1. An otolaryngologist performs a removal of a 3cm tumor present on the patient's face.

The tumor is removed from the deep facial layers within the muscle. What CPT® are
reported?

a. 21015
b. 21016
c. 21014
d. 21012

2. A surgical preparation of a 25 sq cm wound on the right leg is performed with a 25 sq

cm wound on the left leg What CPT is reported?

a. 15002 x 2
b. 15004 x 2
c. 15002
d. 15004

3. What CPT Coding reports the destruction of 20 premalignant lesions by laser

surgery? a. 17000, 17003, 17004

b. 17004
c. 17004-22
d. 17000, 17003 x 20

4. A patient with three thyroid nodules is seen for FNA biopsy. Using ultrasound guidance,
the provider inserts a 25-gauge needle into each nodule. Nodular tissue is aspirated and sent
to pathology.

What CPT® is reported?

a. 10005, 10006 x2, 76942

b. 10005, 10006 x2
c. 10021, 10004 x 2, 76942
d. 10006 x 3

5. A dermatologist excises a basel cell lesion from an area of the scalp. Measuring 3.7 cm. this
is closed with a layered repair What CPT® and ICD 10CM codes are reported?

a. 11424, 12032, C44.41

b. 11624, 12032, C44.41
c. 11624, C44.399
d. 11424, D23.4
6. A foreign body is removed via incision from the lef t third metatarsal jointWhat CPT®
is reported?

a. 28020
b. 28190
c. 28192
d. 28022

7. A 65 year old with lymphoma is having an insertion of central venous catheter via the
right subclavian vein. The catheter is inserted just below the right clavical. Under
fluoroscopic
visualization the catheter tip was placed in the superior vena cava above the right atrium.
Dissection of the deltopectoral area was performed with cautery down to the pectoralis fascia
level. The central venous catheterwas then tunneled from the insertion site to the pocket and
attached to a port, which was placed in the pocket. The incision site is then closed.What central
venous access to procedure is reported What central venous access procedure is reported?

a. 36569
b. 36558
c. 16556
d. 36561

8. A patient has malfunctioning ventricular electrode. The operative reports reflects that the
cardiologist made an incision into the subclavicular pocket. Which housed a single chamber
pacemaker. He detached the malfunctioning ventricular electrode, removed it from the patient,
and made decision to have a thoracic surgeon implant an epicardial lead later in the day(no
new hardware was implanted). He then closed the skin pocket with multiple layers of sutures.

What CPT® code is reported for cardiologist service?

a. 33236
b. 33235
c. 33249
d. 33234

9. A patient has lung cancer in his lower right lobe. The patient is in the operating suite to have
a video-assisted thoracoscopic surgery (VATS). A 10 mm zero degree thoracoscope was
inserted in the right pleural cavity. Removal of total right lower lobe with the mass is
performed.
Inspection of the lung revealed normal pulmonary parenchyma. Scope is removed, inserted a
chest tube and patient was extubated than transferred to the surgical intensive care unit for
observation. What CPT® is reported?

a. 32663, 32601-51
 b. 32666
c. 32671
d. 32663

10. A patient is seen at the doctor's office for nausea, vomiting and sharp abdominal pain. Labs
come back indicating an increased WBC count. The physician determines the patient has a
acute appendicitis. The physician schedules an appendectomy and takes the patient to
operating room. A scope is inserted through an umbilical incision. Trocars and ports are
inserted. The appendix is severed from the intestines and removed. What CPT® and diagnosis
codes are
reported?

a. 44950, K35.891
b. 44970,k35.80 , R11.2
c. 44950, K35.890, R11.2, R10.9
d. 44970, K35.80

11. An Ob-gyn examines the cervix and upper/adjacent portion of the vaginawith a
colanoscope. Biopsies on the lesions in the cervix are performed What CPT code is
reported?

a. 57460
b. 57454
c. 57421
d. 57455

12. The Phalanx is

a. Bone
b. Muscle
c. Tendon
d. Ligament

13. Which of the following is a function of ventricles of the brain?

a. Transmit neuro signals to the spinal cord

b. Fuse the skull bones of young children
c. Increase its surface area
d. Manufacture and distribute cerebrospinal fluid

14. Which entity offers compliance program guidance to form the basis of voluntary
compliance program for a provider practice?

a. American Medical association

(AMA)

b. b. Office of Inspector General (OIG)

 c. Office for Civil Rights (OCR)
d. Centers for Medicare and Medicaid Services(CMS)

15. A 6 year old fell of the jungle gym and hit her head. The injury resulted in a subdural
hematoma. She has been unconscious for last 60 minutes. The surgeon drills three burr holes in
the skull over the affected area. The dura mater is exposed and the burr holes are used to
access and drain the hematoma

What CPT® and ICD codes are reported?

a. 61108 X3, S05.5X3A, W09.2XXA

b. 61154, S06.5X3A, W09.2XXA
c. 61108, S06.5X2A, W09.2XXA
d. 61154X3, S06.5X2A, W09.2XXA

16. The physician prescribes a carbamazepine to treat patient with epileptic seizures after six
mnths the physician performs a thrpeutic drug test to moniter the total level drug in the
patient

What cpt and icd10 CM code is used for 6 mnths evaluation?

a. 80157, R56.9
b. 80156, R56.9
c. 80156, G40.909
d. 80157, G40.909

17. Bob had an upper respiratory viral illness with severe coughing a month ago. The
symptoms of the viral illness have been resolved for over two weeks. A few days bad coughing
spell, he developed hiccups occurring episodically through out the night. He is seen by his
family
physician and the hiccups are determined to be p origin, related to severe episodes of coughing.

What is the ICD-10CM Codes forhiccups

this condition?
is

a. B33.0
b. R06.0
c. B34.9
d. F45.8

18. A women with right breast cancer had a mastectomy six months ago. She sees
her oncologist and is told the cancer was removed successfully. she is still continuing
he
chemotherapy with two more treatments remaining. Using ICD-10CM guidelines for neoplasm.
Which code is reported for visit of oncology

a. Z85.3, Z90.11
b. C50.911, Z90.11
 c. Z51.11, C50.911, Z90.11
d. Z80.3, Z90.11

19. A foreign body is removed via incision from the left third metatarsal joint

? a. 28020
b. 28190
c. 28192
d. 28022

20. Which coding option is correct for 1 hour of crisis psychotherapy for a child abuse
victum with state agency report?

a. 90838
b. 90839
c. 90791
d. 9084

21. The patient has allergic reaction to a bee sting and sees his intermist for a injection with an
antigen mix to treat the condition. The provider supplies the allergy serum and three
injections are performed in the office

What CPT® is reported?

a. 95199
b. 95120
c. 95147
d. 95132

22. An established patient suffering from migraines without aura, no mention of status
migrainosus is seen by his ophthalmologist who conducts a visual field examination of both
eyes. The examination was accomplished plotting four isopters utilizing the Goldmann
perimeter testing method. The patient and requesting physician receives the interpretation and
report on the same date of service

What procedure and diagnosis codes are reported?

a. 92083, G43.019
b. 92082, G43.009
c. 92081, G43.009
d. 92082, G43.019

23. A 4 year old is seen by her pediatrician for vaccinations. The pediatrician counsels
the mother about the importance of the vaccinations and administers the influenza IIV
4(1
componet) by intramuscular route and MMR (3 component combination) by subcutaneous
route

According to CPT® guidelines, What CPT codes are reported?

a. 90460 x2, 90685, 90707

b. 90460 x 2, 90461 x 2, 90685, 90707
c. 90460, 90461, 90685, 90707
d. 90460, 90461 x3, 90685, 90707

24. Mr. Lange is 42 year old gentlemen who saw Dr. Wong last week for his yearly physical.
At that visit his BMI was 32. Lab tests were ordered. And Mr. lange returns today to dicuss
lab results and counseling on the risk of obesity. Dr,wong discussed Mr. Lange's family
history of
obesity, healthy and food choices and exercise. He recommended a program in the community
offering individual nutrition advice and an individual exercise program. The visit lasted 45
minutes.

How wound to report Dr. Wong report this visit?

a. 99412
b. 99403
c. 99407
d. 99409

25. Primary care provider. Dr. Russell, internal medicine Physician services provided and
documented by Dr.Rogers, internal medicine physician(substituting for Dr. Russell while he is on
leave for medical conference) Patient: Kate JohnsDOS: 1/2/20XX Patient is a 26 year old female
who is an established patient of Dr.Russell, she is seen today for upper quadrant pain. Especially
after a fatty meals. This is not a new problem, how ever the episodes of pain is increasing. Dr.
Roggers documentation shows a medically appropriate history and exam. An abdominal
ultrasound LFT's and CBC were ordered to rule out cholecystitis.

What CPT® is reported?

a. 99214-Q6
b. 99214
c. 99204-Q6
d. 99204

26. Dr. X sees a established patient in his office and on the same day, transfers the patient to
the observation status in the hospital with a diagnosis of type 2 diabetes mellitus with
hyperglycemia (Blood sugar 900). He performs a comprehensive history and comprehensive
exam. He evaluates the patient's newly diagnosed type 2 diabetes and orders blood glucose
levels to be monitored. He prescribes an insulin drip along with SQ insulin. The medical decision
making (MDM) moderate complexity. On the day two of the observation admission the
physician performs detailed history, detailed exam and straight forward MDM and his
documentation indicates that the patient's glucose level have improved. He places an order for
the dietician to see the patient. On day three of observation the provider discharges the patient
homeWhat E/M coding is reported by the physician for the patient in observation care?

a. 99235,99238
b. 99215, 99226, 99217
c. 99219,99226,99217
d. 99222,99231,99238

27 case

EXAM Xray lumbar spine

INDICATION FOR PROCEDURE: Nontraumatic low back pain TECHNIQUE Sx views of the
lumbosacral spine and bending views

FINDINGDS: Five non rb bearing lumbar type vertebrae. There is disk space narrowing and
endplate sclerosis with spurring most pronounced at the L2-L3 and 13-14 level on the left
vertebral body heights are maintained. Spinal alignment is normal Impression: Lumbar
spondylosis at 12-13 and L3-L4 levels

what ICD and CPT codes are reported?

a. 72084-26, 72120-26, M47.816

b. 72084-26, M47.817, M54.50
c. 72114-26, M47.816
d. 72114-26, 72120-26, M47.817, M54.50)

28. Chief Complaint: Vomiting

This started just prior to arrival and is still present. He has had nausea and vomiting no
diarrhea, black stools, bloody stools or abdominal pain. Pt is diabetic and has been having
elevated blood sugars (320 mg/dl)

REVIEW OF SYSTEMS: Unobtainable due to patient's altered metal status

PAST HISTORY: poorly controlled diabetes mellitus and history of poor

compliance Medications: see nurse notes

Allergies: PCN
Social history: Non smoker, no alcohol use or drug use

ADDITIONAL NOTES: The nursing notes have been reviewed

PHYSICAL EXAM:

Apperance: Lethargic patient is in mild

distress Vital signs: Have been reviewed -

tachycardiac Eyes: Pupils equal round and

reactive to light ENT: dry mucous membranes

are present

Neck: normal inspection, neck supple

CVS: tachycardia, heart sounds normal, pulses norma!

ED course insulin IV drip per protocol at 10units/hrZofran Smg 01 33 jul 13 2008 IVPPhenergen
25 mg IVP 07.52 discused the case with physician Dr. X review Agreed upon treatment plan:
physician will see patient is hospital Total entical care time: 45 min. Disposition: admitted to
intensive care unit. Condition: Stable, Admit decision based on need for monitoring and IV
hydration and medications Clinical impression: vomiting, diabetic ketosidosis, diabetic insipidus

What E/M code is reported?

a. 99291
b. 99285
c. 99291,99292
d. 99222

29. A 5 year old patient has a fractured radius. The orthopedist provides moderate sedation
and the reduction. The time is documented as 21 minutes

What CPT® is reported for moderate sedation?

a. 99156
b. 99152
c. 99151
d. 99155

30. A Medicare patient that is on dialysis for ESRD is seen by the nurse for Hep B vaccination.
This patient is given a dialysis patient dosage as part of a three dose schedule. The nurse
administers the the Hep B vaccine right deltoid. The physician reviews the chart and signs off on
the nurses's note What procedure and diagnosis codes are reported for scheduled vaccine
injection for medicare patient?
 a. 90471, 90746, Z23, B19.10, N18.6, Z99.2
b. 90471, 90746, 223, N18.6, Z99.2
c. G0010, 90740, Z23, N18,6, Z99.2
d. 99211-25, G0010,90740,B19,10,N18.6 Z99.2

31. A business requires drug testing for cocaine and methamphetamines prior to hiring a
job candidate. A single analysis with direct optical observation is performed followed by a
confirmation for cocaine

What codes are used for reporting the testing and confirmation?

a. 80306 x 2, 80353
b. 80306, 80375
c. 80305, 80353
d. 80305 x2, 80353

32. Pam presented to the emergency room with abdominal pain and vomiting. After an exam
and X rays. She is admitted to observation status to be given intravenous fluids and consult
with surgeon

Which E/M category is reported?

a. Intial observation
b. Consultation
c. Emergency department
d. Intial hospital

33. The patient is taken to the radiology department for radiologic cardiac catheterization.
An acuteMI of the left anterior descending coronary artery is found. The cardiologist
performs a suction, thrombectomy. Followed by artherectomy and a stent to the artery. A
CRNA provides MAC for this patient. Who is status 5

What code/modifier combination would you report for the services of CRNA?

a. 01925-QZ-P5
b. 00520-QX-QS-P5
c. 00520,QZ-P5
d. 01925-Qz-QS-P5

34. Blood from the right ventricle is pumped through the pulmonary semilunar valve
and eventually into the lungs through which of the following?

a. Aorta
b. Pulmonary vein
 c. Superior vena cava
d. Coronary sinus

35. A patient with surgical excision to treat melanoma on his chest wall two days ago, now
returns to operating room for planed free myocutaneous flap with microvascular
anastomosis. Dr. Smith repaired the defect with use of an operating Microscope What CPT®
and ICD 10CM codes are reported?

a. 15757-78, 69990, C44.509

b. 15756-58, 69990, C43.59
c. 15756-78, C44.509
d. 15756-58, C43.59

36. A 35 year old is coming for trigger point injections for right sided thoracic spine pain.
Three points are injected with Depto-Medrol 40mg/ml on the thomboid major muscle under
fluoroscopic guidance What CPT® Coding is reported for the injections?

a. 20552 x3, 77002

b. 20553 x3, 77002
c. 20553
d. 20552,77002

37. A air bag deployed when a driver lost control on his car and crashed into a tree on the
side of the highway. A young girl ridding in the front seat suffers the partial impact resulting
in a fracture of the frontal skull base. The fracture is diagnosed using the MRI scanner and
cerebrospinal fluid is noted dripping the sphenoid sinus into the right nasal passage. The child
requires a surgical nasal sinus endoscopy to assess and repair the injury.

What is the correct procedure and diagnosis coding combination to report this service?

a. 31291, SO2.0XXA, V47.6XXA, Y92.411

b. 31254, S02. 19XA, V47.6XXA, Y92.411
c. 31255, S02.91XA, V47.5XXA, Y92.411
d. 31290, S02.80XA, V47.6XXA, Y92.411

38. A general surgeon performs open surgery for an initial incarcerated epigastric hernia
repair, on a 30 year old, followed by implantation of mesh .According to the CPT® guidelines.
How is this hernia repair reported?

a. 49570, 49568
b. 49572
c. 49570
d. 49572,49568
39.A patient with severe adenomyosis has a vaginal hysterectomy performed
Saprosnopically. After the uterus is moved it in weighed at 300gms

What CPT is reported?

a. 58554
b. 58548
c. 58553
d. 56550

40. A mother expressed concern about the hearing of her 4 year old. The provider performed
a hearing screening with well child wearing headphones to listen to a series of tones. The child
is instructed to raise either hand when a tone is heard

What CPT code is reported?

a. 92553
b. 92551
c. 92550
d. 92552

41. A 4 year old critically ill child is admitted to the PICU from the ED with respiratory failure
due a exacerbation of asthma not manageable in the ER. The PICU provider starts continuous
bronchodilator therapy and pharmacologic support with cardiovascular monitoring and
possible mechanical ventilation support. After treatment is intiated the provider documents a
comprehensive history and Exam and orders are written

What is the E/M code for this encounter?

a. 99471
b. 99291
c. 99475
d. 99285

42 A patient who has deep vein thrombosis in the left forearm receives monitored anesthesia,
personally monitored thrombectomy

a. 01850 -AA-QS
b. 01840-AA-QS
c. 01850-AA-G8
d. 01840-AA G8
43. A 30 year old patient with a scalp defect is having plastic surgery to set the issue
expanders. The provider inserts the implants, closes the skin, and increases the volume of the
expander by injecting saline solution. Tissun is expanded until satisfactory aesthetic outcome is
obtained to repair the scalp defect What CPT code is reported?

a. 11960
b. 11970
c. 15777
d. 19357

44. A 12 old fell of his skateboard and hit his head. His mother took him to the emergency
room just to be checked out. The patient was wearing helmet Examination revealed no
outward head injury. He was admitted to the observation and an internal head injury was ruled
out

What is the correct diagnosis codes for this encounter?

a. Z04.1, V00.131A, Y93.51, Y99.8

b. S09.8XXA, V00.131A, Y93.51, Y99.8
c. S09.8XXA, Z04.1, V00.131A, Y93.51, Y99.8
d. VOO.131A, Y93.51, Y99.8, Z04.1

45. What are the structures the connects one bone to another bone for example the tibia to
the femur bone?

a. Tendons
b. Ligaments
c. Bursa
d. Cartilage

46. According to the repair (closure) CPT® guidelines, what type of repair is reported when
a single layer closure includes copious irrigation and extensive cleaning to remove
particulate matter

a. Simple repair
b. Intermediate repair
c. Simple repair plus code for irrigation
d. Complex repair

47. The patient presents to the urgent care facility with multiple burns acquired while burning
debrs in his backyard. After examination the physician determines the patient had third-
degree burns of the left and right posterior thighs (10%) He also has second degree burns on
the
anterior portion of the right side of chest wall (8%) and upper back (6%) TBSA is 24% with third-
degree burns totaling 10%
What ICD-10CM codes are reported?

a. T21.21XA, T21.23XA, T24.311A, T24.312A, T31.21

b. T24,311A, T24.312A, T21.21XA, T21 23XA, T31.31
c. T24.311A, T24.312A, 121.21XA, T24.23XA, T31.21
d. T24.711A, T24.712A, T21 61XA, T31.63XA, T32.21

48. During her annual physical exam, a mass found in the upper outer quadrant of the
patient's right breast. She scheduled today for her breast biopsy. An 8 gauge vacuum assisted
biopsy
needle was advanced into mass under sonographic guidance and one core was taken from the
mass. A clip was placed. A sonographic image after clip placement shows the clip in the lesion.
The biopsy is sent to the pathology to rule out cancer.

What CPT® and ICD 10CM codes are reported?

a. 19081, C50.411
b. 19083, N63.11
c. 19101, C50.411
d. 19125, N63.11

49. A female patient had an FNA biopsy with ultrasound guidance on two separate nodules
in the upper-outer quadrant of left breast. What CPT and ICD 10CM codes are reported

a. 10021, 10004, 76942, N60.21

b. 10005, 10006, N63.21
c. 10005, 10006, 76942, N60 02
d. 10005 10005-59, N63.21

50. A Grade 1 high velocity open right femur shaft fracture was incurred when a 15-m old
female pedestrian was hit by a car. She was taken to the operating mom with four hours of her
injury for thorough imagation and debridement, including excision of devitalized bone. The
patient was then re-prepped and re-draped and repositioned intramedullary sodding was then
carried out with proximal and datincking screws What CPT and ICD 10CM codes are reported?

a. 27506, 11044-51,537 3018, v03.10XA

b. 27506, 11012-51,572 3018, v03 10XA
c. 27507, 11044-51, 572 301A, VO3.10XA,
d. 27507, 11012-51, $72.324A, V03.10XA

51. A patient that delivered her second child vaginally has a history of having a previous
cesarean delivery for the first child What CPT code is reported delivery of the second child and
postpartum care?
 a. 59614
b. 59400
c. 59610
d. 59410

52. A patient has swelling in both arms and lymphangitis is suspected, She is in the
outpatient radiology department for a lymphangiography of both arms. What CPTS is
correct?

a. 75801-50
b. 75803-50
c. 75801,75803
d. 75803

53. A 60year old female is in the ED with chest tightness and mild shortness of breath ED
physician A is on duty and orders an EKG and interprets normal sinus rhythm The patient is
conservatively treated and placed in observation status with an order to repeat EKG in two
hours. The physician shift changes, and ED physician 8 takes over the care of the patient
from ED physician A. under ED physician B the second EKG is interpreted, and is still a
normal sinus rhythm. The patient is discharged home.

What CPT coding for the EKG by both ED physician

a. 93010 93010-51
b. 93010, 93010-76
c. 93010 93010-91
d. 93010, 93010-77

54. A 49 year old patient arrives with hearing loss in his left ear impedance testing
via tympanometry is performed. What CPTS code is reported

a. 92557
b. 92570
c. 92550
d. 92567

55. A 65 year old female had several episodes of tightness in the chest. Her physician ordered
percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending
coronary artery. The procedure revealed artherosclerosis. It was determined a stent would also
required to keep the artery open. The stent was inserted during the PTCA

What CPT is reported?

a. 92920-LD, 92929-59
 b. 92928-LD
c. 92920-LD, 92928-59
d. 92920-LD

56. A 65 year old patient is brought to ER in cardiac arrest. The emergency room physician
spens 105 minutes with the critically ill patient CPR and emergency endotracheal intubation are
performed to stabilize the patient. The ER physician makes notation that the time for CPR an
and intubation is not included in critical care time

How does the emergency room physician code this service?

a. 99291-25, 99292-25 x 2, 92950, 31500

b. 99291-25, 99292-25, 92960, 31500
c. 99285-25, 92950, 31500
d. 99291-25, 99292-25, 92950, 31500

57. A patient was hit from behind by another car while in her car and being fitted for a
foam cervical collar that is off the shelf Which HCPCS level II code is reported?

a. L0120
b. L0112
c. L0170
d. L0140

58. Report the services by an anesthesiologist providing general anesthesia for a repeat
CABG with pump oxygenation for a 74 year old patient? The patient had a previous coronary
artery bypass three years ago. The patient is status P3

What coding is reported by the anesthesiologist?

a. 00567-AA-P3, 99100
b. 00560-AA-P3
c. 00562-AA-P3, 99100
d. 00563-AA-P3

59. A 32 year old patient was scheduled to undergo an elective repeat cesarean in two weeks
instead at 36 weeks 3 days gestation, she is admitted for premature rupture of membranes
and is taken to the OR. Where she delivers by cesarean section. A 6lb 4 oz male without
complication. Mother and child are both doing well

What ICD 10CM codes are reported to maternal record?

a. 042.919, Z3A.36, Z38.01

b. 082, Z3A.36, Z37.0
 c. 080, Z3A.36, Z37.0
d. 042.913, Z3A.36, Z37.0

60. A surgeon performs bilateral breast biopsy with placement of localization device under
ultrasound guidance. Biopsies of the left breast were taken at 3'o clock and 10'o clock. Biopsy of
the right breast was taken at 7'o clock

What CPT® codes are reported?

a. 19083, 19084 x 2
b. 19085-50, 19086
c. 19083-50, 19084
d. 19085, 19086x2

61. During a self breast exam Julle felt small hard nodules in her right and left breasts, She was
examined by her physician, who also tell the nodules. The physician diagnoses umple breast
cysts and recommendstoUsing ultrasound guidance. A sterile needle is inserted into the cyst
of the right brand is withdown Attention is turned to the left best and the procedure is
performed

a. 19000x2
b. 19000, 19001, 76942
c. 19000, 19001-51, 76942
d. 19000900151

62. A 30 year old female is having suction assisted lipectomy performed on her love handles
and abdomen. She is also undergoing a right and left breast augmentation. The liposuction of
the
love handles was performed through two stab incisions. The right and left handles had a total
of 600cc of the fat removed. Attention was then turned to the abdomen. A periumblical
incision was made and liposuction was performed on each of the four quadrants. A total of
850cc of the fat is removed. Next inframammary crease incision were made on the right breast
going
through the skin, subcutaneous tissue down to the capsule. a subgladular pocket was made
inserting a340cc. alergan textured. High profile implant was used for the same procedure. I
performed on the left breast. all wounds were closed with deep sutures. Antibiotic ointment
and dressings were applied to the incision sites

What are the correct codes for this surgery?

a. 15877, 19340-50
b. 15830, 19340-50
c. 15877, 19325-50
d. 15830, 15847,15772-50
 63. A surgeon performed Mohs micrographic surgery on a lesion on the lower leg. This
required one stage with six tissue blocks. A direct skin flap was used to cover the defect?

What CPT codes are reported?

a. 17313, 17314, 17315, 15570

b. 17313,17315,15572
c. 17311, 17312,15570
d. 17313,17314, 15572

64. A 30 year old male presents with De Quervain's disease of right hand in the OR,with
sterile approach to the right wrist an incision is made dissecting down to the tendon sheath.
The
tendon sheath is incised releasing the contracture that has been causing pressure on Extensor
tendon. Incisions are repaired in layersWhat CPT® and ICD 10CM codes are reported?

a. 25000-RT, M65.4
b. 25001-RT, E34.51
c. 25001-RT, M65.4
d. 20550-RT, E34.51

65. A 1 year old patient was born with two supernumerary digits, one extending from the left
pinky. The digit from his left pinky is larger and includes the metacarpal bone with a joint and
is amputated. The one of the right is the nubbin and contains no bony structure. The hand
surgeon removes the one extra digit containing soft tissue by a simple excision.

What is the CPT® code for the procedure performed?

a. 26910-LT, 11200-RT
b. 26951-50, 11200-50
c. 26587-LT, 11200-RT
d. 26910-50

66. A couple presents to freestanding fertility clinic to start in vitro fertilization Under
radiologic guidance ao aspiration needle inserted (ty and of superimposed guiding line)
punning the overy and preovulatory follicle and withdrawing fluid from the follicle containing
the egg

What is the correct CPT code for this procedure?

a. 58000
b. 58970
c. 58974
d. 58976
67. An emergency department (ED) physician perform an immediate tracheostomy on a 1
year old that has severe head and neck trauma this is obstructing her breathing

What CPT® code is reported?

a. 31500
b. 31601
c. 31600
d. 31603

68. A patient had recent angiogram demonstrating diffuse. High-grade left superficial
femoral artery (SFA) stenosis as well as separate severe stenosis in thetibioperoneal trunk. A
right
femoral access is made and a contralateral sheath is placed. A wire is able to cross both vessel
stenoses and is placed into the posterior tibial artery. A artherectomy is performed of the
diffuse SFA segment and then a smaller artherectomy and placement of stent is placed and
used in the tibioperoneal trunk. A stent placement is also performed in the mid SFA due to
acute
occlusion at the artherectomy site. Completion lower extremity angiography is performed
demonstrating restoration of flowWhat CPT® is reported?

a. 37227,37231
b. 37227, 37229
c. 37226, 37230
d. 37225, 37229

69. A patient diagnosed with GERD presents to the same day Surgery department for an EGD.
The procedure is done to treat the GERD by delivering thermal energy to the muscle of the
gastric cardia and lower esophageal sphincter. There are no clinical findings suggesting a need to
explore the duodenum and the physician determines a repeat examination will not be needed
based on the favorable condition of the patient at the conclusion of EGD.

What is correct procedure and diagnosis code?

a. 43257-53, K20.90
b. 43260-53, K21.9 I
c. 43260-52, K22.10
d. 43257-52. K21.9

70. Patient has cervical spondylosis with myelopathy. The surgeon performed a bilateral
posterior laminectomy with faceectomies at each level andforaminotomies performed
between interspaces C5-C6 and C6-C7. Bilateral decompression of the nerve root is achevied.
What CPT® is reported?

a. 63040-50, 63043, 63043

 b. 63045, 63048
c. 63015
d. 63050-50

71. The provider uses a nerve tissue graft harvested from living donor, for nerve repairon
the first stand of the median nerve in the forearm What CPT® is reported?

a. 64910
b. 64897
c. 64912
d. 64890

72. Procedure: The patient was taken to the minor procedure room where left eye was
prepped with Betadine and draped in the usual fashion. A lid speculum was placed in the
palpebral fissure. A small amount of 2% lidocaine with epinephrine was injected with a
30gauge needle subconjuctivally in the superior temporal quadrant. A 30 guage needle was
inserted into the anterior chamber of the eye and 0.05ml of aqueous was removed. The eye
was soft and the wound was sealed light pressure was placed on the injection site with a Qtip
soaked in
povidone-iodine. The lid speculum was removed without difficulty and patient recovered from
the procedure with out difficulty

What CPT® code is reported for the procedure?

a. 67120-LT
b. 65810-LT
c. 65800-LT
d. 66184-LT

73. A 50 year old female with chronic hepatitis C is undergoing an ultrasound elastography
of the liver to determine the existing, baseline degree of the hepatic fibrosis. The radiologist
analyzes and interprets all the images

What CPT code is reported?

a. 76982
b. 76981
c. 76215
d. 78201

74. A patient with abnormal curvature of the spine will have T3-T7 vertebral segments fused
via anterior approach to secure different vertebrae to one another.

What CPT® is reported?

 a. 22800
b. 22802
c. 22810
d. 22808

75. In an accidental shooting, multiple pellets, from a shotgun blast puncturing the
patient's right upper quadrant of the abdomen, are removed from skin, muscle and fascia.
No pellets penetrated the thoracic or abdominal cavities

a. S31.140A, W33.01XA
b. S31.130A, W33.00XA
c. S31.149A, W33.01XA
d. S31.640A, W33.00XA

76. A 3 day old died in her sleep. The pediatrician determined this was result of crib death
syndrome. The parents give permission to refer the newborn for a necropsy. the
pathologist
receives the newborn with her brain and performs a gross and microscopic examination: The
physician issues the findings and reports they are consistent with normal female newbornWhat
CPT® is reported?

a. 88012
b. 88014
c. 88028
d. 88029

77. A 10 year old had a cochlear implant in his left ear few weeks ago. Today he sees
audiologist to initialize and program the implant.What CPT® code is reported?

a. 92604
b. 92626
c. 92603
d. 92630

78. A cardiologist uses the hospitals equipment for a cardiac stress test as he doesnt own
equipment for the test. He supervises the text and provides the interpretation and report of the
test

What CPT is reported?

a. 93015, 93016
b. 93016, 93017, 93018
c. 93016, 93018
d. 93015, 93018
79. Dr. John requested a cardiology consult with Dr. Ross for a patient recentlydischarged
from the hospital for chest pain. Dr.Ross sees the patient in his office and documents a
detailed
history, detailed exam and moderate medical decision making

What CPT® code does Dr. Ross report for the visit?

a. 99243
b. 99254
c. 99244
d. 99253

80. Dr. Meredith sees Mr. Hollis for the first time in community rest home. She documents a
detailed history, detailed exam and moderate medical decision making. She spends 20
minutes of additional time discussing physical therapy and going over medications

What CPT coding does Dr.Meredith report?

a. 99336
b. 99336, 99354
c. 99326, 99354
d. 99326

81. A physician admitted a 29 day old male baby to inpatient critical care for respiratory
arrest. The physician performs CPR, emergency endotracheal intiation and insertion of an
umbilical venous catheter in order to stabilize his conditionHow does the physician code hes
services?

a. 99291-25.99292, 92950 ,31500,36510

b. 99468-25.92950
c. 99471-25, 92950
d. 92950,31500, 36510

82. A physician has a patient with short bowel syndrome and prescribes parental
nutrition infusion pump is ordered for the patient.

What is the HCPCS Level Il code for insulin pump?

a. B9004
b. B4224
c. B4222
d. B9002

83. A 25 year old patient, P3 was given general anesthesia by an anesthesiologist for an
emergency appendectomy in the lower abdomen Report the services for anesthesiologist?
 a. 00790-AA-P3,99140
b. 00790-AA-P3
c. 00840-AA-P3
d. 00840-AA-P3, 99140

84. CASE : Operative report

Preoperative Diagnosis: History of Colon polyps

Postoperative Diagnosis: Sigmoid diverticulosis

Procedure: Diagnostic Colonoscopy

Anesthesia: IV sedation

Techinique: The patient was brought to the endoscopy suite and placed in the lateral decubitus
position. Digital rectal examination was then performed. The colonoscope was then inserted
under videoscopic visualization and minimal insufflation. The scope went beyond the splenic
flexure. The sigmoid colon did not reveal some diverticulosis. Further advancement of the
colonoscope was unable to accomplished and did not reach the cecum due to retained stool in
the transverse colon. It was decided not to advance scope further due to poor prep. The
colonoscope was then removed and patient was given instruction to go back after one week for
repeat colonoscopy

How is the surgeon services reported?

a. 45379-52
b. 45378-53
c. 45378-52
d. 45330

85. 85.

86. A 5 year old brought to the neighborhood urgent care actively seizing. The child's she
found him with an open box of D-Con(pesticide) which she had accidently left out side. The
child had blue powder residue on his fingers and lips. Lab confirm the patient had ingested this
pesticide. What are the correct

ICD-10CM codes?

a. T60.91XA, R56.9
b. R56.9, T60.91XA
c. T60.92XA, R56.9
d. R65.9, T60.94XA
87. A 33 year old that is 28 weeks pregnant is coming in to check her blood sugar. she has
had type 2 diabetes from past Two years what ICD-10CM codes reported?

a. 024.113, E11.9, Z3A.28

b. E11.9, 024.113, Z3A.28
c. 024.419, E11.9, Z3A.28
d. E11.9, Z33.1, Z3A.28

88. A 55 year old male driver is in traffic accident with another vehicle. He is HIV positive and
has not exihibited any symptoms of the HIV disease. He has a head contusion from the
accident. what ICD10CM codes are reported for this encounter?

a. B20, S00.93XA, V49.40XA

b. S00.93XA, Z21, V49.40XA
c. Z21, SO0.93XA, V49.40XA
d. S00.93XA, B20, V49.40XA

89. 63 year old fractured her scaphoid bone in her right wrist three months ago. She
now presents with a nonunion of the scaphoid bone. What is the ICD 10CM code?

a. S62.101G
b. S62.101A
c. S62.101K
d. S62.001K

90. A patient presents with hypertrophic scarring of her chin from a burn received one year
ago. Scar management has failed. What ICD 10CM codes are reported?

a. T20.03XA, T20.03XS, L91.0

b. L90.5, T20.23XA
c. L91.0, T20.03XS
d. T20.03XA, L90.5

91. A cardiologist performes a 12 lead ECG in his office. He provides an interpretation

and report. How does the cardiologist report the ECG?

a. 93000
b. 93010-26
c. 93000-26
d. 93010

92. 27 year old patient and her mother is present for ongoing assessment on the patient
individual psycho therapy session. Patient is agitated uncooperative and disagrees with the
treatment plan as outlined patient's mother is frustrated with the patient and disagrees with
portions of the proposed treatment plan. The time the physician spent face to was was 45
minutes. What CPT® code is reported for this visit?

a. 90839
b. 90846
c. 90832
d. 90834

93. A 55 year old patient in the hospital with peritoneal dialysis is evaluated and treated by
his physician on time. What CPT® code does physician report for this service?

a. 90962
b. 90970
c. 90935
d. 90945

94. A patient had a allergic reactionto be sting and is coming to the internist's office for an
injection with an antigen mix to treat the condition. The provider does not prepare but only
supplies the all serum. A single injection is performed. What CPT® code is reported?

a. 95130
b. 95115
c. 95165
d. 95145

95. A 65 year old female has had several episodes of tightness in the chest. Her
physician ordered a. the left anterior descending coronary artery. The procedure
revealed
artherosclerosis in the native artery. It was determined by angioplasty that a stent would be
required to keep the artery open was inserted during the procedure.

What CPT® and diagnosis codes are reported?

a. 92928-LD, 125.10
b. 92920-LD,92929-59, 125.811
c. 92920-LD, 92928-59,125.118
d. 92920-LD, 92928-59, 125.10

96. Lab results of a urine test of total proteins reveals abnormally high levels of ketones, which
the body may produce when fats, rather than glucose, are used for energy. Based on the
results, the ordering physician takes blood sample from the patient to test glucose levels the
ordering physician send the blood to lab for a glucose level.
What codes are reported for blood work?

a. 82947
b. 83036
c. 84156, 82947
d. 84156,83021

97. With regards to the pathology and laboratory code panels of the tests in CPT®
which statement is correct?

a. Tests in each panel code can be reported separately with the panel code
b. Test(S) that are not in panel code can be reported separately with the panel code
c. If a group of tests overlaps two or more panels, report both panels
d. If a group of tests overlaps two or more panels, report the panel that has the
lowest number of tests

98. A patient had a vaginal hysterectomy for severe dysplasia of the vulva; VIN III. A surgical
pathology of a gross and microscopic examination was performed on the uterus, fallopian
tube and ovaries. Which CPT® codes is reported?

a. 88305
b. 88307
c. 88309
d. 88302

99. A physician orders a obstetric panel. The obstetric panel includes syphilis screening using
the treponemal antibody approach and automated CBC with manual differential WBC count.
What CPT® code(s) are reported?

a. 80055
b. 85027, 85007, 87340, 86762, 86780, 86850, 86900, 86901
c. 80081, 86780
d. 80055, 85027, 85007, 87340, 86762, 86780, 86850, 86900, 86901

100. A patient presents to the office with dysuria and slight nausea. The physician thinks she
has an UTI. The physician performs a non-automated urinalysis, which read negative. The
appropriate coding for this encounter would be:

a. 81007, R30.0,R11.0
b. 81002, R30.0, R11.0
c. 81002, N39.0, R30.0, R11.0
d. 81000, N39.0
101. A 50 year old male on examination has a couple thyroid nodules without clinical
symptoms of hyperthyroidism. Blood thyroid function tests indicate euthyroidism. Physician
images the thyroid gland by intravenously administering radioiodine. multiple images are
acquired from
different angles and documenting in patient's position. The vascular flow in around the
nodules are looked at to determine benign from malignant flow characteristics. What
radiology code is reported? `

a. 78015
b. 78070
c. 78012
d. 78013

102. A 12 year old male seen in the emergency department sustained an injury several hours
ago to his left ankle when his brother kicked him accidentally while playing soccer at a
public park. Ankle X ray were taken in lateral and transverse positions to rule out a fracture.
The
interpretation of the X ray revealed there was no fracture. He is diagnosed with a
sprained ankle. What CPT® and diagnosis codes are reported?

a. 73610-26, S93.492A, W51.XXXA, Y92.831, Y93.66, Y99.8

b. 73600-26, S93.402A, W50.1XXA, Y92.830, Y93.66, Y99.8
c. 73600-26, S93.492A, W50.0XXA, Y92.830, Y93.66, Y99.8
d. 73610-26, S93.402A, W50.1XXA, Y92.830, Y93.66,Y99.8

103. The patient with hydronephrosis presents to an ASC for a cystourethroscopy with
urethral catherization and irrigation. A right intravenous pyelogram was also performed.
During the procedure the performing physician includes theinterpretation of the pyelogram
in the
operative note.What are the codes for physician's services that are performed at ASC?

a. 52001, 74420-26
b. 52000, 74425-26
c. 52005, 74400-26
d. 52007, 74400-26

104. From a left femoral access, the catheter is placed within the common hepatic artery dye
is injected imaging is obtained. A stenosis within this artery is identified. A percutaneous
transluminal angiography is performed on the common hepatic (visceral) artery in the
outpatient radiology department.What are the CPT® codes reported?

a. 36245, 75716-26-59, 37248

b. 36246, 75726-26-59, 37246
c. 36245, 75726-26-59, 37428
d. 36247, 75716-26-59, 37246
105. A general surgeon performs open surgery for an intial epigastric hernia repair, reducible
on a 27 year old followed by implantation of mesh. How is this hernia repair reported?

a. 49652
b. 49572, 49568
c. 49570, 49568
d. 49570

106. A 10 year old child with regrowth of tonsil tissue is taken to the operating room
for tonsillectomy select the procedure code?

a. 428351
b. 42825
c. 42820
d. 42826

107. A 40 year old patient has symptoms of dysphagia and reflux. The gastroenterologist
introduces a rigid scope through the mouth to examine the esophagus where he observes
a stricture. He then introduces and performs 25mm balloon dilation. What CPT ® reported?

a. 43450
b. 43195
c. 43220
d. 43249

108. A 45 year old female has chronic obstruction of the bile ducts. An incision was made
over the right upper quadrant. The gallbladder and liver bed were inspected with normal
findings except that the common bile duct is dilated with an apparent obstruction. The bile
duct is
dissected from its attachements at both the gallbladder and intestine. A loop of small bowel was
brought up to the gallbladder fossa and was tacked to the surface of the gallbladder. A
cholecystotomy was performed and bile returned from the gallbladder.An enterotomy was
made in the jejunum and a two layer anastomosis was performed. The patient tolerated the
procedure without difficulty. what CPT ® is reported?

a. 47570
b. 44130
c. 47720
d. 47800

109. A patient is seen at the doctor's office for nausea, vomiting and abdominal pain. Labs
come back indicating an increased WBC count. The physician determines the patient has an
acute appendicitis. The physician scheduled an OR and took the patient to the operating room.
An
abdominal incision is made and an appendectomy is performed. The patient is also diagnosed
with generalized peritonitis

a. 44960, K35.2
b. 44960, K37, K65.9, R11.2, R10.9
c. 44950, K36
d. 44970, K36, K65.9,R11.2, R10.9

110. A patient is diagnosed with three liver tumors is taken to the operating room. The
physician uses a needle electrode to go through the skin administratingradiofrequencyfor
destruction of the tumors. CT guidance was used to verify the needle was placed in the correct
spots and to
monitor treatment. what are the procedure and diagnosis codes?

a. 47382, 77013-26, D49.0

b. 47382 X3, 77013-26, D13.4
c. 47380 X 3, 77013-26, C22.9
d. 47380, 77013-26,D49.0

111. A 34 year old male is taken back to the OR for a takedown of his colostomy and reversal of
his Hartman's pouch after 6 months of bowel rest for his colitis. The patient is placed supine on
the operating table and general endotracheal anesthesia is administrated. His abdomen is
prepped and draped in the usual sterile manner. The colostomy stoma was incised and
desected sharply from the abdominal wall. This was closed with 0-0 chromic and 3-prolene. The
distal portion of the colon was brought up reopened and refreshed. The GIA stapler was used
to re anastamose the colon to the rectum.

What CPT® code is reported?

a. 44227
b. 44620
c. 44625
d. 44626

112. A patient diagnosed with GERD presents to the same day surgery department for an EGD.
The procedure is done to treat the GERD by delivering thermal energy to the muscle of the
gastric cardia and lower esophageal sphincter. There are no clinical findings suggesting a need
to explore the duodenum and the physician determines a repeat examination will not be
needed based on favorable condition of the patient at the conclusion of the EGD.What are the
correct procedure and diagnosis codes?

a. 43260-52, K22.10
b. 43260-53, K21.9
 c. 43257-52, K21.9
d. 43257-53, K20.9

113 PROCEDURE: ABDOMINAL WASHOUT WITH VAC PLACEMENT AT BEDSIDE

INDICATIONS: Reopening abdomen. S/P laparotomy

PERMIT: Signed and on the chart

SEDATION: VERSED 10mg

ANESTHESIA: FENTANYL 300mg; This procedure was done on bedside. Therefore the patient's
wound VAC was removed. The skin was prepped with CHLORAPREP and the patient was draped
in sterile fashion. The bowel did not appear edematous. There were portions of the bowel
which appeared to have fibrinous exudate, however, there were no signs of pus or necrotic
material. The abdomen was then washed with approximately 2L of warm saline; an abdominal
VAC was placed and secured in place with staples. A seal was established and maintained. The
patient tolerated the procedure well. A time out was done before the commencement of this
procedure.

ESTIMATED BLOOD LOSS: Minimal, less than 5

ml COMPLICATIONS: None

CONDITION AT THE END OF PROCEDURE: Stable

What is the correct CPT® for this procedure?

a. 49002
b. 49000
c. 49020
d. 49010

114 operative report

Preoperative diagnosis: History of Colon polyps

Postoperative Diagnosis: severe sigmoid diverticulitis

Procedure: colonoscopy

Anesthesia: IV sedation

Techinique: The patient was brought to the endoscopy suite and placed in the lateral decubitus
position. Digital rectal examination was then performed. The colonoscope was then inserted
under videoscopic visualization and minimal insufflation. Advanced to the sigmoid colon.
Further advancement of the colonoscope was unable to be accomplished safely due to severe
sigmoiddiverticulitis and the scope does not reach the splenic flexure. The colonoscope was
then removed

What code for surgeons service?

a. Procedure not coded

b. 45378
c. 45330
d. 45378-52

115.A patient presents to the hospital based clinic in her 15th week of pregnancy with
cramping, cervix dilated to 2cm and a bulging amniotic sac. The physician confirms a
spontaneous complete abortion and decides to manage the patient with monitoring and
medical treatment. How is this coded?

a. 59812
b. 59841
c. 59820
d. An appropriate E/M code

116.A paravaginal defect repair including a cystocele via abdominal approach is performed on
38 year old patient

a. 57284
b. 57285,57240-51
c. 57200, 57285-51
d. 57285, 57260-51

117.The patient found to have a renal abscess requiring drainage. It is done with an open
procedure. What CPT® and ICD-10CM codes are reported?

a. 50020,N15.1
b. 50020, L02.91
c. 50045, L02.91
d. 50010, N15.1

118.A patient underwent a cystourethroscopy with a pyeloscopy using laser technique to

fragment the ureteral calculus. An indwelling stent was also inserted during the same side. This
service was performed in the outpatient hospital surgery center. What CPT® code(s) are
reported?

a. 52356
 b. 52353,52332-51
c. 52352, 52332-51
d. 52325,52332-51

119.Preoperative Diagnosis: Elevated PSA

A patient presents to the hospital special procedure suite and was placed in the left lateral
decubitus position. An incision is made through the skin of the perineum and the tissues are
dissected to expose the prostate. Tissue is obtained from the prostate for analysis. A
multinodular prostate with an approximate size of 79 grams was identified with apparent
urinary obstruction . What CPT® and ICD-10CM codes are reported?

a. 55705,R97.20, N40.3, N13.8

b. 55705, R97.20, N40.3
c. 55700, R97.20, N40.2,N13.8
d. 55700, R97.20, N40.3

120.A patient who has endometriosis has decided to have a supracervical hysterectomy. Under
general anesthesia a 12 mm incision is made in the infraumblical folds and the veress needle is
introduced in the abdominal cavity. The abdomen is insufflated with CO2 gas to pressure of
mm Hg. A 12 mm scope was introduced into the abdomen and intraabdominal placement was
confirmed the laparoscope with the placing of two ports. The uterus is dissected free from the
bladder and surrounding tissues. Both ovaries and both fallopian tubes are removed. The
abdominal cavity is deflated and instruments removed. The incision is closed in two layers. The
uterus weighs 250gms

a. 58542
b. 58570

121.38 year old female requested to have sterilization. The patient is placed supine on the OR
table. Under general anesthesia, scrubbed and draped in the usual sterile manner. The
abdomen is cannulated and insufflated with CO2. Four ports are placed. The colon is retracted.
A laser is used to fulgurate the fallopian tubes. The physician transects the fallopian tubes. All
ports were removed and port site sutured closed with 2-prolene

a. 58661
b. 58662
c. 58673
d. 58670

122.A 2 year old male is diagnosed with a right renal mass that is compressing the liver. Patient
was placed under general anesthesia and incision was made in the right flank and resecting a rib
to get to the mass. The right kidney was removed along with part of the right ureter. What
CPT code is reported?

a. 50240-RT
b. 50234-RT
c. 50220-RT
d. 50546-RT

123. A 16 year old girl presents to the delivery room door in hard labor. She is 7cm dilated,
water intact upon arrival. As she was keeping the pregnancy a secret, she had no prenatal
care. She progresses and has a SVD delivering a healthy female baby with Ap `gars of six and
eight. One hour after delivery, she begins to hemorrhage and is rushed to the OR for a
postpartum D&C due to a retained placenta. The patient is scheduled with the delivering
physician for a postpartum follow-up in three weeks

a. 59410,59160-78,072.0, 043.219, Z37.0, Z3A.00

b. 59410.59160-78.073.1. 043.219.Z37.0. Z3A.00
c. 59409,59430-78, 59160, 073.0, Z37.0, Z3A.00
d. 59515,59160-78, 072.2, Z37.0, Z3A.00

124. Postoperative Diagnosis: Prostatic

hyperplasia Procedure1. Cystoscopy

2. Transurethral resection of

prostate. Justification for procedure:

This 65 year old gentleman, prior laser prostatectomy fourteen months ago, has significant
lower urinary tract symptoms and re-growth of visible obstructive hyperplasia. He is here for
endoscopic resection of the prostate

Description of the procedure: After through Batadine prepping and draping and a suitable
general anesthesia, the optical dilator was inserted per urethra. Urethra was normal. Prostatic
hyperplasia noted particularly lateral lobe hyperplasia with some necrosis in the floor of the
prostatic urethra from the prior laser procedure. A systematic transurethral resection of the
obstructing prostatic tissue was performed. All chips were removed. Minimal bleeding catheter
placed, three way type. The patient tolerated the procedure well and was taken to the recovery
room in good condition.

a. 52601
b. 52630
c. 52640
 d. 52648

125. A 25 year old suffering from thoracic spondylosis presents to an outpatient facility to
receive transforminal epidural steroid injections. The injections are administered on the
right side in T3 and T5 levels. Under ultrasonic guidance. What are the correct CPT ® codes
for this patient's encounter?

a. 64479,64480,76942
b. 64479, 64480
c. 0228T, 0229T
d. 0228T, 0229T, 76942

126. What CPT code is reported for the surgical release of the ulnar nerve at
themedial epicondyle?

a. 64716
b. 64718
c. 64708

127.A patient presents with the Audiant bone conductor which requires replacement. This
electromagnetic bone conduction hearing device was removed via a postauricular incision and
replaced with a new electromagnetic conduction hearing device. The wound is irrigated and
repaired with sutures?

a. 69711
b. 69717
c. 69718
d. 69710

128.A patient is taken to the operating room for a unilateral partial thyroid lobectomy with
isthmusectomy.

a. 60210
b. 60212
c. 60220-52
d. 60225

129.A patient has chronic cholesteatoma in the right middle ear. The otolaryngologist
performed tympanoplasty with a modified radical mastoidectomy, removing the middle ear
cholesteatoma. A reconstruction of the ossicular chain with a PORP was performed and grafting
technique was used to repair the eardrum.

a. 69646
 b. 69636
c. 69642
d. 69644

130. A 45 year old female had a closed fracture of the T4-T8 vertebrea 15years ago and now has
displacement of the thoracic intervertebral disc. The surgeon will decompress the spinal cord
involving one segment of the thoracic spine. The surgeon performs the surgery by using a
transpedicular approach going through the pedicle on the side of the disc's bulge to reach the
herniated disc. The lamina and facet joints is removed along with the disc fragments

a. 63064
b. 63077
c. 63085
d. 63055

131.A 10 year old child with congenital hydrocephalus presents with headache and blurred
vision. The patient has a shunt that is malfunctioning due to an obstructed valve. The old valve
is replaced with a new one and the shunt system is reconnected and tested.

a. 62258, T85,9XXA, Q03.9

b. 62256, T85.09XA, G91.9
c. 62230, T85.09XA, Q03.9
d. 62256, 62258-51, T85.730A, G91.8

132. Procedure performed: Lumbar epidural corticosteroid injection under fluoroscopic

guidance.

Procedure: patient was positioned prone with the C arm at the lumbosacral junction. The entry
point was identified. Skin was cleaned with betadine and the usual sterile prep was done local
anesthestic was injected subcutaneously. A 17guage3-1/2 inch Tuohy neddle was advanced
under fluoroscopic guidance to the epidural space at L5-S1 and there was positive loss of
resistance. Proper positioning was further confirmed with two views. A mixture of 3cc(12mg)
celestone and 3cc strille saline was injected without any problem. The needle was removed and
there was nosign of bleeding.

a. 62323
b. 62323, 77003
c. 62327
d. 62327, 77003

133.A 45 year old male presents to the OR for a partial corpectomy on two lumbar vertebrae.
Two surgeons will be performing the surgery. One surgeon performs the transperitoneal
approach and excises the damaged portion of the vertebrae then removes the discs above and
below the vertebrae inserting bolts in both areas. The second surgeon inserts a bone graft into
the vertebral gap and inserts a metal plate. Because each surgeon continue to work together as
a primary surgeon. How will each provider report their portion of surgery?

a. 63090-62, 63091-62
b. 63087-62, 63088-62
c. 63087-80, 63088-80
d. 63090-66, 60391-66

134.A 28 year old male was rock climbing and hit his head on a rock, suffering an injury resulting
in left subdural hematoma and skull fracture on the right. He has been unconsciousness for the
last thirty minutes. The surgeon uses a twist drill to create a hole in the skull over the affected
area. The dura matter is exposed and the hole is used to access and drain the hematoma.

a. 61154, S06.891A, S02.19XA, W22.09XA, Y93.31, Y99.8

b. 61108, S06.5X1A, S02.91XA, W22.09XA, Y93.31, Y99.8
c. 61156, S06.341A, S02.91XA, W22.09XA,Y93.31,Y99.8
d. 61105, S06.2X1A,S02.19XA, W22.09XA, Y93.31,Y99.8

135. The physician orders and performs an ultrasound with real time image documentation
for fetal and maternal evaluation using a transabdominal approach on a patient who is
expecting twins and is in the 11thweek of getation.

a. 76801, 76802
b. 76811,76812
c. 76815
d. 76816 x2

136. A diagnostic mammogram is performed on the left breast utilizing computer

aided detection to analyze lesions

a. 77066-LT
b. 77065-LT
c. 77067-LT
d. 77058-LT

137. 65 year old male has early stages of prostate cancer. Physician decides to brachytherapy.
First the physician performs a transrectal ultrasound performs to locate the tumor and to
know where the radioactive seeds should be placed in the prostate.

a. 76870
b. 76872
 c. 76856
d. 76873

138. A physician performs a transrectal ultrasound of the prostate for a mass noted
in examination This is to ruled out Malingnancy in the prostate gland

a. 76870, N42.89
b. 76872, N82.89
c. 76942,C61
d. 76873, C61

139 A kidney transplant patient with a diagnosis of hypertensive heart disease without
heart failure and stage IV chronic kidney disease receives an ultrasound without duplex
Doppler to check the overall blood flow of the kidney. What are the correct procedure
codes for this
encounter?

a. 76776, 113.10, N18.4, Z94.0

b. 76770, 113.0, N18.4, Z94.0
c. 76775, 113.10, N18.4, Z94.0
d. 76705, 110, N18.4, Z94.0

140. Radiation Oncology involves clinical treatment planning. A patient presents for
treatment planning and field setting involving two separate treatment areas and

multiple blocks.

a. 77261, 77280
b. 77262, 77280
c. 77262,77285
d. 77263, 77290

141.The muscular ring around a lumen that is contracted to control flow through that lumen
is called a:

a. stricture
b. snare
c. sinus
d. sphincter

142 which of the following is an endocrine disorder?

a. Addison's disease
b. Cushing's disease
c. Grave's disease
 d. All of the above

143. Which of the following is NOT an integumentary system

a. Breast
b. Toenail
c. Lymph node
d. Skin

144. Which of the following is part of peripheral nervous system?

a. Dura mater
b. Brachial plexus
c. Spinal cord
d. Pons

145. How many lobes in pair of lung

a. 4
b. 5
c. 6
d. 7

146. A patient is coming in for arthroscopic knee surgery. Anesthesiologist prepares the
patient at 9:00am and surgery begins at 9:30am. The surgery finishes at 11:30am and
anesthesiologist is no longer required at 11:45am. What is the anesthesia time

a. 2 hours and 15 minutes

b. 2 hours
c. 2 hours and 30
minutes d. 2 hours
45minutes

147. A 64 year old fell in the kitchen while mopping the floor and could not get up. The fall
resulted in a broken hip. Upon examination of the break, the physician decides hip replacement
is needed. The patient was taken to the operating room where anesthesia is injected for total
hip replacement. What CPT codes are reported for anesthesiologist services?

a. 01210, 99100
b. 01210
c. 01214
d. 01214, 99100

148 Patient monitored by an anesthesiologist for repair of injured vein in the west. The
anesthesiologist is also involved with five concurrent cases
 a. 01840-AA
b. 01820-QK
c. 01810-QX
d. 01850-AD

149. A patient presents to the labor and delivery department in first stages of labor. The
baby was not in a correct position for the head presentation to perform a vaginal delivery.
decision was made to have an cesarean delivery. The patient is taken to the operating room
where she received anesthesia for this procedure.

a. 01967
b. 01961
c. 01963
d. 01960

150.The patient presents with pressure ulcer of both lower extremities. The doctor debrides
a 25sq cm ulcer on the right calf to the subcutaneous tissue and 10sq cm ulcer of the right
heel debrided subcutaneously totaling 35 sqcm. Also 15 sq cm ulcer of the left heel is
debrided to the bone

How are the debridement codes reported?

a. 11042, 11045-59,11045-59
b. 11043, 11046-59,11406-59
c. 11044, 11042-59, 11042-59
d. 11044, 11042-59, 11045-59

151 A 25 year old women is having nipple discharge of the left breast with
questionable palpable mass. The patient underwent a percutaneous breast biopsy with
placement of Gelmark clip the procedure was performed using ultrasound guidance

a. 19083, 19285
b. 19083
c. 19083,76942
d. 19110,19285

152.Which code is reported for injection of knee contrast

arthroscopy a. 20610
b. 20611
c. 27370
d. 29999
153 A 42vyeatrs old with chronic left trochntory bursitis is scheduled to receive an injection at
the clinic. under ultrasound guidance s 22-guage spinal needle is introduced into the
trocantory bursa and total volume of Bcc of normal saline was injected

a. 20611-LT
b. 20611-LT, 76942
c. 20610-LT, 76942
d. 20552-LT

154 Megan, a cheerleader in her younger days, participated dodge ball at her 10 year high
school class reunion, the former quatter back of the football team hit her in her face with the
doge ball. She immediately knew in a game of something is was very wrong, felt the pain, saw
blood and passed out a half later she was in the OR at the university medical center she had
an open blowout fracture of her right orbital floor requiring open treatment including bone
transplant.

a. 21387, s02.31XA
b. 21395, S02.31XB
c. 21408, S02.31XB
d. 21395, s02.81XA

155 A patient with planter facial fibromatosis receives high energy extracorporeal shock
wave therapy (ESWT) for therapeutic results.

a. 28890
b. 0101T
c. 0102T
d. 28899

156. Diseased tissue is surgically removed from the ethmoid sinus by an extra nasal
approach through an incision made between nasal and the medial canthrus of the the eye

a. 31254
b. 31255
c. 31276
d. 31205

157. 15 year old male was seen this morning in his pediatrician office for control of
nosebleed with extensive anterior packing in the left nare. Patient returns to the office in the
afternoon
with the nose bleed continuing after initial packing. The pediatrician removes the initial packing
and repacks again with extensive cautery anteriorly in the left nare. Select the CPT code for
second visit of the day?
 a. 30901-78
b. 30903-52
c. 30903-76
d. 30903-78

158.A patient suffers a dissecting infrarenal abdominal aortic aneurysm requiring emergent
placement of a modular bifurcated prosthesis joining a single docking limb extending from one
iliac artery to the main portion of the prosthesis.

a. 34803
b. 34825
c. 34802 Deleted
d. 34805

159. A 65 year old male presents to the outpatient department for mediastinoscopy with
biopsy for an enlarged lymph node. A biopsy is performed and is returned with diagnosis of
secondary malignant neoplasm of the lymph node of the mediastinum of unknown origin.

a. 39010, C78.1, C80.1

b. 39401, C77.1, C80.1
c. 39402, C77.1, C80.1
d. 39000, C78.1, C80.1

160.The physician admitted a 19 year old established patient to the hospital from his office
to rule out meningitis. The patient has fever of 101 degrees and neck pain. A detailed
history, comprehensive exam, and moderate medical decision making is documented. A
lumbar
puncture is performed and comes back positive forbacterial meningits which is final diagnosis?

a. 9921499222-25, 62270, GOO.9

b. 99234-25, 62270, G00.9, R50 81, M54.2
c. 99234-25, 62270, G00.9, R50.9, M54.2
d. 99221-25, 62270,G00.9

161 A physician admitted a 20 day old male baby to inpatient critical care for respiratory arrest.
Physician performs CPR emergency endotracheal intubation and insertion of an umblical
venous catheter in order to stabilize the condition

a. 99471-25-92950
b. 99469-25, 92950, 31500, 36510
c. 99468-25, 92950
d. 99291-25,99292-25,92950,31500, 36510
162 A patient presents to the ED following a fall from the bleachers at school. She is
complaining pain near her collar bone The ED provider performs an expanded problem
focused history and detailed examination and moderate medical decision making is
performed. The ED physician ordered an X ray of the clavicle. A review of the X ray reveals a
clavicle fracture. The ED physician performs a manipulation of realign the bone and applies a
clavicle, brace

a. 99283-57, 23505-54
b. 99284-57, 23505-54
c. 99283-57, 23515-54
d. 99284-57, 23500-54

163 An OB/GYN requested a pediatrician to be present for C-section for possible fetal
distress. The pediatrician was in attendance at the delivery. The baby was examined by the
pediatrician and no problems were found.

a. 99465
b. 99464
c. 99465,99460
d. 99464, 99460

164 A 15 year old girl is an established patient scheduled for her yearly physical with
her pediatrician. During the physical examination lesion on her legs and arms are noted.
The
physician performs complete physical and additional documentation on the lesion providing an
expanded problem focused exam and low complexity medicl decision making

a. 99394,99213-25
b. 99394-25, 99213
c. 99394
d. 99213

165 Medical review and documentation of an established patient supports detailed history
and four elements of HPL five elements of ROS, and a complete past, family and social (PFSH).
Also supported by the documentation of comprehensive eight organ systems the physician
documents low

MDM. a 99214

b. 99213

C.99212

d. 99215
 166. It has been two years since Ms. Hopkins saw her dermatologist. She has come into the
office for evaluation of her recurring psoriasis. The physician that originally saw her is on
medical leave. She is seen on this visit by the partner in the same practice. She asked the
physician to look at some new plaque, she noticed on the back of the scalp. The
dermatologist performed expanded problem focused history, expanded problem focused
exam, moderate MDM

a. 99213
b. 99214
c. 99202
d. 99242

167 The ED physician places a patient in observation care in the morning hours for severe
shortness of breath and chest pain. ED physician performs a comprehensive history,
comprehensive exam and moderate MDM. The patients symptoms are gone by the
afternoon and he is discharged that afternoon from observation care.

a. 99217
b. 99219 Deleted
c. 99284
d. 99235

168. A patient presents to the physician office for the first time in four years with fever and sore
throat. The physician suspects strep throat and documents detailed History, and expanded
problem focused exam. A strep test is performed in the office and is positive for strep

a. 99202, 87880, J02.0

b. 99203, 87880, J02.0, R50.9, J02.9
c. 99214, 87880, R50.9, J02.9
d. 99204, 87880, J02.0

169 A Patient has a scar tissue from a previous glaucoma surgery The Opthalmologist
performs the trabeculotomy on both eyes under local anesthesia. What is the CPT Coding for
the procedure?

a. 65850,66030
b. 66172-50
c. 65850-50
d. 66170-50

170 . A 47 year old female presents to the Operating room for a partial corpectomy on one
upper throracic Vertebral body T3. Two surgeons are performing the surgery one surgeon
performs the transthoracic approach and excises the damaged portion of the vertebral body.
The second surgeon inserts a bone graft into the vertebral gap,closing the gap and inserts
the metal plate. Both surgeons work together each as a primary surgeon.

How does each surgeon report their portion of surgery?

a. 63090-66,63091-66
b. 63085-62,63086-62
c. 63087-62,63088-62
d. 63090-80,63091-80

171. A Patient is seen for capsule endoscopy of the esophagus to ileum. The capsule and the
visuals of the ileum are not visualized. The patient will be gets stuck rescheduled to have an
Esophagogastroduodenoscopy (EGD)ina couple of weeks. What is the cpt procedure for the
encounter?

a. 91110
b. 91110-52
c. 91110-53
d. 91111

172 A 67 year old male presents with DJD and spondylolisthesis at L4-L5,The patient is placed
prone on the operating table and after induction of general anesthesia, the lower with a probe
under fluoroscopy Laminectomies are done at vertebral segments L4and L5 back is sterilely
prepped and draped. One incision was made over L1-L5. This was confirmed with facectomies
to relieve pressure to the nerve roots Allograft was packed in the gluttersfrom L1-L5 for a
posterior arthrodesis.Pedicle screws were placed at L2,L3,L4. The construct was coupiosly
irrigated andmuscle,fascia and skin were closed in layers.Select the procedure codes for this
scenario:

a. 63005x2,22612,22614x3,22842
b. 63047,63048,22612.22614x3,22842
c. 63017,63048,22612,22808,22842x3
d. 63042,63043,22808,22841x3

173. The ENT Physician performed removal of multiple nasal polyps in both the right and
left nares in the office. What CPT Coding is reported?

a. 30110-50
b. 30110
c. 30115
d. 30115-50
174. What is the term for chemicals that relay, amplify and modulate signals between a
neuron and another cell?

a. Neurotransmitters
b. Myelin
c. ions
d. Hormones

175. According to CPT Guidelines, Which scenario best represents the correct use of

78 modifier?

a. Patient had an appendectomy 3 days ago in the hospital, the patient developed a
fever and receiving an IV Antibiotic for treatment.
b. A patient returning to the ED in the same day for the same ED Physician to perform
an extensive anterior packing for hemostasis a second time.
c. Patient had an open inguinal hernia repair two weeks ago. He is in the doctors
office because the surgical wound is bleeding. The physician cleans the wound and
applies wound adhesive to reclose a small opening.
d. The patient has an abscess under the diaphragm from an appendectomy. He is
returned to the OR for the same physician who performed the appendectomy to drain
the
abscess.

176. The 14 year old patient is being seen for physical therapy. She has an abnormality of
gait(Spastic) and speech problems that are both sequal of viral encephalitis for which she was
hospitalized last year. The encephalitis was caused by the measles virus. The measles virus
has been resolved.

What ICD-10CM codes are reported?

a. B05.0,R26.1,R47.9
b. R26.1,R47.9,B94.1
c. B94.1,B05.0
d. B94.1,R26.1,R47.9

177.A Patient had stomach polyps removed on a previous esophagogastroduodenoscopy. The

patient returns one year later for a followup examination for another EGD. No new stomach
polyps are seen. What diagnosis codes are reported for the second EGD?

a. Z09,Z86.010
b. Z87.19,Z09
c. Z09,K31.7
d. Z09,Z87.19
178.A Patient came in to the ED after she smashed her big toe under the bedroom door.
There is a hematoma under the toenail. The ED physician uses cauterization to burn through
the nail to drain and evacuate the hematoma. What CPT code is reported for this procedure?

a. 11640
b. 11730
c. 10160
d. 10140

179.A Physician performed an incision and drainage of a single Paronychia of the leftfinger What
CPT Code is reported?

a. 11400
b. 10060
c. 10040
d. 10061

180 A 65 Year old is seen by her dermatologist for keratosis. The decision is made to layers of
skin until the area is smooth and healthy tissue is visible underneath. perform an abrasion on
four lesions on her face. A Sharp blade is used to scrape away thin What CPT coding is reported?

a. 15786,15787
b. 15786,15787-51x3
c. 15787x4
d. 15786x4

181.A 30 year old comes in with a puncture wound In her left thigh. Further examination of the
wound reveals she has a foregin body in the wound. Local anesthetic is performed. Using an 11-
blade scalpel a 1cm incision is made on the left thigh to the subcutaneous tissue. The wound is
explored and tweezers are used to remove a wooden foreign body

What CPT and ICD-10 CM Codes are reported?

a. 27372,S71.142S
b. 10120,S71.142A
c. 10120,S81.842S
d. 27372,S81.842A
182 A 65 Year old type 1 diabetes with diabetic ulcers on her lower left calf. The ulcers were
debrided and repaired with a homograft last week. Today she is in the the operating suite for a
planned split thickness autografting. The homograft is taking ute nacely the wounds appears to
be clean. With good hemostasis donor site was obtained on the right anterior high measuring
100 sq cms. The wounds were then go with a split thickness autograft that was harvested with a
Brown dermatome set at 12000 of an inch thick. This was the skin graft was then applied over
the wound, measuring approximately 6sqcmsin dimension on the left calf. What CPT Coding is
reported?

a. 15273-78
b. 15100-78
c. 15220-58,15221-58x4
d. 15100-58

183.Tony has undergone deformity correction with the application of a Unilateral Fixation
System. He now requires a removal and replacement of the two external fixation StrutsWhat
CPT coding is reported?

a. 20680
b. 20697
c. 20697x2
d. 20680x2

184 A Patient is seen for dislocation of the right hip The patient had an arthroplasty on the
same hip several years prior Today a closed reduction of the hip is performed with general
anesthesia
.What CPT codes is reported?

a. 27265
b. 27252
c. 27266
d. 27256

185 Margo presents to her primary care physician for management of her degenerative
Osteoarthritis in her right wrist The physician performs an injection of 1 mg Synvisc in the
right wrist joint. What CPT and ICD-10CM codes are reported?

a. 20551,M19.231
b. 20526,M19.031
c. 20605,M19.031
d. 20606,M19.231
186.A 67 year old patient with an asymptomatic unilateral iliac artery aneurysm has
endovascular repair performed by deployment of an ilio-iliac tube endograft. What CPT code
does the vascular surgeon use to report this service?

a. 34707
b. 34708
c. 34701
d. 34710

187.A 6 year old requiring ECMO requires open insertion of a peripheral cannula. What is
the correct procedure code?

a. 33951
b. 33954
c. 33953
d. 33952

188. An airbag deployed when a driver lost control of the car and crashed into a guardrail on
the side of the highway. The driver suffers partial impact resulting in a skull fracture of the
anterior cranial base. The fracture is diagnosed using the MRI scanner and cerebrospinal fluid
noted
dripping via the sphenoid sinus into the right nasal passage. The patient requires a surgical nasal
sinus endoscopy to assess and repair the injury. What is the correct procedure and diagnosis
coding combination to report this service?

a. 31291,31231-59,S02.109A,V47.5XXA,Y92.411
b. 31291,S02.19XA,V47.5XXA,Y92.411
c. 31287,S02.19XA,V47.5XXA,Y92.411
d. 31235,S02.91XA,V47.5XXA,Y92.411

189. From a left femoral acess, the catheter is placed with in the proper hepatic artery.dye
is injected and imaging is obtained. A stenosis with in the artery is identified A
percutaneous
transluminal Angioplasty is performed on the proper hepatic (Visceral)artery in the Outpatient
radiology Department. What CPT code is reported?

a. 36253,75736-26-59,37248-51
b. 36253,75726-26-59,37246-51
c. 36247,75736-26-59,37248-51
d. 36247,75726-26-59,37246-51

190. A patient complains of tarry, black stool, and epigastric tightness.AN EGD is esophagus
appears normal on the scope insertion. No evidence of bleeding in the stomach. The scope
is
passed into the duodenum, where the polyp is found and removed with hot biopsy forceps. No
evidence of bleeding post procedure What CPT Code is reported.

a. 43250
b. 43251
c. 43270
d. 43255

191.A 42 year old male is diagnosed with a left renal mass Patient is placed under general
anesthesia and in prone position A periumbilical incision is made and trocar inserted. A
laparoscope is inserted and advanced to the operative site. The left kidney is removed along
with part of the left ureter. What CPT code is reported for this procedure?

a. 50548
b. 50220
c. 50543
d. 50546

192.There is a malfunction of a vagus nerve electrode array. The surgeon replaces the array
What cpt code for this procedure?

a. 64568
b. 64568,64570
c. 64570
d. 64569

193.A 25 year old sustained a rupture of the left eye with partial loss of intraocular Tissue in an
ATV Accident. The remaining ocular contents of the eye ball are removed and only the sclera
shell remains. A permanent implant is inserted into sclera shell and is attached to thesclera with
sutures. What CPT Code is reported?

a. 65093
b. 65114
c. 65105
d. 65110

194. What code is reported for multiple studies at rest and with exercise for cardiac blood
pool imaging using a radionuclide confined to vascular compartment?

a. 78481
b. 78494
c. 78483
d. 78492
195.An independent radiologist, not employed by the hospital performs the injection and
radiology supervision and interpretation for elbow arthrography in a hospital. What CPT Code is
reported by the radiologist?

a. 24220,73085-26
b. 24220,73085-TC
c. 24220,73085-26
d. 24220,73085

196. What is the function of a pacemaker?

a. Uses the electrical impulses to control the hear rhythm.

b. Removes plaque buildup in the coronary arteries.
c. Replaces the heart.
d. Delivers shocks to the heart only when it stops beating.

197. A 45 year old female presents to the ED with chest pain. The provider has an
Albumin Cobalt Binding Test to determine if the chest pain is ischemic in nature. What lab
test is
reported?

a. 82045
b. 82043
c. 83857
d. 84134

198.A patient with pneumonia has a sputum culture and blood drawn to test for fungus.
What CPT Codes are reported?

a. 87106,87107
b. 87102,87103
c. 87101,87103
d. 87040,87070

199.A 6-French sheath and catheter is placed into the coronary artery and is advanced to the
left side of the heart into the ventricle. Ventriculography is performed using power injection of
contrast agent. Pressure in the left heart are obtained. The coronary arteries are also selected
and imaged. What CPT Code is reported?

a. 93460
b. 93456
c. 93458
d. 93454
200. Mr. Rappold has physical therapy status post knee replacement. The physical therapist
flexion Direct one to one contact with the patient is performed to instruct the patient in
initiates a therapeutic c exercise program using a stationary bike to increase right knee gentle
range of
motion exercises to improve strength and flexibility. The total treatment time is
30Minutes.What CPT Code is reported?

a. 97530X2
b. 97112X2
c. 97110X2
d. 97116X2

201.Dr.Winston sees a patient with abdominal pain in the observation unit in the hospital.
Dr. Reynolds reviews the ED notes with the lab, X-Ray and EKG results. He spent an
additional 70 minutes of face to face contact with the patient. What prolonged service code
is reported in addition to the primary CPT Code?

a. Prolonged visit code is not reported separately

Deleted
b. 99356
c. 99357
d. 99358

202.Dr.Burns sees new born baby james at the birthing centre on the same day after the
cesarean delivery .Dr.Burns examined baby james,the maternal and newborn Shistory, ordered
appropriate blood tests and hearing screening. He met with the family at the end of the exam.
How would Dr.Burns report his services?

a. 99463
b. 99460
c. 99462
d. 99461

201 Dr. Winston sees a patient with abdominal pain in the observation unit in the hospital
Or Reynolds reviews the ED notes with the lab, X-Ray and EKG results. He spent an
additional 70 minutes of face to face contact with the patient. What prolonged service code
in reported in addition to the primary CPT Code?

a. Prolonged visit code is not reported

separately b. 99356
c. 99357
d. 99358
202. Dr.Bums sees new born baby james at the birthing centre on the same day after the
cesarean delivery Dr. Bums examined baby james the maternal and newborn history.
ordered appropriate blood tests and hearing screening He met with the family at the end of
the exam How would Dr. Burns report his services?

a. 99463
b. 99460
c. 99462
d. 99461

203. A wheel chair bound resident of skilled nursing facility is seen in the physician office The
physician office makes arrangements with a social worker to take the patient back to the
skilled nursing facility. What is HCPCS Level II Transportation Service code?

a. A0130
b. AD120
c. A0160
d. A0100

205 A 64 year old patient has right pleural effusion which could not be drained by
thoracocentesis Right Thoractomy is performed to evacuate the pleural effusion What
anesthesia code is reported for when the anesthesiologist is medically directing one CRNA?

a. 00541-QX
b. 00540-QY
c. 00520-QY
d. 00524-QX

206. The documentation states:An incision was made down to bare sclera in the inferior
temporal fomix. The Lateral rectus muscle was hooked and secured with a double armed Vicryl
suture. What anatomical structure is being referred to?

a. Nail
b. Ear
c. Brain
d. Eye

207. The CPT Code book provides full descriptions of medical procedures, although some
descriptions require the use of a semicolon; to distinguish among closely related procedures

a. With intact or reconstructed canal wall with ossicular chain reconstruction

 b. Tympanoplasty with mastoidectomy (including Canaplasty middle ear surgery
tympanic membrane repair) with out ossicular chain reconstruction with intact or
reconstructed canal wall with ossicular chain reconstruction
c. Tympanoplasty with mastoidectomy(including canalplasty, middle ear
surgery.tympanic membrane repair)with intact or reconstructed canal wall, with
ossicular chain
reconstruction
d. with out Ossicular chain reconstruction with intact or reconstructed wall with
Ossicular chain reconstruction

208. A 52 year old male patient with known AIDS saw his orthopaedic physician today for
severe pain in the right knee. The physician documents that his knee pain is due to a flare up of
posttraumatic Osteoarthritis and he gives him a cortisone injection in the right knee joint. The
Osteoarthritis is not related to AIDS.What ICD-10CM codes are reported for this encounter?

a. Z21,M08.861
b. M17.11,B20
c. M17.31,B20
d. B20,M17,31

209 A 38 year old female presents to her primary care physician due to passing frequent,small
amounts of urine. The physician diagnosed her with urinary tract infection and prescribed
ciprofloxacin 500mg po q12h for 10 days. Two weeks later she presents to the physician with
symptoms and testing showed she still has a urinary tract infection On questioning this patient
only took the Cipro once a day and was saving pills for the next time she needed an
antibiotic.due to financial problems.She was given implicit instructions on how important it is to
take what is prescribed?

a. N39.0,Z91.120
b. N39.0,T36.8X6A,Z91.120
c. T36.8X6D,N39.0
d. Z91.120,T36.8X6D

210. The documentation states He was then sterilely prepped and draped along the flank
and abdomen in the usual sterile fashion, I first made a skin incision off the tip of the twelfth
medially along the banger's lines of the skin. This was approximately 3.5cm in length. Once this
incision was carried sharply, electrocautery was used the access through the external oblique,
internal oblique, and the transverse abdominis musculature and fascia What surgical approach
was used for this procedure

a. Cannot determine based on the documentation

 b. Percutaneous
c. Open
d. Laparoscopic

211.The patient is diagnosed with trichomycosis. The patient has?

a. Skin tumor
b. Fungal Infection of the hair
c. Diffuse red skin
d. Inflammation of the nail and nail bed

212 Patient is diagnosed with dacryocystitis, which is the inflammation of

a. Lacrimal sac
b. Ear drum
c. Cornea
d. Fingernail

213.A patient has been diagnosed with meningitis What is meningitis?

a. Infection of the ventricles of the heart

b. Enlargement of the lymph nodes in the neck
c. Swelling of the brain
d. Inflammation surrounding the brain and spinal cord

Anatomy

214. Where is Warthin's tumor found?

a. Back of eye
b. Bone
c. Salivary gland
d. Ovary

215.How many lobes are there in a pair of lungs?

a. 5 lobes, Three lobes on right ,two lobes on the left

b. 2 lobes, one lobe in each lung
c. 6 lobes, three on each lung
d. 4 lobes, two lobes on right lung, two lobes on left lung

216. The carries urine from the bladder and travels through the prostate to the

outside of the body

 a. Ureter
b. Penis
c. Urethra
d. Epididymis

217 Blood from the right ventricle travels next to

a. The right atrium

b. The brain
c. The left
ventricle d. The
lungs

COMPLIANCE AND REGULATORY

218 An ABN form is given to a patient to sign and acknowledge that Medicare

may deny the service or procedure What does ABN stand for?

a. Accommodation Beneficiary Note

b. Advanced Benefit Notation
c. Advance Beneficiary Notice
d. Alternate Benefit Notice

219.Which of the following is a commercial or private payer?

a. Medicaid
b. Veterans Health Adminstration(VHA)
c. Blue cross Blue Shield
d. Medicare

220 Which is NOT covered entity under HIPAA?

a. Medicare
b. Worker's compensation
c. Clinic
d. Psychiatrist

CODING GUIDELINES

221 According to parenthetical instructions in the CPT® code book, what modifier(s)

will be reported when a blepharoplasty is performed on the right and left lower eyelids (15820)

a. 59
b. RT,LT
 c. E2, E4
d. 50

222 A diagnostic colonoscopy is performed, but the scope does not reach the splenic
flexure Using the Colonoscopy Decision Tree illustrated in the CPT® code book, how is it
coded?

a. 45378-52
b. 45330
c. 45378
d. 45378-53

223 Which of the following is an example of a case, In which a diabetes

related problem, exists and the code for diabetes is never sequenced first?

a. If the patient being treated for secondary diabetes

b. if the patient has hyperglycemia that is not responding to medication
c. If the patient is being treated for type II diabetes
d. If the patient has an underdose of insulin due to an insulin pump malfunction

224 According to the Application of cast and strapping CPT® guidelines, what is reported when
an Orthopedic provider performs intial fracture care treatment for a closed scaphoid fracture
of the wrist, applies a short arm cast, and the patient will be returning for subsequent fracture
care?

a. 29075-22
b. 25622, 29075
c. 25622
d. 29075

225 According to CPT coding guidelines, which scenario best represents modifier 247.

a. patient is coming back to have stitches removed from his hand within the
postoperative 10day global period of the repair
b. Patient had hernia surgery two days ago and returns to the operating room to incise
and drain a postoperative abscess
c. New patient is seen in the physician's office for effusion on the left knee.
Physician examines the patient and performs a minor surgical procedure
d. Patient had an appendectomy two weeks ago. Patient returns to see the physician
who performed the appendectomy complaining of a swollen foot the swollen right
foot providing an E/M service, which is unrelated to the appendectomy, within the 90-
day postoperative period
226. A surgeon performs a percutaneous balloon angioplasty and atherectomy in the
femoral/popliteal artery According to the endovascular revascularization CPT ®guidelines,
what is reported?

a. 37225
b. 37227
c. 37224,37225
d. 37224

227 According to CPT Medicine guidelines which is NOT reported as imaging

a. Magnetic resonance imaging

b. Fluoroscopy
c. Radar signals
d. Computed tomography

228 An elderly patient comes into the emergency department (ED) with shortness of breath. An
ECG is performed. The final diagnosis at discharge is impending myocardial infarction.
According to ICD-10-CM guidelines how is this reported?

a. I20.0
b. I21.3, R06.02
c. R06.02
d. I20.0, R06.02

229 A patient is diagnosed with diabetic polyneuropathy Using ICD-10-CM coding

guidelines what ICD-10-CM coding is reported?

a. E10.42
b. 10.9,G62.9
c. E11.9, G62.9
d. E11.42

230. The patient is ingested some wild mushrooms while camping and was brought to the
emergency room with excessive salivation, nausea, shortness of breath, low blood pressure,
visual disturbances and irregular pulse. The symptoms started with in minutes of eating and
cooked mushrooms. She reported Atropine was administered to counteract the poison
.muscarine found in some poisonous mushrooms Relief was almost immediate, but we are
holding the patient in observation overnight?

a. A50.9
b. T62.0X1A
c. T62.0X1S
 d. K52.29

231 A 33 year old that is 28 weeks pregnant is coming in to check her blood sugar She has had
type 2 diabetes for the past two years Select the ICD-10-CM codes that are correctly
sequenced and appropriate to report

a. E11.9, 024.113,Z3A.28
b. E11.9, 233,1, Z3A.28
c. 024.113, E11.9, Z3A.38
d. 024.419, E11.9, Z3A.28

232 A 44 year old female patient with chest pain had CT of her chest that identified a mass
in her left lower lung. The patient currently has ovarian cancer with metastases to the liver.
The radiologist suspects the cancer has to her lungs The physician performed an out patient
bronchoscopic biopsy and the pathology report documents the mass as a Tumor of
uncertain behavior

a. C78.02, C22.9, C79.82

b. C56.9, C78.7, C78.02
c. R91.8, C56.9, C78.7
d. D38.1, C56.9, C78.7

233.What CPT code is reported for an excision of a sacral pressure ulcer with primary

closure? a. 15934
b. 15920
c. 15933
d. 15931

234 A 25 year old continues to have flare-ups of acne despite the use of topical
medications. The dermatologist applies salicyclic acid to the acne

What CPT code is reported?

a. 17340
b. 17360
c. 10040
d. 15780

235 A 25 year old women underwent percutaneous breast biopsy on the right breast with
placement of Glenmark Clip. The procedure was performed using stereotactic imaging What
CPT code is reported?
 a. 19101, 19283
b. 19100, 76098
c. 19081, 19283
d. 19081

236 A 3 year old boy placed his hand under the moving belt of threadmill receiving a
full thickness autograf t of the left long and ring fingers. The measurement of the
wound
approximately 1.5 sq om including both ring finger and long finger. A skin graft measuring 2 x2
cm was harvested from the right groin What CPT is reported?

a. 15050-LT 15040-51
b. 15260-LT
c. 15240-LT
d. 15240-LT 15040-51

237 A 4 year old has third degree circumferential burns to his torso. To avoid respiratory
compression an escharotomy is performed. A total of four incisions through the eschar down
to the subcutaneous fat to release the restrictive effects from the eschar What CPT coding
should you report?

a. 16035, 16036 X 3
b. 16035 X 4
c. 16030
d. 16035,16036-51

238. The pass with pressure ulcer of both lower extremities. The doctor Betrides a 25sqom ulcer
of the right calf to the bone. A 10 sq cm ulcer of the right heel is debrided subcutaneously and
15 sq cm ulcer of the left heel is debrided subcutaneously totaling 25sq cm. code all services

a. 11044, 11042-59, 11042-59

b. 11044, 11047, 11042-59, 11045-59
c. 11044, 11042-59
d. 11011, 11010-59, 11010-59

239 The patient presents with pain and spasm in the right scapular area Trigger point
pections were placed in the infraspinatus and supraspinatus muscles of the right scapular
area

a. 20552 x2
b. 20552
c. 20560
d. 20553
240 Kathy broke her wrist while on a hiking trip and a gautlet cast was applied by the local
ER phy hit you to her pimary care provider one month later to have the

What CPT code is reported for the primary care provider?

a. 29700
b. 29280
c. 29705
d. 29584

241 A-45 year old has dislocated patella in the left knee after a car accident. She taken to the
hospital by EMS for surgical treatment in the surgery suite the patient is placed under general
anesthesia after being prepped and drapped the surgeon makes an incision above the knee
joint in the front of the patella. Dissection is carried through the soft tissue and reaching the
patella
in attempt to reduce the dislocation. When the patella is exposed it is severely damaged due to
cartilage breakdown. The tendon is

a. 27566-LT
b. 27552-LT
c. 27556-LT
d. 27562-LT

242 A patient was brought to the operating room to repair meniscal tear. A arthroscope is
inserted into the trocar to examine the knee. Tibial plateau was good condition. The posterior
horn of the medial meniscus showed a complex tear. Using basket forceps and a full radius
resector, the tear is debrided back to a healthy peripheral rim. The lateral meniscus was intact
without evidence of tears

a. 29880
b. 29881
c. 27403
d. 27405

243 A 36 year old male suffering from degenerative disc disease at c3-c4 level has total disc
arthoplasty. He was placed under general anesthesia, using an anterior approach the c3-04
disc space was exposed. Using blunt dissection the disc material is removed and the disc space
is
cleaned. The disc space was the sized and trialed. Excellent placement and insertion of the
artifial disc at c3-c4 was noted. The area was inspected and there was no compression of any
nerve roots, peritoneum was then allowed to return a normal anatomic position and the entire
area was copiously irrigated. The wound was closed in a layered fashion. The patient tolerated
the procedure well and was returned to recovery room
what CPT is reported ?

a. 22856
b. 22551
c. 22808
d. 22861

244 A surgeon performs midface LeFort I reconstruction on a patient's facial bones to correct
a congenital deformity. The reconstruction is performed in two pieces in moving the upper
jawbone forward and repositioning the maxilla of the mid face What CPT code is reported?

a. 21141
b. 21145
c. 21146
d. 21142

245 An oncologist performs two bone marrow biopsies on the left posterior iliac What CPT
code is reported?

a. 38220 X2
b. 38221 X2
c. 38220
d. 38221

246. The cardiothoracic surgeon takes a patient to the operating room to perform an

a. 37224 37225
Question
b. 37227
c. 37224, 37227
d. 37225

247. The pulmonologist performs a bronchoscopy with fluoroscopic guidance. The scope
is introduced into the right nostril and advanced to the vocal cords and into the trachea.
The
scope is advanced to the right upper lobe and a lung nodule is noted. An endotracheal biopsy is
performed. What CPT code is reported?

a. 31624
b. 31625
c. 31622
d. 31628

248 A 60 year old male has three vessel disease and supraventricular tachycardia which has
been refractory to other management He previously had pacemaker placement and stenting of
LAD coronary artery stenosis, which was failed to solve the problem. He will undergo CABG and
autologous saphenous vein and an extensive modified MAZE procedure to treat the tachycardia

He is brought to the cardiac OR and placed in the supine position on the table he is prepped and
drapped and adequate endotracheal anesthesia is assured. A median sternotomy incision is
made and cardiopulmonary bypass is intiated. The endoscope to harvest an adequate length of
saphenous vein from his left leg this is uneventful and bleeding is easily controlled. The vein
graft prepped and cut to the appropriate lengths for anastomosis. Two bypasses are performed
one to the circumflex and another to the obtuse marginal. The left internal mammary is then
freed up and it is anastomosed to the ramus. The first diagonal and the LAD. An extensive maze
procedure is then performed and the patient is weaned from bypass. At this point, the sternum
is closed with wires and the skin is reapproximated with staples. The patient tolerated the
procedure without difficulty and was then taken to tha PACU Code the CPT® for this
procedure?

a. 33535, 33259-51, 33519-51, 33508-51

b. 33533, 33257-51, 33519-51, 33508-51
c. 33535, 33259, 33519, 33508
d. 3533, 33257, 33519, 33508

249.A 16-year old needs a peripherally inserted venous access catheter for cancer treatment.
The patient was placed in the supine position Following the administration of light anthem, de
night arm was prepped and draped in the usual fashion. Next,50 co of 1 percent Lidocaine with
bicarb was infused in the skin and subcutaneous tissue and the baslic vein was punctured
using seldinger technique, the subclavian vein was cannulated on the first attempted. A J wire
passed easily under fluoroscopic guidance to the subclavian vein. The wound was closed with a
3-0
vicryl Benzoin and steri-strips were applied. Sponge and needle count correct The patient was
awakened from light anesthesia and taken to the recovery room in stable condition

a. 36571, 77001
b. 36569, 77001
c. 36573
d. 6570

250 A mother brings her 2 year old son to the pediatrician's office because he stuck a bead up
his nostril The pediatrician uses a nasal decongestant to open the blocked nostril and
removes the bead with nasal forceps What CPT code is reported?

a. 30300-50
b. 30210-50
c. 30300
d. 30210
251 A 2 year old male presents with a single ventricular septal defect (VSD) and is in current
heart failure. The decision is made to use a patch for the closure. Under general anesthesia the
skin incision is made via median sternotomy. Cardiopulmonary bypass is intiated Under
epicardial guidance the muscular VSD is located. The guidewire is placed transmyocardially
through the VSD. A patch is then delivered over guidance to close the VSD. After successful
closure, the guidewire is removed and the site is repaired. A chest tube is placed in the sternum
What CPT® code is reported?

a. 33647
b. 33681
c. 33675
d. 33645

252 A patient has recurrent ventral hemia that is strangulated. The physician repairs the
hemia with mesh.What CPT code is reported?

a. 49560
49613
b. 49566, 49568
c. 49560, 49568
d. 49566

253. The surgeon performs Roux-en-Y anastomosis of the extrahepatic billary duct to
the gastrointestinal tract on a 45 year old patient What CPT code is reported?

a. 47740
b. 47780
c. 47760
d. 47785

254. A patient who has colon adenocarcinoma undergoes a laparoscopic partial colectomy.
The surgeon removes the proximal colon and terminal ileum and reconnects the cut ends of
the
distal ileum and remaining colon What procedure and diagnosis codes are reported?

a. 44205, C18.9
b. 44160, C18.2
c. 44140, C18.9
d. 44204, C18.2

255 A 40year old patient has symptoms of dysphagia and reflux. The
gastroenterologist introduces a rigid scope through the mouth to examine the
 a. 43220 Incomplet
b. 43450
c. 43195
d. 43249

256 An interventional radiologist performs a abdominal paracentesis in the office

utilizing ultrasonic imaging guidance to remove excess fluid. What CPT coding is
reported?

a. 49082, 76942
b. 49083, 76942-26
c. 49082, 76942-26
d. 49083

257 This 27 year old male has morbid obesity with a BMI of 45 due to high calorie diet. He has
decided to have an open Roux-en-Y gastric bypass. The patient is brought to the operating
room and placed in supine position. A midline abdominal incision is made. The stomach is
mobilized, and proximal stomach is divided, and stapled creating a small proximal pouch in
continuity with the esophagus. A short limb of the proximal bowel of 155cm is divided, it is
brought up and anastomosed to the gastric pouch. The other end of the divided bowel is
connected back into the distal small bowel to the short limb's gastric anastomosis to restore
intestinal continuity.
The abdominal incision is closed What are the procedure and diagnosis codes for this
encounter?

a. 43847, E66 01, 268.42

b. 43644, E66.01, 268.43
c. 43645, E66.8, 268.42
d. 43847, E66.9, Z68.42

258.A 27 year old male has condyloma in the ventrum of the penis. In the operating suite,
general anesthesia was administered. The lesions were individually lasered with a power to 10-
15. Once this was completed, the eschar was removed from the base of condylorna and the
area was free of lesions

What CPT are reported

a. 54056
b. 54057
c. 54055
d. 54050

259.Patient with erectile dysfunction is presenting for a penile implant. An inflatable penile
prosthesis is inserted. What CPT code is reported for this service?
 a. 54417
b. 54401
c. 54416
d. 54400

260.A patient underwent a cystourethroscopy with a pyeloscopy using lithotripsy to break

up the ureteral calculus. An indwelling stent was also inserted during the same operative
session on the same side. This service was performed in the outpatient hospital surgery
center What CPT coding reported?

a. 52356
b. 52352, 52332-51
c. 52325 52332-51
d. 52353 52332-51

261 The patient was taken to the operating room to incise and drain a scrotal abscess General
anesthesia was administered A15 blade scalpel is used to make 5cm incision down through the
skin and subcutaneous tissue. Minimal purulent material is evacuated and sent for culture. The
remainder of the wound is then copiously irrigated with normal saline, hydrogen peroxide and
Betadine Then 2-0 chromic sutures are used to approximate the wound. The patient is
awakened from general anesthesia and transferred to recovery in stable condition

What procedure codes are reported?

a. 55100.
b. 54700
c. 10061
d. 10060

262. A patient who has endometriosis is having supracervical hysterectomy. Under

general anesthesia, a12 mm incision is made in the infraumbilical folds and the veress
needle is
introduced in to the abdominal cavity. The abdomen is inflated with co2 and a 12mm scope is
introduced into the abdomen and placement is confirmed. The gas uterus was dissected free
from the bladder and surrounding tissues. Both ovaries and both fallopian tubes are
removed.
The abdominal cavity is deflated and instruments removed. The incision is closed in two layers.
The uterus weighed 250grams

a. 58542
b. 58180
c. 58570
d. 58291
263 A B-day old new born, weighing 3 kilograms, is seen for a circumcision. The infant is
placed on a restraining board and a dorsal penile block is given as the anesthetic, A dorsal slit
is made at the top of the penis, the Gomco circumcision clamp is applied, and the foreskin was
excised with a scalpel What CPT coding is reported?

a. 54150-52-63
b. 54150
c. 54160-63
d. 54160

264 A patient with Parkinson's has sialorrhea. The physician administers an injection of
atropine bilaterally into a total of four submandibular salivary glands What CPT coding is
reported?

a. 64611
b. 64611-50
c. 64611x4
d. 64611-52

265.An incision is made in the scalp a craniectomy is performed to access the area where
electrodes are present. The electrodes are removed. The surgical wound is closed What
procedure code is reported?

a. 61535
b. 61880
c. 61860

266 Patient has esotropia of the right eye and presents to the operating suite for strabismus
surgery. The physician resects the medial rectus horizontal and lateral rectum muscles of the
eye and secures them with adjustable sutures Extensive scar tissue is noted due to a previous
surgery involving an extraocular muscle. Extraocular muscle is isolated, and the muscle is freed
from surrounding scar tissues

a. 67311,67334
b. 67316,67335
c. 67314, 67334
d. 67312, 67335

267. Two therapeutic injections are provided in a single level at the intercostal nerve as a
regional block for the thoracic spinal nerves to relieve pain for a patient with multiple
ribs fractured. How is this reported?
 a. 64420,64421
b. 64420 x 2
c. 64421 x 2
d. 64420

268. The patient has severe cholesteatoma in the right middle ear. The otolaryngologist
performed tympanoplasty and radical mastoidectomy, removing the middle ear cholesteatoma
Grafting technique was used to repair the eardrum without assicular chain reconstruction

a. 69642
b. 69641
c. 69645
d. 69643

269.A patient suffering from idiopathic dystonia is seen today and receives the following
Botulinum injections. Five muscles in the left leg, six muscles in the right leg and four muscles
in the right arm

What CPT coding is reported?

a. 64642-50,64645
b. 64644, 64645,64643
c. 64644-50,64642
d. 64644-50, 64643

270 Mr. Hill is having difficulty swallowing and is seen for a video swallow exam. He is seated
upright where food and liquids with barium are given to him to observe his pattern od
swallowing Fluoroscopic images are recorded on videotape for later review

What CPT code is reported?

a. 70370
b. 74230
c. 70371
d. 74210

277 A patient is taking tacrolimus for a transplanted organ. A therapeutic drug assay is
performed to measure the concentration of tacrolimus in the patient's blood What lab test is
reported?

a. 80197
b. 80202
c. 80299
 d. 80184

278 A patient presents to the office with dysuria and slight nausea. The physician thinks she
has an UTI. The physician performs a non automated urinalysis with Microscopy, which reads
negative the final diagnosis is ruled out UTI

a. 81002, N39.0
b. 81000, R30.0, R11.0
c. 81000, N39.0, R30.0, R11.0
d. 81007, R30.0, R11.0

279.On examination, the physician notes a yellowish vaginal discharge with a foul odor. A
gram stain is performed in the office by collecting a sample of the discharge and a thin layer is
placed on a glass slide. The results show the patient has chlamydia. The lab test was
performed in the office which is regulated by federal rules under the Clinical Laboratory
Improvement
Amendments (CLIA) How is this lab test reported?

a. 87205-QW
b. 87207-QW
c. 87205-GA
d. 87207-GA

280.A physician orders a basic metabolic panel which includes total calcium and an electrolyte
panel. Applying CPT® guidelines for organ or Disease-oriented Panels, what CPT coding is
reported?

a. 80047, 80051
b. 80048, 80051
c. 80048
d. 80048

281 A patient diagnosed with depression has been taking doxepin. After six months, the
physician performs a drug test to measure the amount of the drug in the patient. What
CPT® coding?

a. 80306, 80337
b. 80335
c. 80337
d. 80306

282 Mrs. Banfield has braitycardia and had a multiple lead pacemaker implanted two years ago.
Today she returns to the clinic for evaluation of the function of the device and any necessary
reprogramming
 a. 93280
b. 93281
c. 93283
d. 93284

283 A 55 year old female with chronic obstructive lung disease sees her physician for
shortness of breath during a commercial air flight. The physician orders High altitude
stimulation
test(HAST). The patient breathes a low oxygen mixture while the provider monitors the patient's
oxyhemoglobin saturations, Supplemental oxygen is not felt to be necessary. The provider
interprets the results and creates a report to be placed in the patient's chart. What CPT coding
is reported?

a. 94453,94760
b. 94452,94760
c. 94453
d. 94452

284 A patient with lymphocytic leukemia is in the oncology office for her scheduled
chemotherapy. She is administered Rituximab IV for 2 hours and 30 minutes. Then a
sequential IV infusion of Fludarabine is given for 45minutes

a. 96413, 96415, 96417

b. 96413, 96415x2, 96411
c. 96413, 96415-51 x2,96417-51
d. 96413, 96415-51, 96411-51

285. The ophthalmologist tests the refractive state at the time of a comprehensive
ophthalmologic exam related to an established patient's irregular astigmatism in the left eye
What CPT® and diagnosis codes are reported for the visit?

a. 92014, 92015, H52212

b. 99202, 92004, H52.222
c. 99204, 92015, H52.212
d. 92014, 92015, H52.202

286.A new patient presents to the ophthalmologist with a complaint of visual disturbances and
decreased vision for one month. He has blind spots in his peripheral visual field. A
comprehensive medical eye exam is performed, in addition to fundus photography and an
extended visual field examination. The interpretation and report are in the medical record. Final
diagnosis is primary open angle glaucoma, mild stage in both eyes What CPT® and ICD-10-CM
codes are reported?

a. 92002,92250, 92082.H40 1131

b. 92002, 92250, 92083, H40 1111, H40.1121
c. 92004 92250, 92081, H40.1111, H40.1121
d. 92004, 92250, 92083, H40.1131

287. Mr. Ponds presents to his ophthalmologist's office for continued management of his
retinopathy, his eyes are dilated, and photographs are taken of the inside of his eyes Then,
a fluorescein dye is injected into a vein in his elbow, and additional images are taken of the
fundus of his eyes as the dye moves through her blood vessels the angiography is
performed
with multiframe imaging on both left and right eyes Following the fluorescent dye,
indocyanine- green is injected, which provides beter images of the tiny vessels in the choroid at
the back of the eye and again multiple images see taken?

a. 92242
b. 92235, 92240
c. 92242-50
d. 92235-50,92240-50

E/M

288. Dr. Carter sees Mrs. White at the Spring valley Nursing Facility. He saw last month after
she was admitted to the facility and today it is a follow up visit. She is doing well. He
documented an expanded problem focused interval history, detailed exam and moderate
medical decision
making. What CFT code does Dr. Carter report for the visit

a. 99304
b. 99318
c. 99315
d. 99309

289.A patient is seen in the ED and then admitted to the observation by the ED
provider. According to the initial Observation CPT® guidelines, what is reported?

a. Only a code from 99281-

99285 b. Only a code from 99218-
99220
c. A code from 99281-99285 and code from 99218-99222
d. A code from 99202-99205 and a code from 99218-99220
290. Ms. M is a type 2 diabetic who was recently diagnosed with significant coronary artery
disease after being admitted to the hospital with chest pain. She saw a cardiologist after
discharge who developed a care plan that incudes monitoring medication, adjustment and
communication with her endocrainologist. The cardiologist spent a total time of 65 minutes of
personal management time during the first month. How would the cardiologist report this
service?

a. 99424, 99427
b. 99426,99427
c. 99426x2
d. 99424,99425

291 During the course of a hospital admission. Dr. Miller requests an orthopaedic to take over
the care of his patient with a diagnosis of osteoporosis. The orthopaedist sees the patient on
day 3 of admission. He performs an expanded problem focused history and problem focused
examination. He evaluates the patient's newly diagnosed osteoporosis. He orders bone density
study and prescribes. Bonivia for the patient. Medical decision making is moderate What CPT
code is reported by the orthopaedist?

a. 99233
b. 99221
c. 99253
d. 99232

293 A patient with sincatnal disease has a single chamber non-rate responsive HCPCS
pacemaker implanted? What HCPCS code is reported?

a. C2620
b. C2619
c. C2621
d. C1786

294.A patient with malignant lymphoma is administered the antineoplastic drug Rituximab
800mg and then 100mg of Benadryl. Which HCPCS Level II codes are reported for both drugs
administered intravenously?

a. J9312 x 80, J1200x2

b. J9312 x 80, 00163 x 2
c. J9312, 00163
d. 19312, J1200
295 A witness of a traffic accident call 911. An ambulance with emergency basic life support
arrived at the scene of the accident. The injured party was stabilized and taken to the
hospital. What HCPCS Level Il coding is reported for the ambulance's service?

a. A0427-QM-HS
b. A0428-OM-HS
c. AD429-ON-SH
d. A0426-ON-SH

ANESTHESIA

296 A patient presents to the labour and delivery department for a planned cesarean section
for triplets. She is at 37 weeks gestation. She is given a continuous epidural for the delivery.
What anesthesia coding is reported?

a. 01967,01968
b. 01958
c. 01961
d. 01967

297 A CRNA personally performing a case without supervision of an anesthesiologist.

What modifier is reported for the CRNA service?

a. QZ
b. QX
c. QS
d. QY

298 A male patient passes out while jogging in the park. Upon examination at the hospital,
he found to have a wide complex tachycardia and undergoes an electrophysiologic study and
radiofrequency abilation, for this procedure he is placed

What is the anesthesia coding for this otherwise healthy 35 year

old? 01926-P1

00532-P2

00537-P1

01922-P2
299 A 6 month old male is having an inguinal hernia repair, Dr. X the anesthesiologist for
this case documents he is normal healthy infant and begins to prepare the patient for
surgery at 9:00 am. Surgey begins at 09:30 am The surgery concluded at 10:00am The
anesthesiologist releases the patient to the PACU nurses at 10:15am What is the anesthesia
and anesthesia coding for this?

a. 00830-AA-P1, 30minutes
b. 00834-AA-P1,99100, 1 hour
c. 00830-AA-P1,99100, 1hour 15minutes
d. 00834-AA-P1, 1hour 15minutes

300.Operative Report Preoperative Diagnosis: Basal cell carcinoma postoperative Diagnosis:

Same Anesthesia: 1% xylocaine solution with epinephrine warmed and buffered and injected
slowly through a 30 guage needle for the patient's comfort Location: Right Cheek Size of
Excision: 5cm Procedure: The patient was taken to our surgical suite in a comfortable position
prepped and draped and locally anesthesized in the usual sterile fashion A #15 scalpel blade
was used to excise the basal cell carcinoma plus a margin of normal skin in a circular fashion in
the natural relaxed skin tension lines as much as possible. The lesion was removed full
thickness including epidermis, dermis and partial thickness subcutaneous tissues. The wound
was then spot electro desiccated for hemorrhage control. The specimen was sent to the lab on
saline for frozen section 0 to T flap repair on defect created by foil thickness frozen section
excision of basal cell carcinoma of the right cheek. We were able to devise 9 sq. cm flaps and
adavance
them using O to T flap closure technique. This will prevent infection dehiscence, and
reconstruct the area to approximate the situation as it was prior to surgical excision diminishing
the risk of significant pain and distortion of the anatomy in the area. Two laterally based flaps
were freed up using cutback incisions and wide undermining. These were advanced medially to
close the defect with 5-0 Vicryl and 6-0 prolene stitches Estimated blood loss: minimal
Complications:
None Specimen: Sent to the lab in saline for frozen section margin control What CPT coding is
reported for this patient?

a. 14040
b. 14040, 11646
c. 14040, 11646, 12052
d. 11646, 12052

2 Preoperative Diagnosis: Acute rotator cuff tear Postoperative Diagnosis. Acute rotator cuff
tear, synovitis Procedures: 1. Rotator cuff repair 2. Biceps tenodesis 3. Claviculectomy 4.
Coracoacromial ligament release Indication: Rotator Cuff injury of a 32 year old male, sustained
while playing soccer Findings: Complete tear of the right rotator cuff, Synovitis, Impingement
Procedure: The patient was prepared for surgery and placed in the left lateral decubitus position
standard posterior arthroscopy portals were made followed by an anterior superior portal
Diagnostic arthroscopy was performed Significant synovitis was carefully debrided. There was a
full thickness upper 3rd subscapularis tear, which was repaired the lesser tuberosity was
debrided back to bleeding healthy bone and a mitek

4.5mm helix anchor was placed in the lesser tuberosity sutures were passed through The
subcapularis in a combination of horizontal mattress and simple interrupted fashion and then
tied There was a partial thickness tearing of the long head of the biceps. The biceps were
released and then anchored in the intertubercular groove with a screw. There was a large
anterior acromial apur with subacromial Impingement. A CA ligament was released and
acromioplasty was performed. Attention was then directed to the supraspinatus tendon tear.
The tear was V shaped and measured approximately 2.5cm from anterior to posterior. Two
smith & nephew PEEK anchors were used for the medial row utilizing Healicoli anchors side
to side stitches were placed One set od suture tape from each of the medial anchors was
then
placed through a laterally placed Mitek helix PEEK knotless anchor which was fully inserted
after tensioning the tapes. A solid repair was obtained. Next there were severe degenerative
changes at the AC joint of approximately 8 to 10mm. The distal clavicle was resected taking
care to
preserve the superior AC joint capsule. The shoulder was thoroughly lavaged. The
instruments were removed and the incisions were closed in routine fashion.

Sterile dressing was applied. The patient was transferred to recovery in stable condition.
What CPT coding is reported for this case?

a. 29827, 29824-51, 29826-51, 29805-59

b. 29827, 29824-51, 29826-51
c. 29827, 29828-51, 29824-51, 29826, 29805-59
d. 29827, 29828-51, 29824-51, 29826

303 Operative Report Preoperative Diagnosis: Nonfunctioning right kidney with ureteral
stricture Postoperative Diagnosis: Nonfunctioning right kidney with ureteral stricture Procedure:
Right nephrectomy with partial ureterectomy Findings and Procedure: Under satisfactory
general anesthesia, the patient was placed in the right flank position. Right flank and abdomen
were prepared and draped out of the sterile field. Skin incision was made through the
underlying subcutaneous tissues, muscles and fascia the right retroperitoneal space was
entered. Using blunt and sharp dissection the right kidney freed circumferentially. The right
artery vein and ureter were identified. The ureter was dissected downward where it is
completely obstructed in its distal extent. The ureter was clipped and divided distally the right
renal artery was then isolated and divided between 0 silk suture ligatures. The right renal vein
was also ligated with suture ligatures and 0 silk ties. The right kidney and ureter were than
submitted for pathologic evaluation. The operative field was inspected, and there was no
residual bleeding noted and then it was carefully irrigated with sterile water. Wound closure was
then undertaken using 0 vicryl for the fascial layers,0 vicryl for the muscular layers, 2-0 chromic
for subcutaneous tissue and clips for the skin. A penrose drain was brought out through the
dependent aspect of the incision. The patient lost minimal blood and tolerated and procedure
well What CPT coding is reported for this case?

a. 50230
b. 50240
c. 50220
d. 50234

304.Operative Report Preoperative Diagnosis: chronic otitis media in the right ear
Postoperative Diagnosis: Chronic otitis media in the right ear Procedure: Eustachian tube
inflation Anesthesia: General Blood loss: Minimal Findings: serious mucoid fluid Complications:
None Indications: The patient is a 2year old who presents to the office with chronic otitis media
refractory to medical management. The treatment will be Eustachian tube inflation to remove
the fluid risks, benefits and alternatives were reviewed with the family which include general
anesthetic bleeding
infection, tympanic membrane perforation routine tubes, and need for additional surgery. The
family understood these risks and signed the appropriate consent form Procedure in details:
after the patient was properly identified, he was brought to the operating room and placed
supine. The patient was prepped and draped in the usual fashion general anesthesia was
administrated via inhalation mask, and after adequeate sedation incison was made on
tympanum and thick mucoid fluidwas suctioned patient tolerated the procedure

a. 69433-RT
b. 69421-RT
c. 69436-RT
d. 69420-RT

305 Laboratory report Cytogenetic studies Clinical Indications. Diagnosis of a Autistic

disorder Specimen Whole Blood 5 mil room temperature Methodology Chromosomal
Analysis, Whole Blood Indication: A 10 year old male is referred to a geneticist for a
diagnosis of a autistic
disorder. The physician perfoms a physical examination and recommends cytogenic studies to
identify the presence of chromosome Abnormality. The physician explain to the parents that the
chromosome analysis may be diagnostic prognostic or direct the treatment of their son. The
Laboratory received the sample and performed a lymphocytic tissue culture for non neoplastic
disorders.A chromosome analysis was also performed and analysed 15-20 cells and 2karyotype
cells with banding. Initial test results The results are reported as a normal male Karyotype

What CPT® codes are reported?

 a. 88273,88262
b. 88273,88264
c. 88230,8826
d. 88230,88262

306. Established patient office visit Chief compliant: patient presents with bilateral thyroid
nodules History of present illness: A 54 year old patient is here for evaluation of bilateral
thyroid nodules. Thyroid ultrasound was done last week which showed multiple thyroid masses
likely due to multinodular goiter. Patient stated that she can “feel” the nodules on the left side
of her thyroid. Patient denies difficulty swallowing and she denies unexplained weight loss or
gain.
Patient does have a family history of thyroid cancer in her maternal grandmother. She gives no
other problems at this time other than a palpable right sided thyroid mass.

Review of Systems: Constitutional: Negative for chills, fever and unexpected weight change
HENT: Negative for hearing loss, trouble swallowing and voice change Gastrointestinal:
Negative for abdominal distention, abdominal pain, anal bleeding ,blood in stool Constipation,
diarrhea, nausea, rectal pain, and vomiting

Physical Exam: Vitals: BP 140/72, Pulse 96, Resp :16, Temp:97.6 F(36.4 C) Temporal
Spo2:97% Weight: 89.8Kg (198 lbs) Height:165.1cm (65”) General appearance: Alert,
cooperative, in no acute distress

Head: Normocephalic, without obvious abnormality, atraumatic Throat: No oral lesions no

thrush, oral mucosa moist Neck: No adenopathy supple, trachea midline, thyromegally is
present no carotid bruit, no JVD Lungs: Clear to auscultation,

Respirations regular, even and unlabored Heart. Regular rhythm and normal rate, normal S1 and
S2, no murmur, no gallop, no rub, no click Assesment/Plan: 1. Multinodular goiter- The patient
will have a percutaneous biopsy performed (minor procedure)

What E/M Code is reported for this Encounter?

a. 99212
b. 99213
c. 90214
d. 90215

307. Preoperative and post operative Diagnon Grade 1 endometria cancer Procedure
Radical hysterectomy and pelvic lymph node sampling Anesthesia

General Complications: None

Estimated Blood loss: 400ml

Specimens: Submitted to the laboratory labelled as pelvic, washings, uterus, tubes, ovaries and
pelviclymph nodes. Fluids administered: 21 crystalloid

Description of procedure: patient was placed under the general anesthesia. She was converted
to a frog leg position perineum and prepped in a sterile fashion transurethral foley catheter was
the placed. A midline certical incision was made from the umbilicus to the symphills and the
abdomen was entered the peritoneum over the left and right paracoiliac gutter, surface of the
spleen, liver and left and right hemidiapharam were normal. The Gallblader did not contain
stones. The small bowel was examined from the ligament of Treitz to the llepcecal valve and
was normal. There was no paraarotic adenopathy. The omentum was normal both kidneys were
palpable. Examination of the pelvis and perineum revealed normal peritoneum in all 4
Quadrants. The uterus well suspended. It was normal in size. There was no obvious tumor. Both
adnexa were normal. The bookwalter refractor was placed. Bowel was packed into the
abdomen. Washings were collected using normal saline the uterus grasped with kocher clamps.
The right round ligament was transected with electrocautery. The retroperitoneal space were
opened and fully developed. We saw no adenopathy. The ureter was visualized the ovarian
vessels were isolated cross clamped transected

a. 58210
b. 58548, 38770
c. 58210, 38770
d. 58200

308 Type of exam: Bilateral lower extremity venous ultrasound Indication for Exam: Mrs.
Walters is complaining of bilateral leg swelling

Exam: Duplex and color Doppler interrogation of bilateral lower extremity deep Venous system
was performed. Compressibility, augmentation and colour flow as Well as Doppler flow was
demonstrated within the common femoral, superficial Femoral, proximal femoral, greater
saphenous and popliteal veins bilaterally. The Paired personal and posterior tibial calf veins are
patient bilaterally

a. 76882-50
b. 93970
c. 76882
d. 93970-50

309.A patient has been diagnosed with meningitis. What is meningitis

a. Swelling of the brain

 b. Enlargement of the lymph nodes in the neck
c. Infection of the ventricles of the heart
d. Inflammation surrounding the brain and spinal cord

310. a patient is diagnosed with trichomycosis. The patient has?

a. Skin tumor
b. Fungal infection of the
nail c. Diffuse red skin
d. Inflammation of the nail and nail bed

311 Which approach is used to perform an upper gastrointestinal endoscopy ?

a. Intra-atrial
b. Transoral
c. Transvenous
d. Intra venous

312.What is thrombophlebitis?

a. A swelling of an extremity due to excess Fluid

b. inflammation of the heart valves
c. Inflammation of a vein associated with formation of a Blood clot
d. Constriction or narrowing of a vein

ANATOMY

313 The mediastinum is

a. Both the heart and lungs

b. A small endocrine organ behind the heart
c. A location in the chest, bounded by the sternum, diaphragm, and lungs
d. A part of the lymphatic system

314. Which bone is located in the lower Extremity?

a. Ulna
b. Femur
c. Radius
d. Humerus

315. The spleen is in what organ system?

a. Digestive
b. Lymphatic
 c. Endocrine
d. Nervous

316 What is the purpose of venous

Valves? a. To prevent the backflow of

blood
b. To release hormones intects to the blood stream
c. To provide a pump assist to circulation
d. To slow the heart rate in patients with hypertension

COMPLIANCE AND REGULATORY

317.HIPAA provides which service?

a. Governs physician self-referral for Medicare patients

b. Prevents identity theft
c. Protects patients against fraud and abuse
d. Protects the privacy of individually identifiable health information

318.A (n) is a digital version of a patient’s medical chart

a. Health Information Technology

b. Information Technology record
c. Fax
d. Electronic health record

319 What entity offers compliance program guidance to form the basis of a Voluntary
compliance program for a provider practice?

a. American Medical Association(AMA)

b. Office of Inspector General(OIG)
c. Office for Civil Right (OCR)
d. Centers for Medicare & Medicaid Services (CMS)

CODING GUIDELINESS

320. According to ICD-10-CM coding guidelines which medical condition does NOT have a
causal relationship with hypertension?

a. Chronic Kidney disease(N18)

b. Congestive heart Failure (150-)
c. Heart disease (151.4-151.7151.89151.9)
d. Acute kidney Failure (N17)
321.Which of the following is an example of a case, in which a diabetes related problem,
exists and the code for diabetes is never sequenced first?

a. If the patient being treated for secondary diabetes

b. if the patient has hyperglycemia that is not responding to medication
c. If the patient is being treated for type li diabetes
d. If the patient has an underdose of insulin due to an insulin pump

malfunction 322 Which Statement regarding lesion excision is true?

a. Lesion excision codes include removal of lesion, with margins and simple(non
Layered) closure when performed
b. Lesion excision codes include removal of lesion, with margins and complex Closure
when performed
c. Lesion excision codes include removal of lesion with margins and intermediate
closure when performed
d. Lesion excision codes are selected by measuring the greatest clinical diameter of a
lesion excluding the margins required to complete the excision

323. According to the ICD-10CM Coding guidelines when is a poisioning code (T36- T50)
NOT reported as a primary code?

a. Adverse effects
b. Accidental Poisoning
c. Intentional poisoning
d. Assault poisoning

324. According to the Application of cast and strapping CPT® guidelines, what is reported when
an Orthopedic provider performs intial fracture care treatment for a closed scaphoid fracture
of the wrist, applies a short arm cast, and the patient will be Returning for subsequent fracture
care?

a. 29075-22
b. 25622, 29075
c. 25622
d. 29075

325 According to CPT® Medicine guidelines which is NOT reported as imaging guidance?

a. Magnetic resonance imaging

b. Fluoroscopy
c. Radar signals
d. Computed tomography
10000

326 A 60 year old female has a right breast mastectomy. The surgeon proceeds with an
immediate reconstruction and uses a biologic implant for soft tissue reinforcement what
CPT coding is reported?

a. 19303, 19396
b. 19303, 19342
c. 19303, 19340
d. 19303, 15777

327.A 55 year old has a 1.0 cm squamous cell carcinoma on her neck. She is Seeing
her dermatologist to have it destroyed using cryosurgery. What CPT® code is
reported?

a. 17000
b. 17250
c. 17106
d. 17271

328. The ED physician repairs multiple lacerations resulting from a broken window. A wound
of the scalp requiring a 12cm layered closure. The left forearm has a laceration that is
required a 10cm simple repair. A laceration above the eyebrow requires a 4 cm simple repair.
What CPT coding is reported?

a. 12034, 12005-59
b. 12034, 12004-59, 12013-59
c. 12034, 12044-59, 12013-59
d. 13121, 13122, 12004-59, 12013-59

329. A patient has bilateral upper eyelid myogenic ptosis. After the patient is appropriately
prepped and anesthetized, the surgeon then excises the excess skin and closes the wound
with sutures. What CPT and ICD-10-CM codes and reported for this surgery?

a. 15820, H02.423
b. 15822-50, H02.423
c. 15820-50, H02 421.H02.422
d. 15822, H02.421,H02. 422

330.A patient has a stage 3 sacral decubitus pressure ulcer. The dermatologist uses a 10-blade
scalpel, making an oval shaped incision around the ulcerated region and removing the necrotic
tissue. The area is irrigated and closed with sutures. What CPT Band ICD 10CM codes are
reported?

a. 15934, L89.323
b. 15934, L89 153
c. 15931, L89.323
d. 15931, L89.153

331 A 4 year old patient is brought into the ED by her dad with a fishhook that has
puncturedher in the right elbow. After much manipulation by the ED physician, the
hook
removal was unsuccessful. The ED physician uses an 11blade to make a small incision to the
subcutaneous tissue in getting both barbs easily removed, Both wounds are cleansed profusely
with soap. Dry sterile dressing applied?

a. 10121, S51.041A
b. 10120, S51.041A
c. 10120, S50 351A
d. 10121, S50 351A

20000

332 An established patient, complains of generalized muscle weakness and muscle

inflammation. The physician decides to perform a in muscle biopsy through the skin using a
biopsy needle. What CPT codes are reported?

a. 20206
b. 20200
c. 20220
d. 20205

333. A patients left eye is damaged beyond repair due to a work injury. The provider fabricates
a prosthesis from silicone materials and makes modifications to restore the patient’s cosmetic
appearance. What CPT code is reported?

a. 21080
b. 21088
c. 21077
d. 21086

334. A 60 year old male is suffering from degenerative disc disease at the L3-L4 and L5- $1
levels was placed under general anesthesia, using a anterior approach, the L3-L4 disc space was
exposed. Using blunt dissection the disc space was cleaned. The disc space was then sized and
treated. Excellent placement and insertion of the artificial disc at L3-L4 was noted. The area
was inspected and there was no compression of any nerve roots Same procedure was
performed on L5-S1 level, Peritoneum with then allowed to return to normal anatomic position
and entire
area was coplously irrigated. The wound was closed in a layered fashion. The patient tolerated
the discectomy and arthroplasty well and was returned to recovery in good condition?

a. 22857, 0163T Deleted

b. 22857 X2
c. 0163TX2
d. 22861, 0165T

335 A 30 year old has a recurrent dislocated right patella. He is in the hospital out
patient orthopaedic center to have the patella reconstructed. The patient is placed
under general
anesthesia. An incision is made above the knee joint and extended to the tibial tuberosity.
The dissection gets down through the soft tissue to gain access to the patellar tendon. The
patellar tendon along with a thin piece of the bone from the tibial tuberosity is resected.
Then the
tendon is reattached and achieved into the inner aspect of the tibia and staples. This
tighteness the tendon and improves stability of the knee. The incision is closed with steri-
strips. The
patient had no complications and was released after recovery?

a. 27420- RT
b. 27422-RT
c. 27558-RT
d. 27562-RT

336 A patient with type 1 diabetes has gangrene that started in his left hand and is spreading
up the forearm, requiring an amputation of the forearm. The patient is in the operating
room, and an electronic saw is used to cut around the radius and ulna, just below the elbow,
in a
circular motion, removing that part of the limb. The bone end is covered with
compressive dressing. Which procedure and diagnosis codes are reported?

a. 25907, E10.9,l96
b. 25905,E10.52
c. 25920, E10.52
d. 25900, E10.52, l96

337 A patient presents with a broken pin in the right ankle. The patient is taken to the
surgical suite and placed in the supine position. After local anesthesia, the patient’s right
ankle is prepped and draped. A 1 cm incision is made and dissection is carried just under the
skin,
removing the broken pin. The wounds are thoroughly irrigated with Antibiotic containing saline.
Skin is closed with adhesive strips

a. 20670, T84.418A
b. 20680, T84.418A
c. 20680, T84.9XXA
d. 20670, T84.69XA

30000

338. The patient is brought to the ED with an obstructed airway. The provider immediately
makes an incision through the ompressive membrane and inserts a tracheostomy tube to
assist the patient’s breathing. What CPT code is reported for this scenario?

a. 31605
b. 31603
c. 31610
d. 31600

339.an oncologist performs a bone marrow aspiration and a bone marrow biopsy on the
Right posterior iliac spine. The procedure were performed during the same encounter.

What is the appropriate coding?

a. 38221
b. 38221, 38220
c. 38220
d. 38222

340.A lymphangiogram of the lef t side is performed on a patient with early onset of
Endocervical cancer. The provider makes a small incision over the ducts and injects Contrast.
Imaging is performed to view the vessels of the lymphatic system. The Provider performs the
injection, as well as the radiologic supervision and interpretation.

What CPT codes are reported?

a. 38792-LT, 75807- LT
b. 38792-5075807-50
c. 38790-50, 75805-50
d. 38790-LT,75805-LT

341 A catheter was placed into the abdominal aorta via the right common femoral artery
access. The catheter was used to selectively catheterize only the right renal artery selective right
renal angiography was then performed demonstrating a widely patent right renal artery
 a. 36245
b. 36251
c. 36252, 75625
d. 36253, 75625

342 Patient has lung cancer in his right middle and inferior lobes and is in the OR for a
bilobectomy. A thoracotomy is performed, and a rib spreader is used to access the right lung.
Removal of the total right middle and inferior lobe with the mass is performed. The incision
is closed with staples and the patient is transferred to the surgical intensive care unit for
observation. What CPT code is reported?

a. 32482
b. 32670
c. 32480
d. 32662

343A 16-year old needs a peripherally inserted venous access catheter for concer treatment.
The patient was placed in the supine position. Following the administration of light anesthesia,
the right arm was prepped and draped in the usual fashion fest 20 oo of 1 percent Lidocaine
with bicarb was infused in the skin and subcutaneous tissue and the bastic vein was punctured
using seldinger technique, the subclavian vean was cannulated on the first attempted. AJJ wire
passed easily under fluoroscopic guidance to the subclavian vein. The wound was closed with
a 3-0 vicryl Benzoin and sten-strips were applied: Sponge and needle count correct. The
patient was awakened from light anesthesia and taken to the recovery room in stable
condition

a. 36571, 77001
b. 36569, 77001
c. 36573
d. 36570

E/M

344 The patient is seen in the ED and then admitted to the observation by the ED
provider. According to the initial Observation CPT® guidelines, what is reported?

a. Only a code from 99281-

99285 b. Only a code from 99218-
99220
c. A code from 99281-99285 and code from 99218-99222
d. A code from 99202-99205 and a code from 99218-99220
345 A patient arrives at the ED with painful sunburn with blisters on her back, She reports
passing out from standing up. The provider performs a detailed history, expanded problem
focused exam, and medical decision making low complexity. What ED E/M visit is
reported?

a. 99282
b. 99281
c. 99283
d. 99284

340 A 16 year old female just moved to the area and is living in a campground with her parents.
She has several medical conditions and the parents are unable to take her to a physician’s
office. A physician sees the patient in the campground and documents. A comprehensive
history and physical. Medical decision making is moderate complexity. After the visit, the
physician spends an additional 25 minutes in a prolonged discussion with the patient’s parents;
he reviews
complex and detailed medical records from her previous physicians and completes a
comprehensive treatment plan. A care plan with the local health agency and a dietician is
inuated. What E/M coding is reported for this visit?

a. 99344
b. 99205, 99354
c. 99344, 99354
d. 99203, 99354

347 The ED physician places a patient in observation care in the morning hours for severe
shortness of breath and chest pain. The ED physician performs comprehensive history,
comprehensive examination and medical decision making is moderate complexity. The
patient’s symptoms are gone by the afternoon and he is discharged that afternoon from
observation care 99235

a. 99284
b. 99218
c. 99219
d. 99217

348 An OB/GYN perform a caesarean section for a possible fetal distress. A paediatrician is
asked to attend the delivery the baby was suctioned and cried and had a final Apgar of 9
The paediatrician also performed a newborn physical exam and met with the family. The
services were documented in the medical record. How does the paediatrician report the
services?

a. 99465
b. 99464, 99460
c. 99464
d. 99465, 99460
349 A patient has not been seen in the physician’s office in one year. Patient comes today with
a fever and painfull sore throat, the physician suspects strep throat and performs a medically
appropriate history and exam. Astrep test is performed by the physician in the office. The quick
strep test result is positive for strep throat and documented as a final diagnosis. Prescription is
given

a. 99212-25, 87880, J02 0,R60.9, J02.9

b. 99213-25, 87880, J02.0
c. 99213-25, 87880, J02.0, R50.9, 102.9
d. 99212-25, 87880, R50 9, J02.9

MEDICINE

350 A 45 year old patient with multiple sclerosis receives continuous IV infusionTherapy of
a therapeutic medication for 1 hour and 15 minutes. What is the correct way to report the
infusion?

a. 96365
b. 96369,96370
c. 96369
d. 96365, 96366

351. A 67 year old has a calcific aortic valve stenosis. To treat the stenosis, a

Cardiologist opens the stenotic valve using a balloon catheter to allow the blood to flow more
freely. What CPT code is reported?

a. 92986
b. 92987
c. 92997
d. 33741

352 The neurologist spends 15 minutes one on one preparing the patient and placing needles
for acupuncture with electrical stimulation. She leaves the needles in place for 20 minutes. She
returns, removes the needles and repeates the procedure, again spending 15 minutes one on
one placing the needles, leaving the needles in place for 20inins and then removing the
needles. What CPT codes are reported according to acupuncture CPT Guidelines?

a. 97810, 97811
b. 97813 x 2
c. 97813, 97814
d. 97810x2
353 A 5 year old is brought to the emergency department for treatment of an open fracture
of the left distal radius Due to the nature of the injury and the anxiety of the patient .it was
decided to place the patient under sedation to properly evaluate and treat the injury .The ED
physician provided moderate sedation with assistance of a nurse to monitor the patient’s vitals
and the ED physician sets the fracture. The patient was under sedation for 45 minutes

a. 99152,99153 x 2
b. 599156, 99157x2
c. 699152 ,99153-51 x2
d. 99156,99157-51 x2

354 Mr. Ponds presents to his ophthalmologist’s office for continued management of his
retinopathy, his eyes are dilated and photographs are taken of the inside of his eyes Then, a
fluorescen dye is injected into a vein in elbow, and additional images are taken of the funds
of his eyes as the dye moves through her blood vessels the angiography is performed with
multi aging on both left and night eyes. Following the fluorescent dye indo cyaninegen is
injected which provides beter mages of the tiny vessels in the choroid at the back of the eye
and again multiple images are taken?

a. 92242
b. 92235, 92240
c. 92242-50
d. 92235-50,92240-50

355.A 5 year old child returns to her pediatrician for a ompressive routine well child visit exam,
The paediatrician does not counsel the mother about vaccination and administer the Dtap by
intramuscular route MMR (live) immunization subcutaneous route, and varicella by
subcutaneous route: What CPT codes are reported for this encounter?

a. 99393-25, 90790, 90710,90716.90460x3,90461x4

b. 99215-25, 90700,90710,90450x3
c. 99393-25,90700, 90707, 90716, 90471, 90472x2
d. 99393-25, 90715,90707,90716,90471x3

ANESTHESIA

356 A patient is seen in the CR hold room and is given an axillary block by the anesthesiologist
the administration of the block takes 20 minutes thirty minutes later the patient is taken to
the OR for hand surgery. The block is the method of anesthesia Anesthesia starts at 10 am
surgery
begins at 10:20 am and ends at 11:00 am Anesthesis and time 11:10 am what is de total
anesthesia time and include the time for administration of the siliary block?

a. 40 minutes
b. 90 minutes
c. 70 minutes
d. 60 minutes

357 A 56 year old male is having two bladder masses removed via cystoscopy . what anesthesia
code is reported?

a. 00914
b. 00870
c. 00912
d. 00860

358 A 40 year old women with progressive sensory neural hearing loss in the right ear since
the age of 13 has not gained benefit from her hearing aid. She has normal hearing in the left
ear. A cochlear implant is placed in the right ear. What anesthesia and ICD- 10CM codes are
reported?

a. 00126, H90 41
b. 00300, H90.72
c. 00210, H90.72
d. 00120, H90,41

359.A 57 year old women with a physical status of 3 received general endotracheal anesthesia
for a panniculectomy, the anesthesiogist personally performed the entire anesthesia service.
What CPT is reported for anesthesia?

a. 00802-AA-P3
b. 00800-AA-P3
c. 00802,99140-AA-P3
d. 00800-P3, 99140-P3

40000

360 A 13 year old is taken to the operating room for a tonsillectomy. The surgeon also Performs
adenoidectomy?

a. 42821
b. 42825,42835
c. 42820
d. 42826,42831
361.The provider performs an adenotonsillectomy on a 20 month old with a history Of sleep
disordered breathing?

a. 42820
b. 42821
c. 42825,42835
d. 42825, 42830

362.A 65 year old patient has screening colonoscopy of the entire colon from the rectum to the
cecum. Two polyps are found in the transverse colon and are removed by snare technique.
What CPT is reported?

a. 45378,45385
b. 45385
c. 45378, 45385 X2
d. 45385 X2

363 A Medicare patient has a screening colonoscopy. The patient’s mother has a history
of colon cancer. What CPT® and ICD-10CM codes are reported for this encounter?

a. 45378, Z12:11, 280.0

b. G0121, 280.0, Z12.11
c. G0105, Z1211, 280.0
d. 45378, Z80.0, Z12.11

364 A 45 year old patient has symptomatic external haemorrhoids in three columns. In the
lithotomy position the perianal tissue is anestheszed with Marcaine 0.25% with epinephrine.
The haemorrhoids are grasped and elliptically excised.

What CPT coding is reported?

a. 46946
b. 46250, 46220
c. 46945
d. 46250

365 A 35 year old has cholelithiasis and is in the operating suite for cholecystectomy. An
incision is started in the right upper abdomen and carried down to the gallbladder. The liver
and
gallbladder are exposed, Gallbladder is grasped and withdrawn over the liver. Cystic duct and
artery are delineated, clipped on the galllader side and incised. Guided transhepatic
cholangiography reveals no intraluminal defector or obstruction Cystic duct triply clipped and
transected. Gallbladder resected from the liver bed and removed. The incision is closed with
layered sutures. What CPT codes are reported for the procedure performed?
 a. 47605, 74300-26
b. 47000, 74300-26
c. 47563, 74300-26
d. 47562, 74300-26

50000

366 Patient with erectile dysfuntion is presenting for a penile implant. A non- inflatable
penile prosthesis is inserted.

a. 54400
b. 54417
c. 54416
d. 54401

367 A patient presents for a biopsy of her left ovary via open surgery through an
abdominal approach. What CPT code is reported?

a. 49321
b. 58920
c. 58900
d. 58925

368.A pregnant patient is 12 weeks pregnant and presents to her obestrician with bleeding. An
examination and ultrasound confirm that she had a missed abortion. A cannula is placed in the
endocervical canal and passes into the uterus. A suction machine is activated, evacuating
products of conception. What CPT® and ICD-10-CM codes are reported?

a. 59821, 002.1
b. 59851, 007.1
c. 59820, 002 1
d. 59812, 003.1

369 An 8 day patient presents to the outpatient department of the hospital with his mother
for a circumcision. The surgeon administer’s regional penile block and uses a Mogen Clamp.

a. 541.50-52
b. 54160-63
c. 54160
d. 54150

370 The patient is found to have a renal abscess requiring drainage, which is performed as
an open procedure
 a. 50020, N15.1
b. 50020, N281
c. 50045, N28.69
d. 50010, N15.1

371 A patient is diagnosed with two bladder lesions. The physician performs a
cystourethroscopy with fulguration and biopsy on a 0.3 cm bladder lesion and 0.4 cm
bladder lesion. What CPT coding is reported?

a. 52224 x 2.52204 x2
b. 52224 x2
c. 52224
d. 52224, 52204

60000

372. A neurosurgeon placed a catheter in the lumbar spine after a craniotomy to drain
cerebrospinal fluid. What CPT code is reported?

a. 62273
b. 62270
c. 62320
d. 62272

373 A 3 year old has hydrocephalus due to a car accident. He undergoes an extracranial
shunt placement. The neurosurgeon inserts the proximal portion of the shunt in the
subarachnoid space and tunnels the far end of shunt of the atria.

a. 62190
b. 62223
c. 62220
d. 62192

374 patient has an entropion on the lower right eyelid and an ectropion on the lower left
eyelid. The entropion is repaired with a tarsal wedge excision. The repair of ectropion is with a
suture. What CPT and modifiers are reported?

a. 67921-E2, 67916-E4
b. 67923-E4, 67914-E2
c. 67921-E4, 67916-E2
d. 67923-E2, 67914-E4
375 A lesion is getting larger on the helix of the left ear for this 29 year old male. Decision is
made to remove the lesion. The surgeon removes portion of the ear with the lesion and repairs
the wound with a single layer closure. How is the procedure reported?

a. 69110
b. 69145
c. 69110,12011-51
d. 69145,12011-51

376 A 45 year old male presents to the OR for a partial corpectomy on two lumbar vertebrae.
Two surgeons are performing the surgery. One surgeon performs the transperitoneal Approach
excises the damaged portion of the vertebrae, and then removes the discs above and below
the vertebrae, inserting bolts in both areas. The second surgeon inserts a bone graft into the
vertebral gap, closing the gap and inserting a metal plate, Both surgeons work together, each
as a primary surgeon. How does each surgeon report their portion of the surgery?

a. 63000-66, 63091-66
b. 63087-80, 63088-80
c. 63087-62, 63088-62
d. 63090-62, 63091-62

377 Two therapeutic injections are provided in a single level at the intercostal nerve as a
regional block for the thoracic spinal nerves to relieve pain for a patient with multiple
ribs fractured How is this reported?

a. 64420,64421
b. 64420 x 2
c. 64421 x2
d. 64420

70000

378 In this procedure, the provider uses ultrasound guidance to insert a fine needle through
a pregnant patients abdomen and into the uterus to obtain fluid from the amniotic sac,
surrounding the fetus. Imaging supervision and interpretation is done by the provider and
placed in the medical record. What radiology code is reported to this service?

a. 76946
b. 76941
c. 76948
d. 76942
379. A 70 year old male with bone cancer is in the radiology department for a vertebral fracture
assessment via DXA scan. What CPT codes are reported?

a. 77086
b. 77080
c. 72081
d. 77085

380 CT images were taken of the abdomen and pelvis with administration of oral Contrast only.
What is the correct radiology code?

a. 74176
b. 74150, 72192
c. 74160, 72193
d. 74177

381. The patient with hydrocephrosis is in surgery for a cystourethroscopy with ureteral
catheterization and irrigation. A right intravenous pyelogram was also performed. During the
procedure, the performing physician includes the interpretation of the pyelogram in the
operative note.

a. 52007, 74400-26
b. 52001, 74420-26
c. 52005, 74400-26
d. 52000, 74425-26

382.A core needle biopsy of an intra abdominal mass is performed under CT guidance How
is this reported?

a. 10009
b. 10009, 77012
c. 49180, 74150
d. 49180, 77012

383 A 4 year old with leukemia is taken to the outpatient surgical center and undergoes the
placement of infuse-A port for chemotheraphy. Fluoroscopic guidance is used to help the
physician with the placement of the port. What CPT coding is Reported?

a. 36561, 77001
b. 36560, 77002
c. 36561, 77002
d. 36560, 77001
80000

384. Lab results of a urine test of total proteins reveals abnormally high levels of ketones in a
diabetic patient. Based on the results, the physician takes a blood sample from the patient
by finger stick and drop of blood was placed on the reagent strip to Test for glucose levels.
The ordering physician compared the reagent strip to a color Chart

a. 82951
b. 82948
c. 82947
d. 82962

385.A patient with osteomyelitis is given vancomycin for the infection. On follow up. The patient
infection is not improving. The provider performs a genotype analysis by nucletic acid for
vancomycin resistance using an amplified probe technique. What lab test is reported?

a. 80299
b. 80202
c. 87501
d. 87500

386.A patient diagnosed with depression has been taking doxepin. After six months, the
physician performs a drug test to measure the amount of the drug in the patient. What CPT®
coding?

a. 80306, 80337
b. 80335
c. 80337
d. 80306

387 A patient presents to the office with dysuria and slight nausea. The physician thinks she
has an UTI. The physician performs a non automated urinalysis with… which reads negative.
The final diagnosis is ruled out UTI with

a. 81002, N39.0
b. 81000, R30.0, R11.0
c. 81000, N39.0, R30.0, R11.0
d. 81007, R30.0, R11:0

388 A physician is performing a yearly exam on a male patient and orders comprehensive
panel and phosphate (phosphorus inorganic) test to be performed in an outside lab How does
the lab report these services?
 a. 80053
b. 80053, 84100
c. 90069
d. 80053, 80069

389 A 35 year old presents to the urologist to discuss vasectomy. He was accompanied by
his wife who is reported that they currently do not have any plans for children. The urologist
discussed the option of cryopreservation to store his sperm/semen prior to vasectomy.
Preserving samples may allow the couple to have children without undergoing invasive re-
attachemet procedure. The couple discussed this option and decided to preserve the
husbands sperm with a banking facility the husband’s specimen is transported to the
cryopreservation banking facility and his sperm will undergo cryopreservation and be stored at
this facility for at least one year?

a. 89343
b. 89264
c. 89259
d. 89260

HCPCS

390. What is the HCPCS level II code for a long arm fiberglass cast for a 24 year old patient?

a. 04012
b. 04006 there is not O series only Q
c. 04008
d. 04005

391 A physician provides two hours of mental health crisis intervention for a patient who has
been unable to cope with a death of her twin sister what HCPCS level Il code is reported?

a. 59485
b. 59485 x 2 This is S
c. 59484
d. 59484 X2

392.A patient presents to the office for an injection to the office for an ceftriaxone sodium for
a UTI. The nurse reviews the physician’s order and administers 250mg of ceftriaxone sodium.
The route of administration is IM

a. 96365, J0698 x 250

b. 96372, J0696
c. 96372, J0695 x 5
 d. 90473, J0696

10000

393 A patient is diagnosed with Diabetic polyneuropathy. What ICD-10-CM coding is

reported? a. E10.42
b. E11.42
c. E11.9,062.9
d. E10.9, G62.9

394 An elderly patient comes into the emergency department ED with shortness of breath.
An ECG is performed. The final diagnosis at discharge is impending myocardial infarction

According to ICD-10-CM guidelines how is thin Reported

a. R06.02
b. 121.3, R06.02
c. 120.0, R06.02
d. 120.0

395.Which diagnosis codes are reported for a patient that has hypertention and Acute renal
failure?

a. 112.9, N17.9
b. 112.9, N18.6
c. 110, N17.9
d. 110, N19

396 A 25 year old male enters the ER for symptoms of nausea, vomiting, excessive Sweating,
and impaired judgment. Drug toxicity screening is positive for heroin. He is Transferred to
the detoxification unit for withdrawal and dependence on opiods

a. F11.93
b. F11.220
c. F11.188
d. F11.23

397 A 32 year old female who is 38 weeks pregnant with triplets goes in to labour and
vaginally delivers two healthy girls with apgar of 9. The third baby is in a transverse
Presentation and the patient is taken to the OR for caesarean section and a baby boy With
apgar is delivered What
ICD 10CM codes are reported?
 a. 032.2XX1, Z37 51, Z3A.38
b. 032.2XX0, Z38.61, Z38.62, Z3A.38
c. 032.2XX3, 238.61, Z38.62, Z3A 38
d. 032.2XX3, 237.51, Z3A.38

Cases

398 Operative Report: Preoperative Diagnosis: strangulated right inguinal hernia in 5

months Old male PostOperative Diagnosis as above

Findings: Strangulated inguinal hernia

Technique:The patient was placed on the operating room table in the supine position. IV
sedation was admisintered without complications. Oxygen and monitoring were in place per
protocol. Right groin and scrotum were prepped and Betadine and drapped in a sterile fashion.
Local anesthesia was infiltrated in the subcutaneous tissue in a field block using a mixture of
idocaine Marcaine and saline. The patient was placed in a general trendelenburg position. The
incision was made over the inguinal ligament and dissection was carried down sharply the
external oblique aponeurosis which was opened along the course of its fibers. Hernia and
spermatic cord were enclosed with penrose drain at the pubic tubercele The Longural nerve was
identified and carefully preserved, retracted superiorly. The strangulated hemia sac was gently
dissected away from the vas deference and testicular vessels with careful preservation of the
vessels, the hernia was reduced and the defect is closed with an extra large marlex mesh plug
which was sutured in place at various points using 2-0 vicryl suture. The mesh onlay patch was
then palced as an reinforecement. The suture scarpus was closed with interrupted 2.Ovieryl
suture. Skin was closed with staples. Antibiotic ointment and sterile dressing were placed over
the incision. All sponge, instrument and needle counts were correct. The patient tolerated the
procedure well, he was taken back to the recovery room in stable condition.

a. 49501, 49568
b. 49496, 49568
c. 49496
d. 49495

399 Preoperative and post operative Diagnosis: Grade I endometrial cancer Procedure:
Radical hysterectomy and pelvic lymph node sampling Anesthesia: General Complications
None
Estimated Blood loss 400ml

Specimens: Submitted to the laboratory labelled as pelvic, washings, uterus, tubes, Ovaries and
pelvic lymph nodes. Fluids administered: 21. Crystalloid
Description of procedure patient was placed under the general anesthesia. She was converted
to a frog leg position perineum and prepped in a sterile fashion transurethral foley catheter was
the placed. A midline certical incision was made from the umbilicus to the symphills and the
abdomen was entered the peritoneum over the left and right paracoiliac gutter, surface of the
spleen, liver and left and right hemidiapharam were normal. The Galiblader did not contain
stones. The small bowel was examined from the ligament of Treitz to the llepcecal valve and
was normal. There was no paraarotic adenopathy. The omentum was normal both kidneys were
palpable Examination of the pelvis and perineum revealed normal peritoneum in all 4
quadrants. The uterus well suspended. It was normal in size. There was no obvious tumor. Both
adnexa were normal. The bookwalter refractor was placed. Bowel was packed into the
abdomen. Washings were collected using normal saline the uterus grasped with kocher clamps.
The right round ligament was transected with electrocautery. The retroperitoneal space were
opened and Fully developed. We saw no adenopathy. The ureter was visualized, the ovarian
Vessels were isolated cross clamped transected

a. 58210
b. 58548, 38770
c. 58210, 38770
d. 58200

400 CC: Shortness of breath

HPI: 16 year old female comes into the ED for shortness of breath for the last two days. She is
an asthamatic

Current Medications being used to treat symptoms is Advair Which is not working and
breathing is getting worse. Does not feel that Advair has been helping patient tried Albuterol is
persistent coughing is not helping Coughing 10-15minutes at a time Patient has used Albuterol
3x in the
last 16 hours. ED physician admits her to observation status

ROS: No fever, no headache, no purelent discharge from the eyes, no sarache, no nasal
discharge or sore throat, No swollen glands in the neck, No palpitations dyspnea and cough
,some chest pain, No nausea or Vomiting. No abdominal pain PMH Asthma

SH : living with both parents

FH: Family History of asthma, paternal side- ALLERGIES PON 200CAPS, allergies has been
reviewed with child’s family and no Changes reported

PE: General appearance: normal alert talkins in sentences, pink lips and cheeks. Oriented well
developed well nourished ,hydrated EYES: Normal External eye, no hypermia of the conjunctiva,
No discharge
From the conjunctiva Ears/General

Bilateral What E/M code is Reported?

a. 99218
b. 99234
c. 99284
d. 99285

401 Preoperative Diagnosis

Preoperative Diagnosis chronic otitis media in the right ear Postoperative Dignosis: Chronic
otitis media in the right ear

Procedure Eustachian tube Inflation Anesthesia:

General Blood foos: Minimal

Findings: serious mucold fluid

Complications: None Indications: The patient is a 2year old who presents to the office With
chronic otitis media refractory to medical management. The treatment will be Eustachian tube
inflation to remove the fluid risks, benefits and alternatives were reviewed with the family
which include general anestheuc bleeding infection, tympanic membrane perforation routine
tubes, and need for additional surgery. The family understood these risks and signed the
appropriate consent form Procedure in details after the patient was properly identified, he was
brought to the operating room and placed supine. The patient was prepped and draped in the
usual fashion general anesthesia was administrated via inhalation mask, and after adequate
sedation incison was made on tympanum and thick mucold fluidwas suctioned patient tolerated
the procedure

a. 69420-RT
b. 69421-RT C2 25
c. 69436-RT
d. 69433-RT

402 Operative report Preoperative Diagnosis Acute Mt. Severe left main arteriosclerotic
coronary artery disease Postoperative Diagnosis: Acute Mi, Severe left main arteriosclerotic
coronary artery disease Procedure in detall Placement of an intra-aortic balloon
pump(ABP)
right common femoral artery Description of procedure: patient’s right groin was prepped and
draped in the usual sterile fashion. Right common femoral artery is found, and an incision is
made over the artery exposing it. The artery in opened transversely, and the tip of the
balloon
catheter was placed in the right common femoral artery. The balloon pump was good waveform
The balloon pump catheter is secured to his skin after local anesthesia of 2ce of 1% xylocaine is
used to numb area, the balloon pump is secured with a 0-silk suture. The patient has sterile
dressing placed. The patient tolerated the procedure There were no complications What CPT
coding is reported for this case?

a. 33975
b. 33967
c. 339702
d. 33973

403. Office visit

CC Sore throat and fever.

HPL Mother brought in 2 year old child today for complaint of sore throat and fever starting two
days ago. Mother gives the history and states she has given children’s motrin for the pain and
fever which has helped reduced from for 101 ROS: No nausea and vomiting or diarrhea. No
headaches or rash PE General appearance: well nourished and hydrated Temperature 991 TM
normal: nose: nasal discharge seen

Orders, quick strep test performed in the office today: Positive Assesment Strep throat

Prescription : medication azithromycin 12mg/kg once daily given for next 5 days

a. 99215
b. 99212
c. 99213
d. 99214

404 Rejulla p Baker MR#300-3 Cardiology-Dr Blake

Chief Complaint : The patient is a women with a history of chronic atrial fibrillation History:
Second day in the hospital for chronic fibrillation, she reports no Significant symptoms for
cardiac arrhythmias today. The patient denies chest pain respiratory or neurologic complaints.
All other symptoms were reviewed and negative. The Patient is not smoking

Coumadin therapy: patient has her INRs followed as an outpatient Exam: She is healthy
appearing and obese

Eyes: Conjunctive and sclerae clear Neck: Supple with no carotid bruits

Lungs: Clear, normal respiratory effort Cardiac: S1,S2 within normal limits Abdomen: No
abdominal masses
Extremities No clubbing, edema, carotids, femoral, dorsalls pedis, and posterior tibial pulses are
2+ bilaterally with no bruits

Psychological Oriented to time, place and Person

Assessment: Chronic atrial fibrillation Plans Cardizem IV has helped control the initial ventricular
rate when admitted. Ordered a EKG, will check on patient tomorrow if all is normal will
discharge

a. 99232, 148 201

b. 99222, 148.20
c. 99221, 148.19
d. 99231, 148.19

405 Type of exam, Bilateral lower extremity venous Ultrasound indication for Exam

Mrs. Walters is complaining of bilateral leg swelling Exam: Duplex and color

Doppler
interrogation of bilateral lower extremity deep venous system was performed compressibility,
augmentation and colour flow as well as Doppler flow was demonstrated within the common
femoral, superficial femoral, proximal femoral, greater saphenous and popliteal veins bilaterally.
The paired personal and posterior tibial calf veins are patient bilaterally

a. 76882-50
b. 93970
c. 76882
d. 93970-50

406.Office Visit

Chief Complaint: Prior to arrival the patient sustained a laceration to the chin wile playing at the
park. The patient complaints of mild pain, No loss of consciousness or neck pain: All other
systems otherwise negative Physical Exam: Apperance Alert: No acute distress attentive. The
patient eye

Contact. Eyes: pupils equal, round, reactive to light EOM intact ENT: No dental injury,

Normal external inspection LACERATION REPAIR: Wound depth/shape linear 3.5cm length.
Anesthesia provided using 1% lidocaine with epi prepped with Betadine. Wound irrigated with
normal saline Closure of superficial layer with 6-0(3 sutures), Protect wound and keep wound
area clean you may wash wounds briefly, then dry, apply Neosporin twice daily sutures should
be removed in seven days.
 a. 12020, S01 91XA, Y92.830
b. 12013, S01 81XA, Y92 830
c. 12001, S01.81XA, Y92.830
d. 12013, S01.82XA, Y92.830

407 Established patient office visit CC: Patient complains of ear pain in both ears. School
nurse told him he had wax in his ears. History: 12 year old established patient is brought by
mom for ear pain that has been lasting for the last three days.

No fever, Fatigue, headache Allergies: NKDA PFSH: No changes WT 116 TEMP-98.7 EXAM:
Appears healthy and well developed. Head and face are normal on Inspection. Eyes: Gross visual
field testing by confrontation No abnormalities indicated. ENMT Tympanic membranes
translucent, with good landmarks bilaterally. Impacted wax in canals bilaterally nasal mucosa;
Pink and moist,Septum Midline, Nasopharynx Normal to inspection Dentition, Good repair Oral
mucosa Molit with no thrash/no mucositis. Tongue appears normal Posterior Pharynx Normal
Tonsils Appear normally colored and ovoid Neck palpation revents no cervical nodules. Thyroid
Normal to Palpation, Respiratory: Lungs clear anteriorly, posteriorly, laterally Impression:
Impacted Cerumen Plan: Cerumen removal minor procedure. Deeply impacted cerumen in both
ears Used curettes and suction for successful removal in both ears What CPT @ coding is
reported?

a. 99213,69210
b. 99203-57, 69210-50
c. 99203,69210
d. 99213-25, 69210-50

408 Emergency Department Visit Problem: Foreign body in nose HPI. The patient is a 3year
4month old child who comes in today after having put a raisin in her left nostril Grandmother
was unable to remove this PMH: she has a past medical history of otherwise good health
Medications: she is on no current prescription medications Allergies: has no Known drug
allergies Review of systems: The patient has had some recent URI symptoms Social history:
there are no cigarette smokers at home Physical Examination: Vital signs: Pulse 89,respirations
18, pulse oximetry 98% on room air. Constitutional GENERAL: Alert, smiling child HEENT: There
is clear rhinorrhea. There is raisin noted in the mid left nostril. Pharynx is without
inflammation ENT NECK Supple, Neck CHEST: Lungs are clear without wheeze or rhonchi
Respiratory
ABDOMEN: soft non tender abdomen EMERGENCY DEPARTMENT COURSE The raisin was
grasped with bayonet forceps and removed atraumatically. Examination of the nostril fails to
reveal any further foreign body or problems Diagnosis:FB Nose. What CPT Coding is reported for
this case?
 a. 99282,30310
b. 30310
c. 99282-25,30300
d. 99282

409. The documentation states

He was then sterilely prepped and draped along the flank and abdomen in the usual sterile
fashion, I first made a skin incision off the tip of the twelfth…. Medially along! The banger’s lines
of the skin. This was approximately 3.5cm in length. Once this incision was carried sharply,
electrocautery was used the access through the external oblique, internal oblique, and the
transverse abdominis musculature and fascia

What surgical approach was used for this Procedure

a. Cannot determine based on the Documentation

b. Percutaneous
c. Open
d. Laparoscopic

410. The patient is diagnosed with trichomycosis. The Patient has a

a. Skin tumor
b. Inflammation of the nail and nail bed
c. Fungal Infection of the hair
d. Diffuse red skin

411,Patient is diagnosed with dacryocystitis, which is the Inflammation of

a. Lacrimal sac
b. Ear Drum
c. Cornea
d. Fingernail

412.A patient has been diagnosed with Meningitis. What is meningitis?

a. Infection of the ventricles of the heart

b. Enlargement of the lymph nodes in the Neck
c. Swelling of the brain
d. Inflammation surrounding the brain and spinal cord
ANATOMY

413.Where is Warthin’s tumor found?

a. Back of Eye
b. Bone
c. Salivary Gland
d. Ovary

414 When the patient has ESRD, which system is Affected?

a. Genitourinary
b. Cardiovascular
c. Neurologic
d. Respiratory

415. Blood from the right ventricle travels Next to.

a. The right atrium

b. The brain
c. The left
Ventricle d. The
Lungs

416. The outermost protective layer of the skin is Called the

a. Subcutaneous tissue
b. Hypodermis
c. Epidermis
d. Dermis

417 Which place of service code is submitted on the claim for a service that is performed in
an outpatient surgical floor?

a. 22
b. 24
c. 11
d. 21

418 An ABN form is given to a patient to sign and acknowledge that Medicare may deny
the service or procedure. What does ABN stand for?

a. Accommodation Beneficiary Note

b. Advanced Benefit Notation
 c. Advance Beneficiary Notice
d. Alternate Benefit Notice

419.Which one of the following scenarios is considered Abuse?

a. Unintentionally billing for unnecessary medical Services

b. Knowingly billing for the services at a higher level of complexity than services Provided
or documented in the file
c. Falsifying records for the services not furnished, supplies not provided or both,
including to show delivery of such items
d. intentional unbundling of coders to manipulate coding to maximize payment

CODING GUIDELINES

420. According to CPT coding guidelines for radiology code range 76881-76886. Which codes
are reported for spectral and color Doppler evaluation of extremities?

a. 73560-73565
b. 93925-93931,93970,93971
c. 76881,76882
d. 73700-73702

421 A diagnostic colonoscopy is performed, but the scope does not reach the splenic flexure
Using the Colonoscopy Decision Tree illustrated in the CPT code book, how is it coded?

a. 45378-52
b. 45330
c. 45378
d. 45378-59

422. According to ICD-10-CM coding guidelines which medical condition does NOT have a causal
relationship with hypertension?

a. Chronic Kidney disease(N18)

b. Congestive heart Failure (150-)
c. Heart disease (151.4-151.7.151.89.151.9)
d. Acute Kidney Failure (N17)

423 According to parenthetical instructions in the CPT code book, what modifier(s) will
be reported when a blepharoplasty is performed on the right and left lower eyelids
(15820)?

a. 59
b. RT,LT
c. E2, E4
 d. 50

424 According to CPT coding guidelines, which scenario best represents modifier 24?

a. Patient is coming back to have stitches removed from his hand within the
postoperative 10day global period of the repair
b. Patient had hernia surgery two days ago and returns to the operating room to incise
and drain a postoperative abscess
c. New patient is seen in the physician’s office for effusion on the left knee.
Physician examines the patient and performs a minor surgical procedure
d. Patient had an appendectomy two weeks ago. Patient returns to see the physician
who performed the appendectomy complaining of a swollen foot the swollen right
foot providing an E/M service, which is unrelated to the appendectomy, within the 90-
day postoperative period

425 A surgeon performs a percutaneous balloon angioplasty and atherectomy in

the femoral/popliteal artery

According to the endovascular revascularization CPT guidelines, what is Reported?

a. 37225
b. 37227
c. 37224, 37225
d. 37224

426.A patient suffering from idiopathic dystonia is seen today and receives the following
Botulinum injections three muscle injections in both upper extremities seven injections in six
paraspinal muscles

How are these injections reported according to the CPT Guidelines?

a. 64642-50,64643-50,64647
b. 64644, 64647 X 7
c. 64644 X 3, 64642 X3, 64647 X 7
d. 64642, 64643,64647

ICD-10-CM

427.A patient is diagnosed with diabetic polyneuropathy Using ICD-10-CM coding guidelines
what ICD-10-CM coding is Reported?

a. E10.42
b. E10.9, G62.9
c. E11.9, G62.9
 d. E11.42

428 An elderly patient comes into the emergency department (ED) with shortness of breath An
ECG is performed. The final diagnosis at discharge is impending myocardial infarction. According
to ICD-10-CM guidelines how is this reported?

a. 120.0
b. 121.3,R06.02.
c. R06.02
d. 120. 0, R06.02

429 A patient is diagnosed with sepsis and associated acute respiratory failure. What ICD-10-CM
code selection is reported?

a. A41.9
b. A41.9, R65.21, J96.00
c. A41.9, 396.00
d. A41.9, R65.20, J96.00

430.A 33 year old that is 28 weeks pregnant is coming in to check her blood sugar. She has had
type 2 diabetes for the past two years

Select the ICD-10-CM codes that are correctly sequenced and appropriate to Report

a. E11.9, 024.113,23A.28
b. E11.9, 233.1, 23A.280
c. 024 113, E11.9, Z3A.38
d. 024.419, E11.9, Z3A 28

431.A patient with third-degree burns to the chest wall, with systemic inflammatory Response
syndrome (SIRS). Develops acute kidney failure

What diagnosis codes are Reported?

a. R65.20
b. A41.9, R65.10, T21.31XA, N17.9
c. A41.9, T21.31XA, N17.9
d. T21.31XA, R65.11, N17.9

10000 INTEGUMENTORY SYSTEM

432 A 55 year old male is seen for a hairline transplant. A total of 20 punch grafts were
transferred to the recipient site What CPT® Coding reported?
 a. 15775
b. 15776
c. 15776 X 20
d. 15775, 15776

433.A 35 year old female has cancer in her left breast. The surgeon performs a mastectomy
removing the breast tissue, skin, pectoral muscles and surrounding tissue including the
axillary and internal mammary lymph nodes .Which mastectomy codes is reported?

a. 19303
b. 19305
c. 19306
d. 19307

434.A 4 year old has third degree circumferential burns to his torso. To avoid respiratory
compression an escharotomy is performed. A total of four incisions through the eschar down to
the subcutaneous fat to release the restrictive effects from the eschar

What CPT coding should you Report?

a. 16035, 16036 X 3
b. 16035 X 4
c. 16030
d. 16035, 16036-51

435 A physician performs excisional debridement for a patient with multiple wounds. A wound
on the lower back measures 12 cm and involves the fascia for debrediment. A wound on the left
shoulder measures 8cm and one on the lef t lower leg measures 16cm involves subcutaneous
tissue for the debridement What CPT® codes are Reported?

a. 11043, 11042-59, 11045

b. 11042, 11045
c. 11043, 11046
d. 11043, 11042-59, 11042-59

436 A physician used electrosurgery to destroy 12 actinic keratosis on the temples and cheeks.
He also removed five skin tags from the neck What CPT codes are reported?

a. 11200 X 5,17000-59, 17003-59

b. 11200, 17004-59
c. 11200 X 5, 17000-59, 17003-59 X11
d. 11200, 17000-59, 17003-59 X11
437.Mr. Woolridge has had a suspicious lesion on his left shoulder for approximately

Eight weeks that is not healing. On the dermatologist’s exam on left shoulder blade, there is
excoriation and the lesion not healing. Patient agrees and wishes to proceed with a punch
biopsy of the lesion A punch biopsy is taken of the lesion and sent to pathology. A simple
repair is performed at the biopsy site

What CPT ® and ICD-10-CM codes are reported?

a. 11102, L98.9
b. 11104, D49.2
c. 11104, L98.9
d. 11102, 12001-51, D49.2

20000 Musculoskeletal System

438 A 62 year old patient has an arthritic elbow. The surgeon will perform an arthroplasty. The
joint is repaired using membrane graft tissue fascia lata from the outer side of the thigh, it is
used as a fat pad to separate the joint surfaces of the elbow to relieve pain

What CPT code is Reported?

a. 24361
b. 24360
c. 24365
d. 24370

439.A surgeon performs midface LeFort I reconstruction on a patient’s facial bones to correct a
congenital deformity. The reconstruction is performed in two pieces in moving the upper
jawbone forward and repositioning the maxilla of the mid face

What CPT code is reported?

a. 21142
b. 21141
c. 21145
d. 21146

440. This 36 year old female presents with infective tenosynovitis of the left hand in the OR
with a sterile approach to the left wrist an incision is made dissecting down to the tendon
sheath incision to the flexor carpi radialis opens the tendon sheath releasing the fibro-osseous
tunnel along the ulnar border of the trapezium incisions are repaired in Layers
what CPT 8 and ICD-10CM code is Reported?

a. 25001, M65142
b. 25000, M65.18
c. 25001, M65.842
d. 25024,M65.142

441. A patient is diagnosed with compression fractures of the L2,13 and L4 vertebrae. The
patient agrees to have kyphoplasty. A balloon catheter is inserted in the vertebrae and inflated
restoring the height of the vertebra. Bone cement is injected in the vertebral space until the
whole L4 body is filled. The same procedure is performed on the L2 and 1.3 levels. The
procedure is performed bilaterally on the three vertebrae

What CPT ® code is reported?

a. 22514-50 X 3
b. 22515 x 3
c. 22514-50, 22515-50x2
d. 22514,22515 X2

442. The patient presents to the operating room for repair of a right proximal humerus
fracture. The surgeon incises the skin over the fractured bone the fracture is identified adjust
the bone and realigns the fracture next the upper end of the humerus bone is replaced with a
synthetic humerus bone implant

What CPT and ICD-10-CM code is reported?

a. 23616-RT, S42.201A
b. 23615-RT, S42 211A
c. 23616-RT, S42.201B
d. 23600-RT, S42 2118

443 Patient has a 5cm tumor in the left lower quadrant abdominal wall. A horizontal skin
incision is made directly over the tumor in the patient’s left lower quadrant and dissection was
carried down through the dermis and subcutaneous tissue. The turnor is located and
completely excised using electrocautery. The specimen is sent immediately to pathology to rule
out cancer What CPT and ICD-10-CM codes is reported?

a. 22901.D49.2
b. 22903, D49.2
c. 22901, C76.2
d. 22903, R19.04
30000 Respiratory and Cardiovascular System

444. An oncologist performs two bone marrow biopsies on the left posterior iliac What CPT
code is reported?

a. 38220 X2
b. 38221 X2
c. 38220
d. 38221

445. A mother brings her 2 year old son to the pediatrician’s office because he stuck a bead up
his nostril. The pediatrician uses a nasal decongestant to open the blocked nostril and
removes the bead with nasal forceps

What CPT code is reported?

a. 30300-50
b. 30210-50
c. 30300
d. 30210

446 A 35 year old patient has lung cancer of the left upper lung. Patient is scheduled for a video
assisted thoracoscopic surgery (VATS) to remove the segment of the lung containing the tumor.
Under general anesthesia he was placed in left lateral decubitus position and a thoracoscope
was inserted through a port. Additional operating instruments are inserted through additional
trocars placed in the chest cavity to removes a segment of left upper lung. The port sites were
closed and chest tube was inserted to drain the wound and re-expand the lung

What CPT code is reported?

a. 32666
b. 32671
c. 32662
d. 32669

447.A 2 year old male presents with a single ventricular septal defect (VSD) and in in current
heart failure. The decision is made to use a patch for the closure. Under general anesthesia the
skin incision is made via median sternotomy Cardiopulmonary bypass is intiated. Under
epicardial guidance the muscular VSD is located. The guidewire is placed transmyocardially
through the VSD. A patch is then delivered over guidance to close the VSD. After successful
closure, the guidewire is removed and the site is repaired. A chest tube is placed in the sternum
What CPT® code is Reported?

a. 33647
b. 33681
c. 33675
d. 33645

448. The cardiothoracic surgeon takes a patient to the operating room balloon angioplasty of
the femoral-popliteal artery with artherectomy

What CPT code is reported?

a. 37224, 37225
b. 37227
c. 37224, 37227
d. 37225

449. The cardiothoracic surgeon takes a patient to the operating room to perform an open
balloon angioplasty of the femoral-popliteal artery with artherectomy

What CPT coding is Reported?

a. 37224,37227
b. 37225
c. 37224,37225
d. 37227

40000 Digestive system

450 A 36 year old patient has an ulcer with a single perforation in the small intestine. The
physician performs an enterorrhaphy

What CPT code is reported?

a. 44603
b. 44615
c. 44620
d. 44602

451.The surgeon performs Roux-en-Y anastomosis of the extrahepatic biliary duct to the
gastrointestinal tract on a 45 year old patient

What CPT code is reported?

 a. 47740
b. 47780
c. 47760
d. 47785

452. A patient who has colon adenocarcinoma undergoes a laparoscopic partial colectomy. The
surgeon removes the proximal colon and terminal ileum and reconnects the cut ends of the
distal ileum and remaining colon

What procedure and diagnosis codes are Reported?

a. 44205, C18.9
b. 44160, C182
c. 44140, C18.9
d. 44204, C18.2

453. The gastroenterologist performs a simple excision of three external hemorrhoids and one
internal hemorrhoid, each lying along the left lateral column. The operative report indicates that
the internal hemorrhoid is not prolapsed and is outside of the anal canal

What CPT® and ICD-10-CM codes are Reported?

a. 46250, 46945, K64.0, K64.4

b. 46320, 46945, K64.0, K64.9
c. 46255, K64.0, K64.4
d. 46250, K64.0, K64.9

454 A 60 year old man presents for a sigmoidoscopy. The physician inserts a flexible scope
into the patient’s rectum and determines that the rectum is clear of polyps. The scope Is
advanced to the sigmoid colon and examined. A total of three polyps are found in the sigmoid
column.
Polyps are removed using the snare technique. The flexible scope is withdrawn. What CPT ®
and ICD-10-CM codes are reported?

a. 45308, K63.5
b. 45309, K62.1
c. 45346, K62.1
d. 45338, K63.5

455. This 27 year old male has morbid obesity with a BMI of 45 due to high calorie diet. He has
decided to have an open Roux-en-Y gastric bypass. The patient is brought to the operating room
and placed in supine position. A midline abdominal incision is made. The stomach is mobilized,
and proximal stomach is divided, and stapled creating a small proximal pouch in continuity with
the esophagus. A short limb of the proximal bowel of 155cm is divided, it is brought up and
anastomosed to the gastric pouch. The other end of the divided bowel is connected back into
the distal small bowel to the short limb’s gastric anastomosis to restore intestinal continuity.
The abdominal incision is closed

What are the procedure and diagnosis codes for this Encounter?

a. 43847, E66.01, Z68,42

b. 43644, E66.01, Z68.43
c. 43645, E66,8. 268.42
d. 43847, E66.9, 268.42

50000 Genitourinary system

456 Patient with erectile dysfunction is presenting for a penile implant. An inflatable penile
prosthesis is inserted.

What CPT code is reported for this Service?

a. 54417
b. 54401
c. 54416
d. 54400

457 A couple presents to the freestanding fertility clinic to start in vitro fertilization Under
radiologic guidance, an aspiration needle is inserted (by aid of a superimposed guiding-line)
puncturing the ovary and preovulatory follicle and withdrawing fluid from the follicle containing
the egg.

What is the correct CPT® code for this Procedure?

a. 58999
b. 58976
c. 58970
d. 58974

458.A patient presents to the hospital based clinic in her 12 week of pregnancy. After a series of
examinations, the provider discovered that the fetus would have many abnormalities if the
pregnancy continues. The patient decides to terminate the pregnancy. The physician dilates the
cervix. A cannula is inserted in the uterine cavity and mechanically evacuates the fetus and
products of conception

What CPT code is reported?

 a. 59841
b. 59840
c. 598563
d. 59851

459.A patient underwent a cystourethroscopy with a pyeloscopy using lithotripsy to break

up the ureteral calculus. An indwelling stent was also inserted during the same operative
session on the same side, This service was performed in the outpatient hospital surgery
center

What CPT coding reported?

a. 52356
b. 52352, 52332-51
c. 52325, 52332-51
d. 52353, 52332-51

460 A 8-day old new born, weighing 3 kilograms, is seen for a circumcision. The infant is
placed on a restraining board and a dorsal penile block is given as the anesthetic. A dorsal slit
is made at the top of the penis, the Gomco circumcision clamp is applied, and the foreskin was
excised with a scalpel

What CPT coding is Reported?

a. 54150-52-63
b. 54150
c. 54160-63
d. 54160

461 A women at 36 weeks gestation goes into labor with twins. Fetus 1 is an oblique position,
and the decision is made to perform a cesarean section to deliver the twins. The obstetrician
who delivered the twine, provided the antepartum care, and will provide the Postpartum care.

What CPT® coding is reported for the twin delivery?

a. 59510
b. 59510 x2
c. 59510, 59515
d. 59510, 59514, 59515
60000 Nervous system

462 A patient with Parkinson’s has sialorrhea. The physician administers an injection of atropine
bilaterally into a total of four submandibular salivary glands

What CPT coding is reported?

a. 64611
b. 64611-50
c. 64611 x 4
d. 64611-52

463.An incision is made in the scalp a craniectomy is performed to access the Area where
electrodes are present. The electrodes are removed. The surgical wound is closed What
procedure code is reported?

a. 61850
b. 61535
c. 61880
d. 61860

464.A 32 year old male has a three-year history of progressive keratoconus in left eye. Glasses
and repeated attempts to fit the patient with various types of contact lenses has not helped
his vision. Corneal collagen cross linking is performed to stabilize the cornea in the left eye.
Under an operating microscope, corneal epithelium is removed Riboflavin eye drops instilled
at frequent intervals until the corneal stroma is saturated (approximately 30 minutes). Corneal
thickness is assessed using pachymetry, and ultraviolet light is delivered for approximately 30
minutes.

What CPT coding is reported for this procedure?

a. 65435, 0402T, 69990

b. 0402T, 69990
c. 0402T
d. 65435

465 A 45 year old female had a closed fracture of the L2-L4 vertebrae 15 years ago and now has
displacement of the lumbar intervertebral disc between 1.3 and L4. The surgeon will
decompress the spinal cord, involving one segment of the lumbar spine. The surgeon

Performs the surgery by going through the pedicle on the side of the disc’s bulge to Reach the
herniated disc. The lamina and facet joint are removed along with disc fragments

What are the correct CPT coding for this Procedure?

 a. 63056
b. 63056, 63057
c. 63101, 63103
d. 63101

466.A permanent array of neurostimulator electrodes were percutaneously placed a few years
ago. The cervical spinal cord stimulator is now replaced under fluoroscopic guidance to improve
efficacy

What CPT coding is Reported?

a. 63664
b. 63663, 76000
c. 63663
d. 63661, 63650, 76000

467.Two therapeutic injections are provided in a single level at the intercostal nerve as a
regional block for the thoracic spinal nerves to relieve pain for a patient with multiple ribs
fractured. How is this reported?

a. 64420,64421
b. 64420 x 2
c. 64421 x 2
d. 64420

468.A patient has frontal lobe brain cancer. The physician performs nuclear diagnostic imaging
of the brain using a small amount of gamma-emitting radioactive tracers to examine the
function of the brain. Four static views of the brain are taken

What radiology code is Reported?

a. 78605 x 4
b. 78600 x 4
c. 78600
d. 78605

460 Mr. Roland has difficulty breathing anit congestion with a productive cough. The physician
takes frontal and lateral view chest X-rays in the office (the equipment is owned by the physician
group). The physician reads the X-rays and determines a diagnosis of walking pneumonia. The
physician’s interpretation is placed in the patient’s chart
How does the physician bill for the chest X- Ray?

a. 71046-TC
b. 71046
c. 71046-26
d. 71046-26-TC

470 A patient with jaundice was seen by the physician to obtain liver biopsies. A needle
biopsy was taken using fluoroscopic guidance for needle placement. The Physician obtained
two core biopsies, which were then sent to pathology.

What CPT codes are reported?

a. 47000 ,47001,77002
b. 47000, 77003
c. 47000, 10007, 10008
d. 47000, 770020

471. The procedure is performed at an outpatient radiology department. From a lett femoral
access, the catheter is placed in the abdominal aorta and is then selectively Placed in the celiac
trunk and manipulated up into the common hepatic artery for an abdominal angiography, Dye
is injected, and imaging is obtained. The provider performs the supervision and interpretation

What CPT codes are Reported?

a. 36246, 75635-26
b. 36246, 75741-26
c. 36246, 75716-26
d. 36246,75726-267

472 A patient with a history of chronic venous embolism in the inferior vena cava has a
radiographic study to visualize any abnormalities. In outpatient surgery the physician accesses
the subclavian vein and the catheter is advanced to the inferior 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. 36000, 75825-26
b. 36010, 75825-26
c. 36010, 75827-26
d. 36000, 75827-26
473 A complete cardiac MRI for morphology and function without contrast, followed by
Contrast with four additional sequences and stress imaging, is performed on a patient with
systolic left ventricular congestive heart failure and premature ventricular Contractions,

What CPT and ICD-10-CM codes are Reported?

a. 75563, 150 20, 149.3

b. 75557,75559, 150, 1, 149.1
c. 75561, 75563, 150.1, 149.1
d. 75559, 150 20. 149.3

80000 Pathology and Laboratory

474 What coding scenario is reported for code 822727

a. Screening of the colon due to bloody stools and family history of colon cancer
b. Patient has bleeding ulcer and the test is performed for diagnostic purpose to rule
out crohn’s disease o. Patient had removal of polyps one year ago and personal
history of descending colon cancer
c. Patient has tarry stools and sister was just recently diagnosed for colon cancer

475.On examination, the physician notes a yellowish vaginal discharge with a foul odor. A
gram stain is performed in the office by collecting a sample of the discharge and a thin layer is
placed on a glass slide. The results show the patient has chlamydia. The lab test was
performed in the office which is regulated by federal rules under the Clinical Laboratory
Improvement
Amendments (CLIA)

How is this lab test Reported?

a. 87205-QW
b. 87207-qw
c. 87205-GA
d. 87207-GA

476 A business requires drug testing for cocaine and methamphetamines prior to hiring a job
candidate. A single analysis with direct optical observation is performed followed by a
confirmation for cocaine What codes are used for reporting and testing and confirmation?

a. 80305, 80353
b. 80306 x 2, 80353
 c. 80305 x 2, 80353
d. 80306, 80375

477 A physician orders a basic metabolic panel which includes total calcium and an Electrolyte
panel.

Applying CPT® guidelines for organ or Disease-oriented Panels, what CPT ® coding Is reported?

a. 80047, 80051
b. 80048, 80051
c. 80048
d. 80048

478.A comatose patient is seen in ER. The patient has a history of depression. Drug testing
confirm she overdosed on tricyclic antidepressant drugs doxepin,Amoxapine, and clomipramine

What CPT code is reported?

a. 80338
b. 80336
c. 80332
d. 80335

479 A5 year old who has an allergy history experienced a possible reaction to peanuts A
quantitative, high sensitive fluorescent enzyme immunoassay was used to measure specific IgE
for recombinant peanut components. Results showed there was no reaction indicating the child
has a peanut allergy.

What lab test is reported?

a. 96003
b. 86005
c. 86008
d. 86001

90000 Medicine

480 A 55 year old female with chronic obstructive lung disease sees her physician for shortness
of breath during a commercial air flight. The physician orders High altitude stimulation
test(HAST). The patient breathes a low oxygen mixture while the provider monitors the patient’s
oxyhemoglobin saturations. Supplemental oxygen is not felt to be necessary. The provider
interprets the results and creates a report to be placed in the patient’s chart. What CPT coding
is reported?
 a. 94453,94760
b. 94452.94760
c. 94453
d. 94452

481 A patient with lymphocytic leukemia is in the oncology office for her scheduled
chemotherapy. She is administered Rituximab IV for 2 hours and 30 Minutes. Then a
sequential IV infusion of Fludarabine is given for 45minutes

a. 96413, 96415, 96417

b. 96413, 96415 x 2,96411
c. 96413, 96415-51 x2,96417-51
d. 96413, 96415-51,96411-51

482.A patient presents with recurrent spontaneous episodes of dizziness of unclear etiology.
Calorie vestibular testing is performed irrigating both ears with warm and cold water while
evaluating the patient’s eye movements. There is a total of three irrigations.

What CPT coding is Reported?

a. 92537-50
b. 92537-50-52
c. 92537-52
d. 92538-50

483.A 27 year old patient is present for ongoing assessment in an individual psychotherapy
session. Patient is agitated, uncooperative, and disagrees with the treatment plan as outlined.
The time the physician spends face to face is 35 Minutes

What CPT code is reported for this visit?

a. 90832
b. 90834
c. 90839
d. 890845

484. The ophthalmologist tests the refractive state at the tune of a comprehensive
ophthalmologic exam related to an established patient’s irregular astigmatism in the left Eye
What CPT and diagnosis codes are reported for the Visit?

a. 92014, 92015, H52.212

b. 99202, 92004, HS2.222
c. 99204, 92015, H52.212
 d. 92014, 92015, H52.202

485. A new patient presents to the ophthalmologist with a complaint of visual disturbances and
decreased vision for one month. He has blind spots in his peripheral visual field. A
comprehensive medical eye exam is performed, in addition to fundus photography and an
extended visual field examination. The interpretation and report are in the medical record Final
diagnosis is primary open angle glaucoma, mild stage in both eyes

What CPT® and ICD-10-CM codes are Reported?

a. 92002,92250, 92082,H40.1131
b. 92002, 92250, 92083, H40 1111, H40.11211
c. 92004,92250, 92081, H40.1111, H40.1121
d. 92004, 92250, 92083, H40.1131

E/M

486.Dr. Carter sees Mrs. White at the Spring valley Nursing Facility. He saw last month after she
was admitted to the facility and today it is a follow up visit. She is doing well. He documented an
expanded problem focussed interval history, detailed exam and moderate medical decision
making.

What CPT code does Dr. Carter report for the visit

a. 99304
b. 99318
c. 99315
d. 99309

487 Eric is buying his first life insurance policy from XYZ Life Insurance Company. The company
requires Eric have a physical exam prior to insurance of the policy. Eric sees his primary care
provider who completes the required documentation and forms provided by the insurance
company

How does the primary care provider report his services?

a. 99455
b. 99499
c. 99456
d. 99450

488 A patient is seen in the ED and then admitted to the observation by the ED provider.
According to the initial Observation CPT® guidelines, what is reported?
 a. Only a code from 99281-99285
b. Only a code from 99218-99220
c. A code from 99281-99285 and code from 99218-99222
d. A code from 99202-99205 and a code from 99218-99220

489.A patient presents to the physician’s office for the first time with coughing and shortness of
breath. The patient has a history of asthma and esophageal reflux. The physician performs a
medically appropriate history and exam. The physician assesses the patient with moderate
persistant asthma with acute exacerbation and esophageal

Reflux. The patient was told to take Turns and reflux What CPT ® and ICD-10-CM codes are
reported for this Service?

a. 99203, 145.41, K21.9

b. 99202, J45.901, K21.00
c. 99205, J45:41, K21.9
d. 99204, J45.991, K21.00

490 A 20 year old female is being seen for the first time by a primary care physician to have
an yearly physical. During the examination for the physical, the provider discovers lessions on
her legs and arms. The physician performs a complete physical and additional separate
documentation for the treatment of the lessions providing a focused history and an exam of the
bilateral upper and lower extremities. The provider decides they are low risk and will continue
to watch them

What CPT® coding is reported for this visit?

a. 99385-25,99202
b. 99202
c. 99385
d. 99385, 99202-25

491 A 3 year old critically ill child is seen in the ED with respiratory failure due to aspiration from
falling into a swimming pool. A bystander on the scene provided CPR and the child is breathing
on his own but is nonresponsive. The ED physician called the PICU pediatrician to see the child
and take over the care. The PICU pediatrician intubated the child and mechanical ventilation
was started. The pediatrician admits the patient in PICU and continues the care of the patient
in PICU 20 minutes of critical care time was performed by the PICU pediatrician

Report the services for the PICU Pediatrician

a. 99475
b. 99285-25, 31500
c. 99291-25, 31500
d. 99475-25, 31500

HCPC

492 A patient with malignant lymphoma is administered the antineoplastic drug Rituximab
800mg and then 100mg of Benadryl

Which HCPCS Level Il codes are reported for both drugs administered intravenously?

a. J9312 x 80, J1200 x 2

b. J9312 x 80, 00163 x 2
c. J9312, 00163
d. J9312, J1200

493.A witness of a traffic accident call 911. An ambulance with emergency basic life support
arrived at the scene of the accident. The injured party was stabilized and taken to the
hospital. What HCPCS Level II coding is reported for the ambulance’s service?

a. A0427-QM-HS
b. AD428-QM-HS
c. A0429-QN-SH
d. A0426-QN-SH

494 A 65 year old medicare patient presents to his PCP for an intial preventive Physical exam.
During his exam, a screening 12 lead EKG is performed and sent to The cardiologist for
interpretation. He was also given a pneumonia 13 vaccine

What coding is reported for this visit?

 a. 99397, G0403, G9279,90670
b. G0402, 99397, G0404, 90472,90670
c. G0402, G0403, G0009, 90472, 90670 90472 instead of
d. G0402, G0404, G0009, 90670

Anesthesia

495.A patient presents to the labour and delivery department for a planned cesarean section
for triplets. She is at 37 weeks gestation. She is given a continuous epidural for the delivery.
What anesthesia coding is reported?

a. 01967,01968
b. 01958
c. 01961
d. 01967

496 A 65 year old man had a right axillary block by anesthesiologist. When the arm was prepped
and draped and the surgeon performed tendon repairs of the right first second and third
fingers. The anesthesiologist monitored the patient throughout the case

What anesthesia code is Reported?

a. 01820
b. 01830
c. 01840
d. 01810

497.A 65 year old Medicare patient presents to his PCP for an initial preventive physical exam.
During his exam, a screening 12-lead EKG is performed and sent to the cardiologist for
interpretation. He was also given a pneumonia 13 vaccine

What coding is reported for this visit?

a. 99397, G0403, G9279,90670

b. G0402, 99397, G0404, 90472,90670
c. G0402, G0403, G0009, 90472, 90670
d. G0402, G0404, 00009, 90670

498 A 50 year old patient has a postoperative mycobacterial skin wound infection on her front
chest. The decision is made for debridement of the infected tissue to advance her recovery. The
patient is taken to the OR suite where the infected tissue is debrided The debridement involved
the skin and subcutaneous tissue to the level of the fascia The anesthesiologist provided
general anesthesia and monitored the patient during the surgery
What anesthesia codes is

reported? a. 00400
b. 00560
c. 00520
d. 00540

CASES

499.Operative Report Preoperative Diagnosis: Basal cell carcinoma postoperative

Diagnosis: Sarne Anesthesia: 1% xylocaine solution with epinephrine warmed and buffered and
Injected slowly through a 30 guage needle for the patient’s comfort

Location: Right Cheek Size of Excision 5cm

Procedure: The patient was taken to our surgical suite in a comfortable position Prepped and
draped and locally anesthesized in the usual sterile fashion. A #15

Scalpel blade was used to excise the basal cell carcinoma plus a margin of normal skin in a
circular fashion in the natural relaxed skin tension lines as much as possible. The lesion was
removed full thickness including epidermis, dermis and partial thickness subcutaneous tissues.
The wound was then spot electro desiccated for hemorrhage control. The specimen was sent to
the lab on saline for frozen section O to T flap repair on defect created by foil thickness frozen
section excision of basal

Cell carcinoma of the right cheek. We were able to devise 9 sq. cm flaps and adavance them
using 0 to T flap closure technique. This will prevent infection dehiscence, and reconstruct the
area to approximate the situation as it was prior to surgical excision diminishing the risk of
significant pain and distortion of the anatomy in the area. Two laterally based flaps were freed
up using cutback incisions and wide undermining. These were advanced medially to close the
defect with 5-0 Vicryl and 6- O prolene stitches

Estimated blood loss: minimal complications:

None Specimen: Sent to the lab in saline for frozen section margin control What CPT ® coding is
reported for this patient?

a. 14040
b. 14040, 11646.
c. 14040, 11646, 12052
d. 11646, 12052
500.Preoperative Diagnosis Acute rotator cuff tear Postoperative Diagnosis: Acute rotator cuff
tear, synovitis Procedures

Rotator cuff repair

Biceps tenodesis

Claviculectomy

Coracoacromial ligament release

Indication: Rotator Cuff injury of a 32 year old male, sustained while playing

Soccer Findings: Complete tear of the right rotator cuff, Synovitis,

Impingement

Procedure: The patient was prepared for surgery and placed in the left lateral decubitus
position standard posterior arthroscopy portals were made followed by an anterior superior
portal
Diagnostic arthroscopy was performed Significant synovitis was carefully debrided. There was a
full thickness upper 3 subscapularis tear, which was repaired the lesser tuberosity was
debrided back to bleeding healthy bone and a mitek 4.5mm helix anchor was placed in the
lesser
tuberosity sutures were passed through the subcapularis in a combination of horizontal
mattress and simple Interrupted fashion and then tied. There was a partial thickness tearing of
the long head of the biceps. The biceps were released and then anchored in the intertubercular
groove with a screw. There was a large anterior acromial spur with subacromial impingement. A
CA ligament was released and acromioplasty was performed. Attention was then directed to
the supraspinatus tendon tear. The tear was V shaped and measured approximately 2.5cm from
anterior to posterior. Two smith & nephew PEEK anchors were used for the medial row utilizing
Healicoli anchors side to side stitches were placed One set od suture tape from each of the
medial anchors was then placed through a laterally placed Mitek helix PEEK knotless anchor
which was fully inserted after tensioning the tapes. A solid repair was obtained. Next there
were severe degenerative changes at the AC joint of approximately 8 to 10mm. The distal
clavicle was resected taking care to preserve the superior AC joint capsule. The shoulder was
thoroughly
lavaged. The instruments were removed and the incisions were closed in routine fashion.
Sterile dressing was applied. The patient was transferred to recovery in stable condition.

What CPT coding is reported for this case?

a. 29827, 29824-51, 29826-51, 29805-59

b. 29827, 29824-51, 29826-51
c. 29827, 29828-51, 29824-51, 29826, 29805-59
d. 29827,29828-51, 29824-51, 29826
501 Operative repart

Preoperative Diagnosis: Acute MI, Severe left main arteriosclerotic coronary artery disease
Postoperative Diagnosis: Acute MI, Severe left main arteriosclerotic coronary artery disease
Procedure in detail: Placement of an intra-aortic balloon pump(ABP) right common femoral
artery Description of procedure: patient’s right groin was prepped and draped in the usual
sterile fashion, Right common femoral artery is found, and an incision is made over the artery
exposing it. The artery is opened transversely, and the tip of the balloon catheter was placed in
the right common femoral artery. The balloon pump was good waveform. The balloon pump
catheter is secured to his skin after local anesthesia of 2cc of 1% xylocaine is used to numb area,
the balloon pump is secured with a 0-silk suture. The patient has sterile dressing placed. The
patient tolerated the procedure. There were no complications What CPT coding is reported for
this Case?

a. 33975
b. 33967
c. 33970
d. 33973

502 Operative Report

Preoperative Diagnosis: Nonfunctioning right kidney with ureteral Stricture Postoperative

Diagnosis: Nonfunctioning right kidney with ureteral stricture Procedure: Right nephrectomy
with partial

Ureterectomy

Findings and Procedure: Under satisfactory general anesthesia, the patient was placed in the
right flank position. Right flank and abdomen were prepared and draped out of the sterile field.
Skin incision was made through the underlying subcutaneous tissues, muscles and fascia the
right retroperitoneal space was entered. Using blunt and sharp dissection the right kidney freed
circumferentially. The right artery vein and ureter were identified. The ureter was dissected
downward where it is completely obstructed in its distal extent. The ureter was clipped and
divided distally the right renal artery was then isolated and divided between 0 silk suture
ligatures The right renal vein was also ligated with suture ligatures and 0 silk ties. The right
kidney and ureter were than submitted for pathologic evaluation. The operative field was
inspected, and there was no residual bleeding noted and then it was carefully irrigated with
sterile water. Wound closure was then undertaken using 0 vicryl for the fascial layers,0 vicryl for
the muscular layers, 2-0 chromic for subcutaneous tissue and clips for the skin. A penrose drain
was brought out through the dependent aspect of the incision. The patient lost minimal blood
and tolerated and procedure well What CPT coding is reported for this case?
 a. 50230
b. 50240
c. 50220
d. 50234

503 Operative Report

Preoperative Diagnosis: Calculi of the gallbladder

Postoperative Diagnosis: Calculi of the gallbladder chronic

Cholecystitis Procedure: Cholecystectomy

Indication: The patient is a 50year old women who has a history of RUQ pain, which ultrasound
revealed to be multiple gallstones. She presents for removal of her gallbladder

Procedure: The patient was brought to the OR and prepped and draped in a normal sterile
fashion. After adequate general endotracheal anesthesia was obtained, a trocar was placed
and CO2 was insufflated in to the abdomen until an adequate pneumoperitoneum was
achieved. A laparoscope was placed at the umbilicus and the gallbladder and liver bed were
visualized. The gallbladder was enlarged and thickended and there was evidence of chronic
inflammatory changes. Two additional ports were placed and graspers were used to free the
gallbladder from the liver bed with a combination of sharp dissection and electrocautery cystic
artery and duct are clipped. Dye is injected in the gallbladder. Cholangiography revealed no
intraluminal defect or obstruction, Gallbladder is dissected from the liver bed.

The scope and trocars are removed

a. 47563, 74300-26
b. 47562, 74300-26
c. 47605, 74300-26
d. 47600, 74300-26

504.Operative Report

Preoperative Diagnosis: chronic otitis media in the right ear Postoperative Diagnosis: Chronic
otitis media in the right ear Procedure: Eustachian tube inflation

Anesthesia: General Blood

Loss: Minimal Findings: serious mucoid

Fluid Complications: None

Indications: The patient is a 2year old who presents to the office with chronic otitis media
refractory to medical management. The treatment will be Eustachian tube inflation to remove
the fluid risks, benefits and alternatives were reviewed with the family which include general
anesthetic bleeding infection, tympanic membrane

Perforation routine tubes, and need for additional surgery. The family understood these risks
and signed the appropriate consent form Procedure in details: after the patient was properly
identified, he was brought to the operating room and placed supine: The patient was prepped
and draped in the usual fashion general anesthesia was administrated via inhalation mask,
and after

Adequate sedation incison was made on tympanum and thick mucoid fludwas suctioned
patient tolerated the procedure

a. 69420-RT
b. 69421-RT
c. 69436-RT
d. 69433-RT

505 Emergency Department

Visit Problem, Foreign body in Nose

HPI. The patient is a 3year 4month old child who comes in today after having put a raisin in her
left nostril. Grandmother was unable to remove this PMH: she has a past medical history of
otherwise good health Medications: she is on no current prescription medications Allergies: has
no Known drug allergies

Review of systems: The patient has had some recent URI symptoms Social history: there are no
cigarette smokers at Home

Physical Examination:

Vital signs: Pulse 89,respirations 18, pulse oximetry 98% on room air.

Constitutional GENERAL Alert, smiling child HEENT: There is clear rhinorrhea. There is raisin
noted in the mid left nostril.

Pharynx is without inflammation ENT

NECK: Supple, Neck CHEST: Lungs are clear without wheeze or rhonchi

Respiratory ABDOMEN: soft non tender abdomen

EMERGENCY DEPARTMENT COURSE:

The raisin was grasped with bayonet forceps and removed atraumatically Examination of the
nostril fails to reveal any further foreign body or problems

Diagnosis:FB Nose.

What CPT Coding is reported for this

Case? a. 99282,30310
b. 30310
c. 99282-25,30300
d. 99282

506.Laboratory Report Cytogenetic Studies

Clinical Indications: Diagnosis of a Autistic Disorder Specimen Whole Blood 5 ml room

Temperature Methodology:Chromosomal Analysis, Whole Blood

Indication: A 10 year old male is referred to a geneticist for a diagnosis of a autistic disorder. The
physician performs a physical examination and recommends cytogenic studies to

Identify the presence of chromosome Abnormality. The physician explain to the parents that the
chromosome analysis may be diagnostic prognostic or direct the treatment of their son

The Laboratory received the sample and performed a lymphocytic tissue culture for non
neoplastic disorders. A chromosome analysis was also performed and analysed 15-20 cells and
2karyotype cells with banding

Initial test results. The results are reported as a normal male

Karyotype. What CPT codes are reported?

a. 88273,8826
b. 88273,8826
c. 88230,8826
d. 88230,8826

507 Established patient office visit

Chief compliant: patient presents with bilateral thyroid nodules History of present illness; A 54
year old patient is here for evaluation of bilateral. Thyroid nodules. Thyroid ultrasound was
done last week which showed multiple thyroid masses likely due to multinodular goiter Patient
stated that she can “feel *the nodules on the left side of her thyroid. Patient denies difficulty
swallowing and she denies unexplained weight loss or gain. Patient does have a family history
of
thyroid cancer in her maternal grandmother. She gives no other problems at this time other
than a palpable right sided thyroid mass.

Review of Systems: Constitutional Negative for chills, fever and unexpected weight change
HENT: Negative for hearing loss, trouble swallowing and Voice change

Gastrointestinal: Negative for abdominal distention, abdominal pain, anal bleeding Blood in
stool constipation, diarrhea, nausea, rectal pain, and vomiting

Physical Exam:

Vitals: BP 140/72, Pulse :96, Resp 16, Temp:97.6 F(36.4 C) Temporal Spo2 97% Weight: 89.8kg
(198 lbs) Height 165,1cm (65”) General appearance: Alert, cooperative, in no acute distress
Head: Normocephalic, without obvious abnormality,

Atraumatic ThroatNo oral lesions no thrushoral mucosa Moist

Neck: No adenopathy supple, trachea midline, thyromegally is present LungsClear to

auscultation, respirations regular, even and unlabored

Bruit, no JVD No carotid

Heart Regular rhythm and normal rate, normal $1 and | S 2,1 no murmurno gallop, no rub, No
click

Assesment/Plan

1. Multinodular goiter The patient will have a percutaneous biopsy performed

(minor Procedure)

What E/M Code is reported for this Encounter?

a. 99212
b. 99213
c. 99214
d. 99215

508 Established patient office visit CC Patient complains of ear pain in both ears. School nurse
told him he had wax in his ears. History: 12 year old established patient is brought by mom
for ear pain that has been lasting for the last three days. No fever, Fatigue, headache
Allergies: NKDA

PFSH: No changes
WT: 116

TEMP:98.7

EXAM:

Appears healthy and well developed. Head and face are normal on inspection. Eyes: Gross visual
field testing by confrontation. No abnormalities indicated. ENMT Tympanic membranes
translucent, with good landmarks bilaterally. Impacted wax in canals bilaterally nasal mucosa;
Pink and moist, Septum. Midline, Nasopharynx: Normal to inspection Dentition, Good repair
Oral mucosa Moist with no thrash/no mucositis Tongue appears normal Posterior Pharynx
Normal, Tonsils Appear normally colored and ovoid Neck; palpation reveals no cervical nodules,
Thyroid Normal to Palpation, Respiratory Lungs clear anteriorly, posteriorly, laterally

Impression: Impacted Cerumen

Plan: Cerumen removal minor procedure. Deeply impacted cerumen in both ears Used curettes
and suction for successful removal in both ears

What CPT coding is Reported?

a. 99213,69210
b. 99203-57, 69210-50
c. 99203, 69210
d. 99213-25, 69210-50

509 Urticaria is commonly called as:

a. Bruises
b. Scarring
c. Hair Loss
d. Hives

510.A Thoracoscopy is performed, What is this type of procedure?

a. Examination of the colon and stomach through an

endoscope. b. Examination of the pleural cavity through and
endoscope
c. Biopsy of the lung through an endoscope.
d. An Instrument that measures changes in gas volume and pressure during respiration.

511 A Cardiologist attempted to perform a percutaneous transluminal coronary angioplasty of a

totally occluded blood vessel. The surgeon stopped the procedure because of an anatomical
problem creating the risk for the patient and preventing performance of the catheterization
What modifier would be appropriate to append to the procedure code?
 a. 53
b. 52
c. 76
d. 54

512 A Patient has stage 5 Chronic Kidney Disease and requires chronic dialysis. According to
the ICD-10CM instructional notes in the Tabular list for codes in category N18 how is this
reported?

a. N18.5,299.2
b. N18.6,799.2
c. N18.6
d. N18.5

513.Mrs Woods received sutures for a serious abdominal wound in another state while on
vacation. She is back home and again she requires the Complex suture removal under general
anesthesia What CPT codes are reported?

a. 15852
b. 15851
c. 16020
d. 15850

514.PREOPERATIVE DIAGNOSIS:unstable Right Bimalleolar Fracture dislocation

POSTOPERATIVE DIAGNOSIS: same

PROCEDURES PERFORMED RIGHT ankle external fixation.

Anesthesia General

Estimated blood Loss:15ml

Findings:As below

Specimens:As above

Complications:None

Inherent Occurences. None

INDICATIONS:57 year old female status post fall downstairs with right bimalleolar fracture
dislocation status post failed attempted reduction in the emergency department. I reviewed this
with her and her daughter and discussed treatment options with operative and non- operative
and recommended operative reduction.

Procedure Code
27810

515. Which code is reported for a knee injection with contrast for an arthrography?

a. 20611
b. 27369
c. 29999
d. 20610

516.Ms. Barnes is an established patient and saw her primary care physician two weeks ago.
She calls her physician on the phone and wants to know if she can take another medication
that will not conflict with her blood pressure medication. Her physician discusses the pros and
cons of taking the other medication and suggests another type of medication that can be taken
along with her blood pressure meds. The total time spent on the phone is 12 minutes How is
this
reported?

a. 99447
b. 99441
c. 99442
d. 99446

517.A patient is seen in her physicians office for her monthly scheduled vitamin B12 Injection.
The RN administers 1000mcg Vitamin B12 IM in her left upper arm under the physician
supervision. The patient supplied the medication. How is this scheduled injection Visit
reported?

a. 99211-25.96372
b. 99212-25,90460,J3420
c. 99211-25,90471,J3420
d. 99212-25,96373

518. A Patient saw the dermatologist last week for a lesion on her right arm and one on her left
leg The dermatologist diagnosed both as basal cell carcinoma.She returned today for removal of
lesions. The right arm was measured as 1.0cm in diameter with 0.5cm margins and excised. The
lesion on the left leg was 2.0cm in diameter with 0.2cm margins and excised.

What CPT Codes are reported for the lesion removals?

a. 11402,11400-51
b. 11403,11402-51
c. 11602.11600-51
 d. 11603,11602-51

519. The Patient presents for a followup

Echocardiogram, Echocardiography, Transthoracic,realtime with image documentation with M -

moderecording is performed. What is the correct CPT Code for the test the physician ordered?

a. 93308
b. 93307
c. 93304
d. 93306

520 A 7 Year old with a heart murmur and fatigue since birth has a transesophageal
echocardiography(TEE).Doppler echocardiography is also performed with color flow,Pulse
wave, and continuous wave Pulmonary valve stenosis is diagnosed. What CPT Codes are
Reported?

a. 93315,93320
b. 93315,93325
c. 93318,93320
d. 93318,93325

521.A Patient is referred to the hospital radiology clinic for numbness and tingling in the left
arm. The physician suspects it is related to thoracic outlet syndrome. The radiologist Performs a
bidirectional Doppler waveform analysis and a volume plethysmography at two levels in the
left arm A duplex sean of the left arm is also performed. What procedure codes are reported
for the professional services for the Encounter?

a. 93922-52-TC,93930-50-TC
b. 93922-TC,93930-26
c. 93922-26.93925 TC
d. 93922-52-26.93931-263

522 Which is a clear mucous membrane that covers the outer surface of the front of the eye
and lines the inside of the eyelids?

a. Conjunctiva
b. Sclera
c. Retina
d. Auricle
523.A Patient diagnosed with meningitis is admitted to the isolation unit of the medical
centre.After extensiveLaboratory evaluation, it is determined that the responsible organism is
poliovirus Report the diagnosis codes for this patient.

a. A80.9,602
b. G03.9,A80.9
c. G02 A80.9
d. A80.9,G03.9

524 Ms Foxworth has chronic abdominal pain and the decision is made for her to receive
intrathecal pain therapy Dr W Surgically implants a drugfilled non programmable pump with in
the abdomen that releases a measured dose of pain medication through a catheter at
programmed intervals. What coding is reported?

a. 62367
b. 62360
c. 62350
d. 62361

525.A 56 year old is in the outpatient radiology center to have a PET with CT for acquired
attenuation correction and anatomic correlation of his chest for lung cancer What radiology
Code is reported?

a. 478811
b. 78815
c. 78812
d. 78814

526.A 40 year old sustained a left hand injury and left foot injury at work damaging the sensory
nerves A surgeon repairs the nerve in his left hand and the nerve in his left foot. What CPT
Coding is reported?

a. 64834,64837:51
b. 64837X2
c. 64834X2
d. 64834,64837

527. A35 year old male sees his primary care physician with complaints of muscle weakness
headache,and low grade fever.One week ago he was on a camping trip with his kids in North
Dakota and had numerous mosquito bites The symptoms started when he returned from the
trip. The Physician is concerned he may have west Nile Virus The Physician performs a serum
test for the west Nile Virus IgM antibody Immunoassay to evaluate the presence of infection
A
Positive IgM titer Indicates the presence of the west Nile Virus in this patient. What CPT
and ICD-10CM Codes are reported?

a. 86789,A92.30
b. 86788,A92.30
c. 86789,A92.39,M62.81,R51.9,R50.9
d. 86788/A92.39,M62 81,R51.9.R50.9

528 Ms Daley has been on Coumadin longterm for her deep vein thrombosis A
Prothrombin time labtest is performed to monitor her Coumadin level. What ICD and CPT
codes are to be assigned for the labwork to monitor her Coumadin level?

a. 85610,182.409
b. 85610,251.81,Z79.01,182 409
c. 85730 Z51.81,279.01,182.409
d. 85730,182.409

529 An ENT Specialist conducts cochlear function studies on a new patient who is examined
for hearing loss Electrocochleography determines the patient has a central perforation of the
tympanic membrane in the right ear Which CPT and ICD-10 CM Codes are reported for the
encounter?

a. 92601,H72.2X1
b. 92603,72.91
c. 92584,H72.01
d. 92584,H72.821

530 A Patient diagnosed with liver cancer presents for his weekly chemotherapy treatment.
The Patient receives an intra-arterial infusion of FUDR(Fouxiridine) for 3 hours 45 Minutes
What are the correct codes to report for this infusion?

a. 96420,96423X2
b. 96422,96423X3
c. 96422,96423x2
d. 96420,96423X3

531 An arterial blood gas with oxygen saturation only by direct measurement sample is drawn
from a patient at three different intervals on the same day The ordering physician has the lab
perform the blood test three times the same day What code does the lab report for its
service?

a. 82810,82810-91x2 units
b. 82803-91,99000
c. 82805,82805-91x3
 d. 82805x3 units.2

532 A young man is found dead in his apartment. The physician performs a limited gross
autopsy of organs and tissue within a region of the body to determine the cause of
death?

a. 88020
b. 88045
c. 88040
d. 88036

533. A Lab analyst performs a fecal occult blood test on a patient that has bloody diarrhea and
abdorninal pain. The patient has salmonella gastroenteritis. Which fecal occult blood test is
reported?

a. 82270
b. 82271
c. 82272
d. 86768