, 28092-51-LT d. 28100-LT, 28092-51-LT

20. Under general anesthesia, a 45-year-old patient was sterilely prepped. The wrist joint was injected with
Marcaine and epinephrine. Three arthroscopic portals were created. The articulating surface between the
scaphoid and the lunate clearly showed disruption of the ligamentous structures. We could see soft tissue
pouching out into the joint; this was debrided. There was abnormal motion noted within the scapholunate
articulation. At this point the C-arm was brought in; arthroscopic instruments were placed in the joint and
confirmed the location of the shaver as a probe in the scapholunate ligament. There was a significant gap
between the capitate and lunate. K-wire was utilized from the dorsal surface into the lunate, restoring the
space. Further examination revealed gross instability between the capitate and lunate. With the wrist in
neutral position, a K-wire was passed through the scaphoid, through the capitate and into the hamate. This
provided stabilization of the wrist joint. Stitches were placed, and a thumb spica cast was applied. What
CPT® code(s) should be reported?
a. 29847 c. 29840
b. 29846 d. 29847, 29840-51
 30000 Series
21. A patient underwent bilateral nasal/sinus diagnostic endoscopy. Finding the airway obstructed the physician
fractures the middle turbinates to perform the surgical endoscopy with total ethmoidectomy and bilateral
nasal septoplasty. What CPT® codes are reported?
a. 30930, 31255-51, 30520-51 c. 31231, 30130-51, 31255-50
b. 31255-50, 30520-50-51 d. 31255, 30520-51

22. 55-year-old female smoker presents with cough, hemoptysis, slurred speech, and weight loss. Chest X-ray
done today demonstrates a large, unresectable right upper lobe mass, and brain scan is suspicious for
metastasis. Under fluoroscopic guidance in an outpatient facility, a percutaneous needle biopsy of the lung
lesion is performed for histopathology and tumor markers. A diagnosis of small cell carcinoma is made and
chemoradiotherapy is planned. What CPT® and ICD-9-CM codes are reported? a. 32098, 77002-26, 162.3,
786.50, 786.39, 784.5, 783.21
b. 32400, 77002-26, 162.9
c. 32607, 77002-26, 786.6
d. 32405, 77002-26, 162.3

23. A surgeon performs a high thoracotomy with resection of a single lung segment on a 57-year-old heavy
smoker who had presented with a six-month history of right shoulder pain. An apical lung biopsy had
confirmed lung cancer. What CPT® and ICD-9-CM codes are reported?
a. 32100, 729.5 c. 32503, 162.3
b. 32484, 162.3 d. 19271, 32551-51, 786.50

24. A 3-year-old girl is playing with a marble and sticks it in her nose. Her mother is unable to dislodge the
marble so she takes her to the physician’s office. The physician removes the marble with hemostats. What
CPT® and ICD-9-CM codes are reported?
a. 30300, 932, E912 c. 30150, 932, E915
b. 30310, 932, E912 d. 30320, 932, E915

25. An ICU diabetic patient who has been in a coma for weeks as the result of a head injury becomes conscious
and begins to improve. The physician performs a tracheostomy closure and since the scar tissue is minimal,
the plastic surgeon is not needed. What CPT® and ICD-9-CM codes are reported for this procedure?
a. 31820, 250.30, V44.0 c. 31825, V55.0, 250.30, 959.01
b. 31820, V55.0, 959.01, 250.00 d. 31825, V55.0, 250.00, 959.01
26. A patient has a complete TTE performed to assess her mitral valve prolapse (congenital). The physician
performs the study in his cardiac clinic.
a. 93303 c. 93308
b. 93306 d. 93312

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

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

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

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

32. A patient suffering from cirrhosis of the liver presents with a history of coffee ground emesis. The surgeon
diagnoses the patient with esophageal gastric varices. Two days later, in the hospital GI lab, the surgeon
ligates the varices with bands via an UGI endoscopy. What CPT® and ICD-9-CM codes are reported?
a. 43205, 571.6, 456.20 c. 43400, 571.6, 456.21
b. 43244, 571.5, 456.21 d. 43235, 571.5, 454.2

33. A patient was taken to the emergency room for severe abdominal pain, nausea and vomiting. A WBC
(white blood cell count) was taken and the results showed an elevated WBC count. The general surgeon
suspected appendicitis and performed an emergent appendectomy. The patient had extensive adhesions
secondary to two previous Cesarean-deliveries. Dissection of this altered anatomical field and required the
surgeon to spend 40 additional intraoperative minutes. The surgeon discovered that the appendix was not
ruptured nor was it hot. Extra time was documented in order to thoroughly irrigate the peritoneum.
What CPT® and ICD-9-CM codes are reported?
a. 44960-22,789.00, 787.01, 288.60 540.1 c. 44960-22, 540.0
b. 44950-22, 789.00, 787.01, 288.60 d. 44005, 44955, 789.00, 787.01, 540.0

34. The patient was taken to the operating room and placed in the dorsal lithotomy position, prepped and
draped in the usual sterile fashion. A vertical paramedian incision was made along the left side of the
umbilicus from the symphysis and taken up to above the umbilicus. This incision was carried down to the
rectus muscles, which were separated in the midline. The peritoneal cavity was entered with findings as
described. The ascitic fluid was removed and hand-held retractors were used to assist in surgical exposure.

The tumor was resected from the hepatic flexure into the mid transverse colon. The resection was
extended into the left upper quadrant and the attachments were also clamped, cut and suture ligated with
2-0 silk sutures in a stepwise fashion until mobilization of the tumor mass could be brought medial and
hemostasis was obtained. Attempts to find a dissection plane between the tumor mass and the transverse
colon were unsuccessful as it appeared that the tumor mass was invading into the wall of the bowel with
extrinsic compression and distortion of the bowel lumen.

Given the mass could not be resected without removal of bowel, attention was directed to mobilization of
the splenic flexure. Retroperitoneal dissection was started in the pelvis and continued along the left
paracolic gutter. The ligamentous and peritoneal attachments were taken down with Bovie cautery in a
 stepwise fashion around the splenic flexure of the colon until the entire left colon was mobilized medially.
Similar steps were then carried on the right side as the right colon and hepatic flexure were mobilized.
The peritoneal and ligamentous attachments were taken down with Bovie cautery. Vascular attachments
were clamped, cut, and suture ligated with 2-0 silk until the right colon was mobilized satisfactorily. The
GIA stapler was introduced and fired at both ends to dissect the tumorous bowel free. The bowel was
delivered off the operative field.

Attention was then directed towards re-anastomosis of the colon. Linen-shod clamps were used to gently
clamp the proximal and distal segments of the large bowel. The staple line was removed with
Metzenbaum scissors, and the colon lumen was irrigated. The silk sutures were used to divide the
circumference of the bowel into equal thirds, and the proximal and distal edges of the bowel were
reapproximated with silk sutures. The posterior segment of the bowel was then retracted and secured with
a TA stapler, ensuring a full thickness bowel wall insertion into the staple line. The additional two thirds
were also isolated and, with the TA stapler, clamped, ensuring that all layers of the bowel wall were
incorporated into the anastomosis. A third staple line was fired and the integrity of the anastomosis was
checked. First complete hemostasis was noted. There was well beyond a finger width lumen within the
large bowel. The linen-shod clamps were released and gas and bowel fluid were moved through the
anastomosis aggressively with intact staple line, no leakage of gas or fluid. The abdomen was then
irrigated and water was left over the anastomosis. The anastomosis was manipulated with no
extravasation of air. The abdomen and pelvis were then irrigated aggressively. The Mesenteric trap was
then reapproximated with interrupted 3-0 silk suture ligatures. All sites were inspected and noted to be
hemostatic. Attention was directed towards closing.
What is the correct CPT® and ICD-9-CM coding for this report?
a. 44140, 153.0, 153.1, 153.8 c. 44160, 153.8
b. 44140, 44139, 153.0, 153.8 d. 44147, 44139, 153.1, 153.8

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

36. Operative Report

Indications: This is a third follow-up EGD dilation on this patient for a pyloric channel ulcer which has
been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation.
Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray.
Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted
into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable.
Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The
 pyloric channel was again widened. However, the ulcer as previously seen was well healed with a scar.
The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into
the second portion of the duodenum revealing normal mucosa. Marked deformity and scarring was seen
in the proximal bulb. Following the diagnostic exam, a 15 mm balloon was placed across the stricture,
dilated to maximum pressure, and withdrawn. There was minimal bleeding post-op. Much easier access
into the duodenum was accomplished after the dilation. Follow-up biopsies were also taken to evaluate
Helicobacter noted on a previous exam. The patient tolerated the procedure well.
Impressions: Pyloric stricture secondary to healed pyloric channel ulcer, dilated.
Plan: Check on biopsy, continue Prilosec for at least another 30 days. At that time, a repeat endoscopy
and final dilation will be accomplished. He will almost certainly need chronic H2 blocker therapy to
avoid recurrence of this divesting complicated ulcer.
What CPT® and ICD-9-CM codes are reported?
a. 43245, 43239-51, 537.0, V12.71 c. 43235, 43239-51, 537.1, V12.79
b. 43236, 43239-59, 537.0, V12.71 d. 43248, 43239-59, 537.2, V12.79

37. A patient with hypertension presents to the same day surgery department for removal of her gallbladder due
to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery.
What ICD-9-CM codes are reported?
a. 574.21, V72.83, 401.9 c. V72.81, 574.20, 401.9
b. 574.20, 401.9, V72.81 d. 401.9, V72.84, 574.20

38. A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This attempt
was unsuccessful. The physician then dilates the esophagus transendoscopically using a balloon (25mm).
What CPT® code(s) is/are reported?
a. 43450, 43220 c. 43220, 43450-52
b. 43450-53, 43220 d. 43220

39. Surgical laparoscopy with a cholecystectomy and exploration of the common bile duct, for cholelithiasis.
What CPT® and ICD-9-CM codes are reported?
a. 47610, 574.20 c. 47562, 47552, 574.30
b. 47564, 574.20 d. 47610, 47560, 574.30

40. 45-year-old patient with liver cancer is scheduled for a liver transplant. The patient’s brother is a perfect
match and will be donating a portion of his liver for a graft. Segments II and III will be taken from the
brother and then the backbench reconstruction of the graft will be performed, both a venous and arterial
anastomosis. The orthotopic allotransplantation will then be performed on the patient.
What CPT® codes are reported?
 a. 47140, 47146, 47147, 47135 c. 47140, 47147, 47146, 47136
b. 47141, 47146, 47135 d. 47141, 47146, 47136

50000 Series
41. 67-year-old gentleman with localized prostate cancer will be receiving brachytherapy treatment. Following
calculation of the planned transrectal ultrasound, guidance was provided for percutaneous placement of 1-
125 seeds into the prostate tissue. What CPT® code is reported for needle placement to insert the
radioactive seeds into the prostate?
a. 55860 c. 55875
b. 55920 d. 55876

42. Benign prostatic hypertrophy with outlet obstruction and hematuria.

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

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

44. A 56-year-old woman with biopsy-proven carcinoma of the vulva with metastasis to the lymph nodes has
complete removal of the skin and deep subcutaneous tissues of the vulva in addition to removal of her
inguinofemoral, iliac and pelvic lymph nodes bilaterally. The diagnosis of carcinoma of the vulva with 7 of
 the nodes also positive for carcinoma is confirmed on pathologic review. What are the CPT® and ICD-9-
CM codes reported for this procedure?
a. 56637, 184.4, 196.9 c. 56632-50, 233.32
b. 56640-50, 184.4, 196.5 d. 56633, 38765-50, 184.4, 196.5

45. A woman with a long history of rectocele and perineal scarring from multiple episiotomies develops a
rectovaginal fistula with perineal body relaxation. She has transperineal repair with perineal body
reconstruction and plication of the levator muscles. What are the CPT® and ICD-9-CM codes reported
for this procedure?
a. 57250, 618.04 c. 57300, 56810-51, 619.1, 624.4
b. 57308, 619.1, 624.4 d. 57330, 619.0

46. An 88-year-old widow with uterine prolapse and multiple comorbid conditions has been unsuccessful in the
use of a pessary for treatment elects to receive colpocleisis (LeFort type) to prevent further prolapse and
avoid more significant surgery like hysterectomy. The treatment is successful. What are the CPT® and
ICD-9-CM codes reported for this procedure?
a. 59320, 618.3 c. 57120, 618.1
b. 57130, 654.50 d. 57020, 618.2

47. A 37 year old woman presents with abdominal pain, bleeding unrelated to menses and an abnormal pap
showing LGSIL (low grade squamous intraepithelial lesion). Treatment is hysteroscopy with
thermoablation of the endometrium and cryocautery of the cervix. This is performed without difficulty.
What are the CPT® and ICD-9-CM codes reported for this procedure?
a. 58555, 58353-51, 182.0 c. 58350, 57510-51, 182.0
b. 58565, 57511-51, 795.03 d. 58563, 57511-51, 795.03

48. A patient is diagnosed with an injury to the facial nerve. The surgeon performs a neurorrhaphy with nerve
graft to restore innervation to the face using microscopic repair. The surgeon created a 2 cm incision over
the damaged nerve, dissected the tissues and located the nerve. The damaged nerve was resected and
removed. The 3.0 cm graft taken from the sural nerve was sutured to the proximal and distal ends of the
damaged nerve. What CPT® and ICD-9-CM codes are reported?
a. 64885, 959.09 c. 64886, 69990, 959.09
b. 64886, 951.4 d. 64885, 69990, 951.4
49. 47-year-old male presents with chronic back pain, and lower left leg radiculitis. A laminectomy is
performed on the inferior end of L5. The microscope is used to perform microdissection. There was a large
extradural cystic structure on the right side underneath the nerve root as well as the left. The entire
intraspinal lesion was evacuated. What CPT® code(s) is/are reported for this procedure?
a. 63267, 69990 c. 63272
b. 63252, 69990 d. 63277

50. A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear medicine scan) and
ultrasound and is found to have only one diseased parathyroid. A minimally invasive parathyroidectomy is
performed. What CPT® and ICD-9-CM codes are reported for the surgery?
a. 60500, 252.00 c. 60505, 252.01
b. 60502, 252.00 d. 60500, 252.01

60000 Series
51. A physician uses cryotherapy for removal trichiasis. What CPT® and ICD-9-CM codes are reported?
a. 67820, 127.3 c. 67830, 086.5
b. 67825, 374.05 d. 67840, 124

52. A patient receives chemodenervation with Botulinum toxin injections to stop blepharospasms of the right
eye. What are the procedure and diagnosis codes?
a. 64650, 780.8 c. 64612-RT, 333.81
b. 67345-RT, 378.10 d. 64616-RT, 781.93

53. The surgeon performed an insertion of an intraocular lens prosthesis discussed with the patient before the
six-week earlier cataract removal (by the same surgeon). What CPT® code is reported?
a. 66985-58 c. 66984
b. 66983-58 d. 66985

54. The physician performs an iridotomy using laser on both eyes for chronic angle closure glaucoma;
procedure includes local anesthesia. What CPT® and ICD-9-CM codes are reported? a. 66710-50, 365.11,
365.9 c. 66762-50, 66990, 365.01, 365.9
b. 66625, 365.23, 365.70 d. 66761-50, 365.23, 365.70
55. A physician extracts a tumor, using a frontal approach, from the lacrimal gland of a 14-year-old patient.
What CPT® and ICD-9-CM codes are reported?
a. 68500, 190.7 c. 68520, 224.7
b. 68505, 190.2 d. 68540, 239.89

56. 72-year-old patient is undergoing a corneal transplant. An anesthesiologist is personally performing

monitored anesthesia care. What CPT® code and modifier(s) are reported for anesthesia?
a. 00144 c. 00144-AA-QS
b. 00144-AA d. 00144-QK-QS

57. A CRNA is personally performing a case, with medical direction from an anesthesiologist. What modifier
is appropriately reported for the CRNA services?
a. QX c. QK
b. QZ d. QS

58. An anesthesiologist is medically supervising six cases concurrently. What modifier is reported for the
anesthesiologist’s service?
a. AA c. QK
b. AD d. QX

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

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

What is the E/M code for this visit?

a. 99221 c. 99241
b. 99284 d. 99281

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

63. Mr. Trumph loses his yacht in a poker game and experiences a sudden onset of chest pain which radiates
down his left arm. The paramedics are called to the casino he owns in Atlantic City to stabilize him and
transport him to the hospital. Dr. H. Art is in the ER to direct the activities of the paramedics. He spends 30
minutes in two-way communication directing the care of Mr. Trumph. When EMS reached the hospital
Emergency Department, Mr. Trumph is in full arrest with torsades de pointes (ventricular tachycardia). Dr.
H. Art spends another hour stabilizing the patient and performing CPR. What are the appropriate procedure
codes for this encounter?
a. 99288, 99291, 92950 c. 99288, 99291
b. 99291, 99292 d. 99291, 92950, 92960

64. Patient comes in today at four months of age for a checkup. She is growing and developing well. Her
mother is concerned because she seems to cry a lot when lying down but when she is picked up she is fine.
She is on breast milk but her mother has returned to work and is using a breast pump, but hasn’t seemed to
produce enough milk.

PHYSICAL EXAM: Weight 12 lbs 11 oz, Height 25in., OFC 41.5 cm. HEENT: Eye: Red reflex normal.
Right eardrum is minimally pink, left eardrum is normal. Nose: slight mucous Throat with slight thrush
on the inside of the cheeks and on the tongue. LUNGS: clear. HEART: w/o murmur. ABDOMEN: soft.
 Hip exam normal. GENITALIA normal although her mother says there was a diaper rash earlier in the
week.

ASSESSMENT
Four month old well check
Cold
Mild thrush
Diaper rash PLAN:
Okay to advance to baby foods
Okay to supplement with Similac
Nystatin suspension for the thrush and creams for the diaper rash if it recurs
Mother will bring child back after the cold symptoms resolve for her DPT, HIB and polio

What E/M code(s) is/are reported?

a. 99212 c. 99391, 99212-25
b. 99391 d. 99213

65. 28-year-old female patient is returning to her physician’s office with complaints of RLQ pain and heartburn
with a temperature of 100.2. The physician performs a detailed history, detailed exam and determines the
patient has mild appendicitis. The physician prescribes antibiotics to treat the appendicitis in hopes of
avoiding an appendectomy. What are the correct CPT® and ICD-9-CM codes for this encounter?
a. 99214, 787.1, 541 c. 99213, 541
b. 99202, 789.03, 541 d. 99203, 780.60, 787.1, 789.03, 541

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

67. 37-year-old female is seen in the clinic for follow-up of lower extremity swelling.
HPI: Patient is here today for follow-up of bilateral lower extremity swelling. The swelling responded to
hydrochlorothiazide.
 DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have moderate pulmonary
hypertension.

Exam: Patient is in no acute distress.

ASSESSMENT:
1. Bilateral lower extremity swelling. This has resolved with diuretics, it may be secondary to
problem #2.
2. Pulmonary hypertension: Etiology is not clear at this time, will work up and possibly refer to a
pulmonologist.

PLAN: Will evaluate the pulmonary hypertension. Patient will be scheduled for a sleep study.
a. 99213 c. 99214
b. 99212 d. 99215

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

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

70. 60-year-old woman is seeking help to quit smoking. She makes an appointment to see Dr. Lung for an
initial visit. The patient has a constant cough due to smoking and some shortness of breath. No night
sweats, weight loss, night fever, CP, headache, or dizziness. She has tried patches and nicotine gum, which
has not helped. Patient has been smoking for 40 years and smokes 2 packs per day. She has a family history
of emphysema. A limited three system exam was performed. Dr Lung discussed in detail the pros and cons
of medications used to quit smoking. Counseling and education was done for 20 minutes of the 30 minute
 visit. Prescriptions for Chantrix and Tetracylcine were given. The patient to follow up in 1 month. A chest
X-ray and cardiac work up was ordered. Select the appropriate CPT code(s) for this visit.
a. 99202 c. 99203, 99354
b. 99203 d. 99214, 99354

Anesthesia
71. A pre-anesthesia assessment was performed and signed at 10:21 a.m. Anesthesia start time is reported as
12:26 pm, and the surgery began at 12:37 pm. The surgery finished at 15:12 pm and the patient was turned
over to PACU at 15:26 pm, which was reported as the ending anesthesia time. What is the anesthesia time
reported?
a. 10:21 am to 15:12 pm (291 minutes) c. 12:26 am to 15:12 pm (146 minutes)
b. 12:26 am to 15:26 pm (180 minutes) d. 12:37 am to 15:26 pm (169 minutes)

72. Code 00350 Anesthesia for procedures on the major vessels of the neck; not otherwise specified has a base
value of ten (10) units. The patient is a P3 status, which allows one (1) extra base unit. Anesthesia start
time is reported as 11:02 am, and the surgery began at 11:14 am. The surgery finished at 12:34 am and the
patient was turned over to PACU at 12:47 am, which was reported as the ending anesthesia time. Using
fifteen-minute time increments and a conversion factor of $100, what is the correct anesthesia charge?
a. $1,500.00 c. $1,700.00
b. $1,600.00 d. $1,800.00

73. Code 00940, anesthesia for vaginal procedures, has a base value of three (3) units. The patient was
admitted under emergency circumstances, qualifying circumstance code 99140, which allows two (2) extra
base units. A pre-anesthesia assessment was performed and signed at 2:00 a.m. Anesthesia start time is
reported as 2:21 am, and the surgery began at 2:28 am. The surgery finished at 3:25 am and the patient was
turned over to PACU at 3:36 am, which was reported as the ending anesthesia time. Using fifteen-minute
time increments and a conversion factor of $100, what is the correct anesthesia charge?
a. $800.00 c. $1,000.00
b. $900.00 d. $1,200.00

74. 94-year-old patient is having surgery to remove his parotid gland, with dissection and preservation of the
facial nerve. The surgeon has requested the anesthesia department place an arterial line. What CPT®
code(s) is/are reported for anesthesia?
a. 00300, 36620 c. 00100, 99100
b. 00100, 36620, 99100 d. 00400
75. 5- year-old patient is experiencing atrial fibrillation with rapid ventricular rate. The anesthesia department
is called to insert a non-tunneled central venous (CV) catheter. What CPT® code is reported?
a. 00400 c. 36556
b. 36555 d. 36557

76. 43-year-old patient with a severe systemic disease is having surgery to remove an integumentary mass from
his neck. What CPT® code and modifier are reported for the anesthesia service?
a. 00300-P2 c. 00322-P3
b. 00300-P3 d. 00350-P3

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

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

Radiology
79. 41-year-old male is in his doctor’s office for a follow up of an abnormality, which was noted, on an
abdominal CT scan. He is to have a chest X-ray due to chest tightness. He otherwise states he feels well and
is here to go over the results of his chest X-ray (PA and Lateral) performed in the office and the CT scan
performed at the diagnostic center. The results of the chest X-ray were normal. CT scan was sent to the
office and the physician interpreted and documented that the CT scan of the abdomen showed a small mass
in his right upper quadrant. What CPT® codes are reported for the doctor’s office radiological services?
a. 71020-26, 74150-26 c. 71020-26, 74150
b. 71020, 74150 d. 71020, 74150-26
80. A patient has a history of chronic venous embolism in the superior vena cava (SVC) and is having a
radiographic study to visualize any abnormalities. In outpatient surgery the physician accesses the
subclavian vein and the catheter is advanced to the superior vena cava for injection and imaging. The
supervision and interpretation of the images is performed by the physician. What codes are reported for this
procedure?
a. 36010, 75827-26 c. 36000, 75827-26
b. 36000, 75820-26 d. 36010, 75820-26

81. 70-year-old female presents with a complaint of right knee pain with weight bearing activities. She is also
developing pain at rest. She denies any recent injury. There is pain with stair climbing and start up pain. An
AP, Lateral and Sunrise views of the right knee are ordered and interpreted. They reveal calcification within
the vascular structures. There is decreased joint space through the medial compartment where she has near
bone-on-bone contact, flattening of the femoral condyles, no fractures noted. The diagnosis is right knee
pain secondary to underlying localized degenerative arthritis. What CPT® and ICD-9-CM codes are
reported?
a. 73560, 715.96 c. 73562, 715.36
b. 73562, 715.96, 719.46 d. 73565, 715.36, 719.46

82. Myocardial Perfusion Imaging—Office Based Test Indications: Chest pain.

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

83. After intravenous administration of 5.1 millicuries Tc-99m DTPA, flow imaging of the kidneys was
performed for approximately 30 minutes. Flow imaging demonstrated markedly reduced flow to both
kidneys bilaterally. What CPT® code is reported?
a. 78710 c. 78708
b. 78701 d. 78725
84. An oncology patient is having weekly radiation treatments with a total of seven conventional fractionated
treatments. Two fractionated treatments daily for Monday, Tuesday and Wednesday and one treatment on
Thursday. What radiology code(s) is/are appropriate for the clinical management of the radiation treatment?
a. 77427 c. 77427 x 2
b. 77427 x 7 d. 77427-22

85. Magnetic resonance imaging of the chest is first done without contrast medium enhancement and then is
performed with an injection of contrast. What CPT® code(s) is/are reported for the radiological services?
a. 71550, 71551 c. 71555
b. 71552 d. 71275

86. A CT scan confirms improper ossification of cartilages in the upper jawbone and left side of the face area
for a patient with facial defects. The CT is performed with contrast material in the hospital. What CPT®
code is reported by an independent radiologist contracted by the hospital?
a. 70460-26 c. 70487-26
b. 70481-26 d. 70542-26

87. A patient is positioned on the scanning table headfirst with arms at the side for an MRI of the thoracic spine
and spinal canal. A contrast agent is used to improve the quality of the images. The scan confirms the size
and depth of a previously biopsied leiomyosarcoma metastasized to the thoracic spinal cord.
What CPT® and ICD-9-CM codes are reported?
a. 72255, 239.7 c. 72070, 192.2
b. 72157, 237.5 d. 72147, 198.3

88. A young child is taken to the OR to reduce a meconium plug bowel obstruction. A therapeutic enema is
performed with fluoroscopy. The patient is in position and barium is instilled into the colon through the
anus for the reduction. What CPT® code is reported by the independent radiologist for the radiological
service?
a. 74270-26 c. 74283-26
b. 74280-26 d. 74246-26
 Laboratory and Pathology
89. What is/are the code(s) for thawing 4 units of fresh frozen plasma?
a. 86927 c. 86931
b. 86927 x 4 d. 86931 x 4

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

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

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

a. 85362 c. 85370
b. 85366 d. 85378

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

94. A patient with AIDS presents for follow up care. An NK (natural killer cell) total count is ordered. What
CPT® code(s) is/are reported?
a. 86359 c. 86361, 86359
b. 86703 d. 86357
95. A patient has partial removal of his lung. The surgeon also biopsies several lymph nodes in the patient’s
chest which are examined intraoperatively by frozen section and sent with the lung tissue for Pathologic
examination. The pathologist also performs a trichrome stain. What CPT® codes are reported for the lab
tests performed?
a. 88309 x 2, 88313 c. 88307, 88305x2, 88332
b. 88309, 88305, 88313, 88331 d. 88309, 88307, 88313

96. A couple with inability to conceive has fertility testing. The semen specimen is tested for volume, count,
motility and a differential is calculated. The findings indicate infertility due to oligospermia. What CPT®
and ICD-9-CM codes are reported?
a. 89310, 89320, V26.21 c. 89320, 606.1
b. 89257, 606.9, V26.21 d. 89264, 606.1

97. In a legal hearing to determine child support there is a dispute about the child’s paternity. The court orders
a paternity test, and a nasal smear is taken from the plaintiff and the child. The plaintiff is confirmed as the
father of the child. Choose the CPT®, ICD-9-CM codes and modifier for the paternity testing.
a. 89190-32, V26.39 c. 86900, V70.4
b. 86910-32, V70.4 d. 86910, V26.39

98. A virus is identified by observing growth patterns on cultured media. What is this type of identification is
called?
a. Definitive c. Quantitative
b. Qualitative d. Presumptive

Medicine

99. A female patient fell on the floor as she got out of bed. She has no known head trauma. She noticed
some slight stiffness in her joints and weakness in her lower extremity muscles, with slight stiffness in her
arm joints. The physician decided to test for possible multiple sclerosis (MS). She was sent to a clinic
providing somatosensory studies. The testing included upper and lower limbs. What CPT® and ICD-
9CM codes are reported?
a. 95938, 728.87, 719.59 c. 95926, 728.87, 719.59
b. 95925, 95926, 340 d. 95926, 340
100. 64-year-old patient came to the emergency department complaining of chest pressure. The physician
evaluated the patient and ordered a 12 lead EKG. Findings included signs of acute cardiac damage.
Appropriate initial management was continued by the ED physician who contacted the cardiologist on
call in the hospital. Admission to the cardiac unit was ordered. No beds were available in the cardiac unit
and the patient was held in the ED. The cardiologist left the ED after completing the evaluation of the
patient.

Several hours passed and the patient was still in the ED. During an 80-minute period, the patient
experienced acute breathing difficulty, increased chest pain, arrhythmias, and cardiac arrest. The patient
was managed by the ED physician during this 80-minute period. Included in the physician management
were a new 12 lead EKG, endotracheal intubation and efforts to restore the patient’s breathing and
circulation for 20 minutes. CPR was unsuccessful, the patient was pronounced dead after a total of 44
minutes critical care time, exclusive of other separately billable services. What CPT® codes are reported
by the physician?
a. 99285-25, 93010 x 2, 31500, 92950
b. 99291-25, 31500, 93000, 92950
c. 99291-25, 99292-25, 93005-59 x 2, 31500
d. 99291-25, 31500, 92950

101. A patient with Sickle cell anemia with painful sickle crisis received normal saline IV, 100 cc per hour to
run over 5 hours for hydration in the physician’s office. She will be given Morphine & Phenergan, prn
(as needed). What codes are reported?
a. 96360, 96361 x 4, J7050 x 2, 282.62 c. 96360, 96361 x 3, J7030, 282.62
b. 96360 x 5, J7050, 282.60 d. 96360, J7030, 282.69

102. A patient with bilateral sensory hearing loss is fitted with a digital, binaural, behind the ear hearing aid.
What HCPCS Level II and ICD-9-CM codes should be reported?
a. V5140, 389.11, V53.2 c. V5140, 389.22
b. V5261, V53.2, 389.11 d. V5261, V72.11, 389.11

103. 5-year-old is brought in to see an allergist for generalized urticaria. The family just recently visited a
family member that had a cat and dog. The mother wants to know if her son is allergic to cats and dogs.
The child’s skin was scratched with two different allergens. The physician waited 15 minutes to check the
results. There was a flare up reaction to the cat allergen, but there was no flare up to the dog allergen. The
physician included the test interpretation and report in the record. a. 95024 x 2
b. 95027 x 2
c. 95004 x 2
d. 95018 x 2
104. 42-year-old patient presented to the urgent care center with complaints of slight dizziness. He had
received services at the clinic about 2 years ago. The patient related this episode happened once
previously and his 51-year-old brother has a pacemaker. A chest X-ray with 2 views and an EKG with
rhythm strip were ordered (equipment owned by the urgent care center). The physician detected no
obvious abnormalities, but the patient was advised to see a cardiologist within the next 2 - 3 days. The
physician interpreted and provided a report for the rhythm strip and Chest X-ray. What CPT® and ICD9-
CM codes are reported for the physician employed by the urgent care center who performed a Level 3
office visit in addition to the ancillary services?
a. 99213-25, 71020, 93040, 780.4 c. 99283-25, 71010-26, 93010, 780.5
b. 99213-25, 71020-26, 93042, 780.4 d. 99203-25, 71010, 93000, 786.50

105. 55-year-old male has had several episodes of tightness in the chest. His physician ordered a PTCA
(percutaneous transluminal coronary angioplasty) of the left anterior descending coronary artery. The
procedure revealed atherosclerosis in the native vessel. It was determined a stent would be required to
keep the artery open. The stent was inserted during the procedure.
a. 92928-LD, 414.01 c. 92920-LD, 92928, 414.01, 414.06
b. 92920-LD, 92929-59, 414.06 d. 92920-LD, 92928-59, 414.01

106. A pregnant female is Rh negative and at 28 weeks gestation. The child’s father is Rh positive. The
mother is given an injection of a high-titer Rho (D) immune globulin, 300 mcg, IM. What CPT® and
ICD-9-CM codes are reported?
a. 90384, 96372, 656.13 c. 90384, 90471, 773.0
b. 90386, 96372, 656.13 d. 90386, 90471, 773.0

107. A patient with hypertensive end stage renal failure, stage V, and secondary hyperparathyroidism is
evaluated by the physician and receives peritoneal dialysis. The physician evaluates the patient once
before dialysis begins. What CPT® and ICD-9-CM codes are reported?
a. 90945, 401.9, 585.5, 588.81 c. 90945, 403.91, 585.6, 588.81
b. 90947, 403.91, 588.81 d. 90947, 403.91, 585.5

108. A patient with congestive heart failure and chronic respiratory failure is placed on home oxygen.
Prescribed treatment is 2 L nasal cannula oxygen at all times. A home care nurse visited the patient to
assist with his oxygen management. What CPT® and ICD-9-CM codes are reported?
a. 99503, 428.0, 518.83 c. 99504, 428.40, 518.83
b. 99503, 428.9, 518.82 d. 99503, 428.0, 518.82
 Medical Terminology
109. The meaning of the root “blephar/o” is:
a. Choroid c. Eyelid
b. Sclera d. Uvea

110. The meaning of heteropsia (or anisometropia) is:

a. Blindness in half the visual field c. Unequal vision in the two eyes
b. Double vision d. Blindness in both eyes

111. The radiology term “fluoroscopy” is described as:

a. Technique using magnetism, radio waves and a computer to produce images
b. An X-ray procedure allowing the visualization of internal organs in motion
c. A scan using an X-ray beam rotating around the patient
d. Use of high-frequency sound waves to image anatomic structures

112. Sialography is an X-ray of :

a. Sinuses c. Salivary glands
b. Liver d. Ventricles of the brain

113. A projection is the path of the X-ray beam. If the projection is front to back it would be:
a. Lateral c. Decubitis
b. Recumbent d. Anteroposterior

114. Cytopathology is the study of:

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

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

116. A gonioscopy is an examination of what part of the eye:

a. Anterior chamber of the eye c. Lacrimal duct
b. Interior surface of the eye d. Posterior segment

Anatomy
117. Which cells produce hormones to regulate blood sugar?
a. Eosinophils c. Hemoglobin
b. Pancreatic islets d. Target cells

118. Which part of the brain controls blood pressure, heart rate and respiration?
a. Cortex c. Cerebellum
b. Cerebrum d. Medulla

119. What are chemicals which relay, amplify and modulate signals between a neuron and another cell?
a. Neurotransmitters c. Interneurons
b. Hormones d. Myelin

120. Which of the following conditions results from an injury to the head? The symptoms include headache,
dizziness and vomiting.
 a. Meningitis c. Concussion
b. Parkinson’s disease d. Epilepsy

121. Lacrimal glands are responsible for which of the following?

a. Production of tears c. Production of vitreous
b. Production of zonules d. Production of mydriatic agents

122. Which of the following does NOT contribute to refraction in the eye?
a. Aqueous c. Cornea
b. Macula d. Lens

123. A patient diagnosed with glaucoma has:

a. A lens that is no longer clear c. Abnormally high intraocular pressure
b. Bleeding vessels on the retina d. Corneal neovascularization

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

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

ICD-9-CM
125. Use both ____ and ____ when locating and assigning a diagnosis code.
a. Alphabetic Index and Appendix C c. ICD-9-CM code book and Dictionary
b. Alphabetic Index and Tabular List d. Tabular List and Index to Procedures
126. When a patient has a condition that is both acute and chronic and there are separate entries for both, how is
it reported?
a. Code only the acute code c. Code both sequencing the acute first
b. Code both sequencing the chronic first d. Code only the chronic code

127. A patient with chronic back and neck pain developed a drug dependency on oxycodone (opoid). After
being taken off the drug, he was seen in the clinic for withdrawal symptoms. What ICD-9-CM codes are
reported?
a. 305.50, 292.0, E935.2 c. 292.0, 304.00, E935.2
b. 292.0, 305.50, E935.2 d. 304.00, 292.0, E935.2

128. A patient with metastatic bone cancer (primary site unknown) presents to the oncologist’s office for a
chemotherapy treatment. On examination, the oncologist finds the patient to be severely dehydrated and
cancels the chemotherapy. The patient will receive intravenous hydration in the office and reschedule the
chemotherapy treatment. What ICD-9-CM codes are reported?
a. 170.9, 276.51, 199.1 c. 198.5, 276.51
b. 276.51, 198.5, 199.1 d. 276.51, 199.1, 198.5

129. 22-year-old developed gas gangrene (gas bacillus infection) and went into septic shock after a surgical
procedure. What ICD-9-CM codes should be reported?
a. 995.92, 998.02, 040.0 c. 785.52, 995.92
b. 785.52, 040.0 d. 040.0, 998.02, 995.92

130. A patient with hypertensive heart disease is now experiencing accelerated hypertension due to papillary
muscle dysfunction. What ICD-9-CM code(s) should be reported?
a. 402.00 c. 401.0, 429.81
b. 402.00, 429.81 d. 404.00, 429.81

131. A three-year-old is brought to the burn unit after pulling a pot of hot soup off the stove spilling onto to her
body. She sustained 18% second degree burns on her legs and 20% third degree burns on her chest and
arms. Total body surface area burned is 38%. What ICD-9-CM codes should be reported for the burns (do
not include E codes for the accident)?
a. 945.20, 943.30, 945.20, 948.33 c. 942.32, 943.30, 945.20, 948.32
 b. 942.32, 943.30, 945.20, 948.33 d. 945.20, 943.30, 945.20, 948.12

132. Newborn twin girls delivered at 27 weeks, weighing 850 grams for twin A and 900 grams for twin B. Both
were diagnosed with extreme immaturity. What ICD-9-CM codes should be reported for both twins?
a. 765.03, V32.00 c. 765.13, 765.24, V31.00
b. V31.00, 765.03, 765.24 d. V32.00, 765.13, 765.24

133. Baby boy is born by cesarean section in the hospital. The mother has a history of diabetes mellitus, which
complicated the management of her pregnancy. In addition, the mother abused cocaine throughout her
pregnancy. The newborn was monitored for drug withdrawal, however no symptoms were noted and the
toxicology report came back negative. ABO incompatibility was documented, but the Coomb's test was
negative. What ICD-9-CM codes should be reported for the newborn’s record? a. 648.03, 250.00, 648.43,
305.60. V30.01 c. V30.01, 775.0, V29.8
b. V30.01, V29.8 d. 779.5, 773.1, V30.01

134. The diagnostic statement indicates respiratory failure due to administering incorrect medication. Valium
was administered instead of Xanax. What ICD-9-CM codes should be reported?
a. 969.4, 518.81, E962.0 c. 969.4, 518.81, E853.2
b. 518.81, 969.4, E939.4 d. E939.4, 969.4, 518.81

HCPCS
135. How many days does it take for CMS to implement HCPCS Level II Temporary Codes that have been
reported as added, changed, or deleted?
a. 365 c. 30
b. 90 d. 60

136. What temporary HCPCS Level II codes are required for use by Outpatient Prospective Payment System
(OPPS) Hospitals?
a. C codes c. H codes
b. G codes d. Q codes

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

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

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

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

a. annually c. bi-annually
b. quarterly d. three times a year

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

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

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

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

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

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

Practice Management
146. The Medicare program is made up of several parts. Which part is most significant to coders working in
physician offices and covers physician fees without the use of a private insurer?
a. Part A c. Part C
b. Part B d. Part D

147. If an NCD doesn’t exist for a particular service/procedure performed on a Medicare patient, who
determines coverage?
a. To determine new codes under Current Procedural Terminology (CPT)
b. Centers for Medicare & Medicaid Services (CMS)
c. Medicare Administrative Contractor (MAC)
d. The patient

148. Local Coverage Determinations are administered by ____?

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

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

150. HIPAA was made into law in what year?

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