Free 50 Question Practice Exam

8/27/13 Take the Free 50 Question Practice Exam

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50 Question CPC Practice Exam (free version)

15 out of 50 points

30%

00:39:28

Tue 27th Aug 2013 11:30am

Tue 27th Aug 2013 12:09pm

Results for: slow hand

Key: A tick or cross will show next to chosen answers.

Correctly answered

Incorrectly answered

Missed correct multiple choice option

Question 1 of 50

What type of hernia is most severe?

Correct answer: D)You chose: D)

incarcerated

reducible

ventral

strangulated

Points: 1 out of 1

Feedback:

A reducible hernia can be manipulated and fixed without surgery. An incarcerated hernia means that the



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hernia is so occluded that it cannot be returned by manipulation. A strangulated hernia is anincarcerated hernia so tightly constricted as to compromise the blood supply of the herniated organ ortissue and as such, is the most severe. Ventral refers to the abdomen.

Question 2 of 50

Which of the following is a malignant tumor of the bone marrow?

Correct answer: B)You chose: B)

Myoma

Myeloma

Osteoma

Myotome

Points: 1 out of 1

Feedback:

A - Myoma is a tumor consisting of muscle tissue. C - Osteoma is a benign tumor composed of bonetissue. D - Myotome is an instrument for myotomy (the incision or division of a muscle). B- Myeloma isa malignant tumor of the bone marrow. The Answer is B.

Question 3 of 50

Which of the following is a severe condition characterized by fatigue and progressive muscleweakness?

Correct answer: C)You chose: D)

paramnesia

paramnesia

myasthenia gravis

icterus gravis

Points: 0 out of 1

Feedback:

Look for words with roots and suffixes that suggest severe (gravis) , fatigue (asthenia) and muscle (my-).The answer is C: myasthenia gravis. Answer A) paramnesia is a disorder of the memory. Answer B -Hematocyst is a cyst containing blood. Answer D - Icterus gravis is acute atrophy of the liver marked by



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jaundice and nervous system dysfunctions.

Question 4 of 50

The distal end of this bone articulates with the thumb side of the hand.

Correct answer: A)You chose: A)

radius

ulna

humerus

medial epicondyle

Points: 1 out of 1

Feedback:

The radius is the lower lateral arm bone that is on the same side as the thumb in anatomical view.

Question 5 of 50

This organ breaks down red blood cells, stores blood, and produces lymphocytes andplasma cells.

Correct answer: B)You chose: C)

thymus

spleen

lymph nodes

pancreas

Points: 0 out of 1

Feedback:

The thymus, spleen and lymph nodes are all part of the lymphatic system and all produce lymphocytes,but only the spleen also breaks down red blood cells, stores blood, and produces plasma cells. Thepancreas has functions in the digestive and endocrine system, but does not produce lymphocytes.



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Question 6 of 50

The dorsal surface refers to:

Correct answer: B)You chose: B)

The back of the hand and the bottom of the foot

The back of the hand and the top of the foot

The palm of the hand and the top of the foot

The palm of the hand and the plantar surface of the foot

Points: 1 out of 1

Feedback:

The dorsal surface is in the back of the hand and the top of the foot, answer B. A diagram may be inyour CPT® manual within the Illustrated Anatomical and Procedural Review section in the front of thebook.

Question 7 of 50

HIPAA provides federal protections for PHI when held by covered entities. Which of thefollowing is NOT a covered entity?

Correct answer: C)You chose: C)

nursing homes

pharmacies

clergy

HMOs

Points: 1 out of 1

Feedback:

The clergy (religious personnel) are not a covered entity under the Health Insurance Portability andAccountability Act, or HIPAA. HIPAA defines a covered entity as (1) A health plan, such as Health Insurance companies, HMOs, company health plans, and governmentprograms.(2) A health care clearinghouse.(3) A health care provider who transmits any health information in electronic form, such as doctors,clinics, psychologists, nursing homes, pharmacies.



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Question 8 of 50

Which of the following statements is false?


Abuse consists of payment for items that are billed by mistake but should not be paidfor by Medicare.

The OIG Work Plan outlines priorities for investigating potential problem areas withclaims submissions

HIPAA requires that an individual be notified if there is an unauthorized disclosure ofhis PHI.

An ABN is used to explain to the patient why Medicare may deny a particular serviceor procedure.

Points: 1 out of 1

Feedback:

A, B, and D are true, but it is actually HITECH, the Health Information Technology for Economic andClinical Health Act that requires that an individual be notified if there is an unauthorized disclosure of hisPHI. The answer is C.

Question 9 of 50

The Part of Medicare that helps to cover hospice care is:


Part A

Part A and B

Part C

Hospice care is not covered under Medicare.

Points: 1 out of 1

Feedback:

Medicare is a federal program that provides coverage for people over the age of 65, blind, or disabledindividuals or people with permanent kidney failure or end-stage renal disease. Part A helps to coverinpatient hospital care, as well as care provided in skilled nursing facilities, hospice care and homehealth care.



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Question 10 of 50

A patient presents with a problem where full recovery without functional impairment isexpected and there is little or no risk of mortality without treatment, and the risk of morbiditywithout treatment is low. The severity of the problem is considered to be:


minimal severity

self-limited severity

low severity

minor severity

Points: 1 out of 1

Feedback:

In the CPT® Guidelines, in the E/M section there are definitions of the various severity levels: minimal,self-limited or minor, low, moderate and high. The description in the question matches the definition oflow severity, making answer C the correct choice.

Question 11 of 50

Which types of codes are supplemental tracking codes used for performancemeasurement?


Category II

Category I unlisted codes

Category III codes ending with T

HCPCS

Points: 1 out of 1

Feedback:

The Category II Codes are supplemental tracking codes used for performance measurement. They arefound after the Medicine Section of the CPT® manual.

Question 12 of 50



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Which of the following violates ICD-9-CM guidelines?

Correct answer: A)You chose: D)

042 should be the first listed code even if the patient is seen for an unrelatedcondition.

A patient who is known to be HIV positive but who has no documented symptomswould be assigned code V08.

042 is used if the physician states the patient has an HIV-related illness.

A patient with inconclusive HIV blood test has no diagnosis and no manifestations ofthe illness may be assigned code 795.71.

Points: 0 out of 1

Feedback:

Check the ICD-9-CM Guidelines in section I.C.1.a which pertains to HIV infections. Answers B, C, andD are documented in these Guidelines. Guideline I.C.1.a.2.b states that if a patient with HIV disease isadmitted for an unrelated condition, the code for the unrelated condition should be the principaldiagnosis, making answer choice A in violation of the Guidelines.

Question 13 of 50

A patient with uncontrolled type II diabetes is experiencing a shadow across her field of visionand pain in the eye. She is diagnosed with diabetic retinopathy. What are the correct ICD-9-CM codes?

Correct answer: C)You chose: A)

250.00, 362.0

362.01, 250.52

250.52, 362.01

362.10, 250.02

Points: 0 out of 1

Feedback:

In the ICD-9-CM manual, look up Diabetic/ retinopathy, which is code 250.5 with a 5th digit, followed by[362.01]. The 5th digit is used to distinguish the type of diabetes (type I or type II) and describes if it iscontrolled or uncontrolled. In our scenario the patient had type II diabetes (5th digit: 0 and 2) and it isuncontrolled (5th digit: 2). The full diabetes code should be 250.52, which limits your options to B & C.Checking the Tabular, the correct codes are 250.52, 362.01 with diabetes coded first as directed by thenotes.



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Question 14 of 50

A young child accidentally ingested his mother's antidepressant medication that is of theSSRI type. He is rushed to the ED and is experiencing seizures. What ICD-9-CM codes arereported?


780.39, 969.03, E854.0

969.03, 780.39, E854.8

969.03, 780.39, E854.0

969.02, E854.8

Points: 0 out of 1

Feedback:

The ICD-9-CM code for the poisoning is in the Table of Drugs under SSRI, pointing to code 969.03. Alsonote the Accident code of E854.0. The manifestation of ingesting the SSRI, in this case, is seizures. Inthe ICD-9-CM Alphabetic Index, look up Seizures, and we are directed to 780.39. Verify all codes in theTabular. The order of the codes needs to be the poisoning code, manifestation code(s), and then the Ecode, or 969.03, 780.39, E854.0.

Question 15 of 50

What ICD-9-CM codes should be reported for Bacteremia in a 3 week old baby due topseudomonas?


790.7

790.7, 041.7

771.83, 041.7

041.7, 771.83

Points: 0 out of 1

Feedback:

A baby is considered a newborn for the first 28 day after birth. This means a 3 week old is a newborn. Inthe ICD-9-CM Alphabetic Index, look up Bacteremia/newborn which points to 771.83. There is a note



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telling us to use additional code to identify organism or specific infection. In ICD-9-CM Alphabetic Index,

look up Infection/ Pseudomonas which points to 041.7. The correct order is 771.83, 041.7.

Question 16 of 50

Code for 14 days of premixed parenteral nutrition solution containing compounded aminoacid and carbohydrates with electrolytes, trace elements, and vitamins, includingpreparation, with 60 g of protein:


B4193

B4189

B4220

B5200

Points: 1 out of 1

Feedback:

If you did not have the multiple choice answers, you would look in the HCPCS index, look up Parenteralnutrition/solution which points to B4164 - B5200. Then looking for the description of the describedsolution we can isolate the correct answer which in B4193.

Question 17 of 50

A leukemia patient is given an IV of Daunoxome, 10 mg. How would the chemotherapy drugby coded?


J9150

J9130

J9151

J9171

Points: 0 out of 1

Feedback:

If you did not have the multiple choice answers, you would look in the HCPCS Appendix 1 --Table ofDrugs and Biologicals -- for DaunoXome which points to J9151. Verify this code in the Tabular.



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Question 18 of 50

A 55 year old hospital patient had a myocardial infarction 2 days ago and is now out ofCritical Care. He is now having premature ventricular contractions. Dr. Long spends 30minutes reviewing the medical record and examining the patient. Dr. Long performed adetailed interval history, an expanded problem focused examination, and MDM of highcomplexity. Code for this E&M service.

Correct answer: A)You chose: B)

99233

99232

99231

No code is needed because patient is in the global period.

Points: 0 out of 1

Feedback:

A subsequent hospital care E/M service has been provided. Given that a detailed interval history andMDM of high complexity have been performed, 2 of the 3 key components for 99233 have beencompleted. Therefore, 99233 is the correct code.

Question 19 of 50

A 15 year established patient presents to his dermatologist with dozens of pimples that coverhis face, shoulders and back. Many of the lesions are large, deep, and painful to the touch.After performing a problem focused history and exam, and low complexity medical decisionmaking, the dermatologist diagnosed severe cystic acne. Five of the largest cysts aredrained and oral antibiotics are prescribed by the dermatologist. Over the counter cleansingagents are discussed with the patient. A follow-up visit is scheduled in 3 weeks. What is theE/M code for this visit?

Correct answer: D)You chose: D)

99211

99202

99213

99212

Points: 1 out of 1



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Feedback:

In the CPT® index look up Evaluation and Management/ Office and we are directed to 99201 - 99215,but since this is an established patient the range is 99211 - 99215. Since the doctor performed 2 of the3 key components listed in 99212 (which is all that is required) it is the code we need.

Question 20 of 50

Mrs. Smith, a 70 year old woman is brought to the hospital by her son because she has haddiarrhea, vomiting, and abdominal pain for the past 3 days. The patient states she cannotkeep down any liquid or food, and has scanty urine. She is admitted for observation. Theadmitting physician does a review of systems that includes constitutional, neurological, ENT,eyes, cardiovascular, respiratory, gastrointestinal, endocrine, hematological, genitourinary,musculoskeletal, and integumentary. A complete past, family, and social history was takenand is insignificant. Physical exam: PT is lethargic but responds to verbal commands slowly.Vital signs: heart rate 76; respiratory rate 25; temperature 102.5; blood pressure 100/63.Eyes: PERRLA. The skin shows decreased turgor and mucous membranes are dry. Theneck is supple; lymph nodes are normal. Lungs are clear. Heart is regular rate and rhythm,no murmurs. Abdomen is soft, with increased bowel sounds. The history is detailed, and theexamination is detailed, and the MDM was of moderate complexity.

Correct answer: A)You chose: D)

99218

99219

99203

99204

Points: 0 out of 1

Feedback:

First determine the category of E/M that was done which is Initial Observation Care, codes 99218 -99220. This eliminates answer choice D.

Next determine the level of History. We have a chief complaint: patient unable to digest food. The HPIincludes information about duration (3 days), signs and symptoms (diarrhea, vomiting, abdominal pain,unable to keep food down, scanty urine) which adds up to 6 items for an extended HPI. The ROS wasextended, but not complete, because the physician inquired about the system directly related to theproblems (gastrointestinal) and most but not all additional systems. For example, the physician did notask about the psychiatric, hematological/lymphatic, or the allergic/Immunologic systems. The PFSHwas complete. To recap, the HPI-ROS-PFSH was Extended-Extended-Complete, respectively, whichmakes the final history score Detailed, but not Comprehensive. Note that we need a comprehensiveHistory for either 99219 or 99220, which eliminates answers B and C. Therefore, by process ofelimination, the answer is 99218, answer A.



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Question 21 of 50

Code the anesthesia for this procedure. A 14 year old boy receives 2nd degree burndebridement without skin grafting, for his upper left leg and left hand and forearm. Thedocumentation indicates the burn is 10% of TBSA. The patient has mild asthma.

Correct answer: C)You chose: B)

16030-P2

01952-P1, 01953-P1

01952-P2, 01953-P2

01953-P1

Points: 0 out of 1

Feedback:

In the CPT® Index, look up Anesthesia / Burns and you are pointed to 01951 - 01953. Since the TBSAis 10%, both 01952, and 01953 are required. The correct physical status modifier is P2 which indicatesmild systemic disease and is appropriate for mild asthma.

Question 22 of 50

A 68 year old receives general anesthesia for a Whipple procedure. The anesthesiologistmedically directs a CRNA on this case, while medically directing four other cases by qualifiedhealth care professionals. What are the appropriate codes for both providers?

Correct answer: D)You chose: A)

48150-AA, 48150-QZ

48150-QK, 48150-QX

00790-AA, 00790-QZ

00794-QK, 00794-QX

Points: 0 out of 1

Feedback:

If you don't know what a Whipple procedure is, look it up in the CPT® Index and it directs you to 48150,which is a type of pancreatectomy. Then in the CPT® Index, look up Anesthesia / Pancreas and youare pointed to 00794. We need two codes, both 00794, but one with a modifier for the CRNA who isbeing directed by the anesthesiologist (-QX); and one for the Anesthesiologist who is medically directing4 other cases (-QK).



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Question 23 of 50

An 11 month old baby with rheumatic mitral insufficiency undergoes a valvuloplasty withcardiopulmonary bypass. Code the anesthesia for this procedure.

Correct answer: B)You chose: A)

00561, 99100

00561

00562, 99100

00567

Points: 0 out of 1

Feedback:

In the CPT® Index, look up Anesthesia / Heart and you are pointed to 00560 - 00567, 00580. We needthe code for heart procedure, with pump oxygenator, younger than 1 year of age, 00561. There is a notthat says "Do not report 00561 in conjunction with 99100", so the correct answer is just 00561.

Question 24 of 50

The patient is diagnosed with melanoma of the scalp and face. After discussion with thephysician about different treatment options the patient decides to have these lesionsdestroyed using laser surgery. Consent is obtained and the patient scalp and face preppedappropriately. With the use of laser surgery the physician destroys the lesion on the scalpmeasuring 1.3 cm and the lesion on the face measuring 0.5 cm. What CPT® codes arereported?


17270, 17282-51

17272, 17280-51

17272, 17280-51, 11622-51, 11640-51

11622, 11640-51

Points: 0 out of 1

Feedback:

Melanoma is a malignant lesion. In the CPT® Index, see Destruction/Skin/Malignant, you are directedto code range 17260-17286, 96567. 96567 is for photodynamic therapy. 17260-17286 is used for lasersurgery (and other types, as well). Code selection is based on location and size. For the scalp, a codefrom range 17270-17276 is selected. The scalp lesion is 1.3 cm making 17272 the correct code. For the



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face, a code from range 17280-17286 is selected. The cheek lesion is 0.5cm making 17280 the correctcode choice. Modifier 51 is used on 17280 to indicate multiple surgeries.

Question 25 of 50

A 23 year old woman collided with a rose bush hedge while cross country skiing andlacerated her neck, cheek and right eyebrow area. The cuts on the face were 6, 4, and 3 cmlong. The 2 cuts on the neck were 5 and 6 cm long. All required a layered closure. What ICD-9-CM and CPT® codes are needed?


12055, 12044, 910.8, E003.3

12055, 12044, 873.49, 874.8, E003.3

12054, 12044, 910.8, E003.2

12055, 12044, 874.8, 873.41, 873.42, E003.3

Points: 0 out of 1

Feedback:

The lacerations needed an intermediate repair. In the CPT® Index, look up Repair / Skin / Wound /Intermediate which points to 12031 - 12057. Instructions in the Subsection Guidelines for Repair state toadd up all the lengths when in the same repair classification and anatomical sites grouped together intothe same code descriptor. The face and the neck are two different anatomical sites for these codes. Thesum of the repairs of the face equals 13 cm so 12055 is needed. The sum of the repairs of the neck is11 cm, so 12044 is needed. In the ICD-9-CM Alphabetic Index, look up wound/ open/ neck which pointsto 874.8, and look up wound/ open/ face which points to 873.40. Checking the Tabular, the best codeswould be 874.8 (Other and unspecified parts, without mention of complication), 873.49 Face, withoutmention of complication, other and multiple sites because the documentation indicated both the cheekand the eyebrow. In the Index to External Causes look up Activity/ skiing / cross country which pointsto E003.3. Verify all codes in the Tabular.

Question 26 of 50

A woman is having Mohs micrographic surgery for skin cancer tumor on her lip and nasalarea. The surgeon performs 3 stages before all margins are clear. The first stage has 5tissue blocks and the second stage has 6 tissue blocks, and the final stage has 2 tissueblocks. Repair of the defect was by island pedicle flap. What are the proper CPT® codes forthis procedure?


17311, 17312 X 2, 17315, 15740-51

17311, 17312, 17315 X 2, 15740-51



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17311, 17312 X 2, 17315

17311, 17312, 17315, 13152-51

Points: 1 out of 1

Feedback:

Mohs codes are selected based on location and number of stages, each including up to five blocks.There is an add-on code for each additional block after the first five blocks in any stage. In the CPT®Index, see Mohs Micrographic Surgery. Code 17311 is for the first stage and 17312 is needed for eachadditional stage, and since there are 2 additional stages, we need 17312 X2. One of the stages requiredmore than 5 tissue blocks, so 17315 is required (one time). The pedicle flap is coded separately,because in the Guidelines it states that if repair is performed, use separate repair, flap, of graft codes."The correct code for the island pedicle flap is 15740.

Question 27 of 50

A 23 year old female suffered a fracture of the middle finger in a bike accident three monthsago. She still experiences considerable pain in the area. She is diagnosed with a non-unionfracture. The surgeon repairs the finger using a bone graft with internal fixation. What are theCPT® and ICD-9-CM codes?


26546, 733.82

26615, 816.01, 905.2

26735, 733.82, 816.01

26546, 733.82, 905.2

Points: 0 out of 1

Feedback:

In the CPT® index, look up Bone Graft, metacarpal nonunion which points to 26546. The other CPT®codes, 26615 and 26735 do not include a bone graft, and can be eliminated, in other words, we haveeliminated answers B and C. The residual, the nonunion fracture is coded first, then the late effect code.In the ICD-9-CM Alphabetic Index, look up Fracture/nonunion guiding you to code 733.82, Late effect(s)(of)/fracture/extremity upper guiding you to code 905.2. A late effect fracture code should not be codedwith an acute fracture code and is listed as an additional code according to Guideline 1.B.12.

Question 28 of 50

A 32-year-old presents with left-sided myofascial pain of the upper back trunk. Injections intoa total of 5 trigger points where made on the deltoid, rhomboid major, rhomboid minor,



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levator scapular muscles. What CPT® code(s) should be used for this procedure?


20552, 20553-51

20553

20553 X 5

20550 X 5

Points: 0 out of 1

Feedback:

In the CPT® Index, look for Injection/Trigger Point(s)/Three or More Muscles. You are referred to 20553.Review the code to verify accuracy. 20553 covers the four muscles (deltoid, rhomboid major, rhomboidminor and scapular muscles) that had a total of five (multiple) trigger point injections. Codes for triggerpoint injections are determined by the number of muscles injected not the number of injectionsadministered.

Question 29 of 50

A 23 year old football player is diagnosed with lateral dislocation of the tibia proximal end andderangement of posterior horn of the lateral meniscus. He undergoes surgical arthroscopy ofthe knee with lateral release. Additionally, a medial meniscectomy is performed with shavingof the meniscus in the medial and articular cartilage in the lateral compartment. What are theICD-9-CM and CPT® codes?


29882, 29871, 836.52

29881, 29873-51, 836.54, 717.43

29880, 29873-51, 836.52, 717.42

29880, 29873-51, 836.54, 717.42

Points: 0 out of 1

Feedback:

Look up, in the CPT® index, Arthroscopy / knee which points to 29871 - 29889. Code 29873 is forlateral release, while code 29881 includes medial meniscectomy including shaving of articular cartilage,in same or separate compartment(s). Look up in the ICD-9-CM Alphabetic Index, Dislocation/ knee/lateral are you are directed to 836.54 which the Tabular indicates is for lateral dislocation of tibia,proximal end. In ICD-9-CM Alphabetic Index, look up derangement / knee/ meniscus/ lateral / posteriorhorn which posts to 717.43.



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Question 30 of 50

A COPD patient is in the hospital for a foot injury, but needs clearing of the trachea, bronchi,and bronchial tubes, in the morning, prior to foot surgery, which his pulmonologist providesusing the endoscope. Again, later the same day, it is necessary for the pulmonologist torepeat the therapeutic aspiration of the trachea, bronchi, and bronchial tubes for the patient.Code the appropriate CPT® code(s) for the pulmonologist.


31645, 31646-59

31624 X 2

31635

31645 X2

Points: 1 out of 1

Feedback:

The trachea, bronchi, and bronchial tubes, together, are also referred to as the tracheobronchial tree. Inthe CPT® Index, look up Aspiration / Bronchi / Endoscopy which points to 31645 - 31646. We caneliminate code 31624 (B) because there was no mention of bronchial lavage. Code 31635 (C) can alsobe eliminated as there was no mention of removal of a foreign body. Code 31645 specifies "initial" andshould not be coded twice for the same day. Code 31646, is for "subsequent" and could be used incombination with 31646. You should append modifier -59 (Distinct procedural service) to 31646 toindicate that the physician performed this procedure separately and distinctly from 31645.

Question 31 of 50

A 43-year old male patient is diagnosed with eventration diaphragmatic paralysis due to lateeffect of a thoracic spinal cord injury that compromised the left phrenic nerve. The patient isplaced on the operating table in supine position and prepped and draped sterilely. Thesurgeon makes thoracoabdominal incision to expose the diseased area. The area ofdiseased diaphragm is cut out and closed with a simple repair. The incision of 7.0 cm isclosed in layers. What are the appropriate CPT® and ICD-9-CM codes?


39561-LT, 519.4, 907.2

39545, 12032-51, 519.4, 952.9

39560, 519.4, 907.2

39560, 12032-51, 519.4, 952.9



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Points: 0 out of 1

Feedback:

This is a resection of the diaphragm with simple repair. The closing of the incision is included in theresection. In the CPT® index, look up Resection, diaphragm which points to 39560 - 39561. Code39561 designates "with complex repair" and is incorrect. This eliminates answer A. We eliminateanswers B and D because the repair is included in the main procedure. Answer C is correct. ICD-9-CMcodes can be found by looking up Paralysis / Diaphragm which points to 519.4 and Late/ effects ofinjury/spinal/cord which indicates 907.2 (for injury classifiable to 806 and 952). In this case, the originalinjury was a thoracic spinal cord injury, 952.9. We code the residual code, 519.4 and the late effectcode, 907.2 and not the original injury 952.9.

Question 32 of 50

A 43-year old woman complains of painful varicose veins that have not responded tocompression stockings. Her leg was scanned using duplex ultrasound to excess damage,and to identify affected veins. There are 4 veins with inflamed in the left leg, with one of theveins also ulcerated. All 4 veins are treated using endovenous ablation therapy withradiofrequency to remove abnormal tissue growth. The veins are then injected withsclerosing solutions. What are the appropriate CPT® and ICD-9-CM codes?


36475, 36476, 36471-51, 454.1, 454.0

36476, 36470-51 X2, 454.1, 454.0

36475, 36476, 36471-51, 454.2

36468, 36475, 454.2

Points: 0 out of 1

Feedback:

In the CPT® Index, look up Ablation/ Vein/ Endovenous which points to 36475 - 36479. The codeswithin this range for treatment by radiofrequency are 36475 and 36476. Since 4 veins are treated both ofthese codes are needed. Code 36475 for the first vein treated and code 36476 for the second andsubsequent veins. Look up also Injection / Sclerosing Agent/ Intravenous which points to 36470 - 36471.The correct code is 36471 which is Injection of sclerosing solution; multiple veins, same leg. Imagingguidance is included in code 36476 and should not be coded separately.

In the ICD-9-CM Alphabetic Index, look up phlebectasia which indicates to see Varicose, vein 454.9.Code 454.9 does not include the inflamed vein or the ulcerated vein, however. In the 454 category wefind 454.2 Varicose veins of lower extremities, with ulcer and inflammation. Since "and" appears in thetitle of the subcategory, it can be interpreted to mean either "and" or "or", according to ICD-9-CMGuideline I.A.7. Therefore, code 454.2 is appropriate for all 4 veins because the veins are either inflamedand/or ulcerated.



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Question 33 of 50

A 10-yr old girl arrives at the Emergency Dept. with a laceration to the tongue. The cut is 1cm in length and is on the anterior 1/3 of the tongue. The emergency doctor repairs thelaceration. What are the CPT® and ICD-9-CM codes?


41251, 529.8

41250, 873.64

41510, 529.6

41599, 873.74

Points: 0 out of 1

Feedback:

In the CPT® index, look up Repair/ tongue/ laceration which points to 41250- 41252. The laceration is 1cm and on the anterior 1/3 of the tongue, which is within the anterior 2/3rds of the tongue, which is code421250, Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue. In theICD-9-CM Alphabetic Index, look up Laceration/ tongue / which points to 873.64 and 873.74(complicated). Code 873.64 is correct; Open wound of head; internal structures of mouth, withoutmention of complication, tongue and floor of mouth.

Question 34 of 50

A 52 year old patient presents for an open repair of an initial ventral hernia which isincarcerated. After administration of general anesthesia, an incision is made over the fascialdefect. The peritoneal cavity is entered and the sac is dissected free from the nearbytissues. The intestinal loop is separated free from the hernia. The sac is then reduced.Prosthesis mesh is used to close a defect, which is threaded between the muscles andsutured. The incision is then closed with sutures for healing. The patient has tolerated theprocedure well. What are the appropriate CPT® codes for this procedure?


49655

49657

49566, 49568

49561, 49568

Points: 0 out of 1



A)

B)

C)

D)

Feedback:

The repair being performed is incisional (open) as opposed to using laparoscopy. In the CPT® index,look up Repair / hernia/ incisional/ Incarcerated which points 49561, 49655. Code 49561 is the openprocedure (which is what we need); 49655 is the laparoscopic procedure (which is incorrect). Accordingto the Guidelines for incisional hernia repairs (49560 -49566) the use of mesh or other prostheses isseparately reported, so we can also code 49568 for the mesh. The correct answer is 49561, 49568 oranswer D.

Question 35 of 50

A 73-year-old patient with a history of intestinal polyps is experiencing occasional rectalbleeding. She presents to the hospital for a diagnostic colonoscopy. She is given Versed andFentanyl intravenously for conscious sedation. She is placed in a lateral recumbent position.Perianal area is inspected: no evidence of anal fissure, hemorrhoids, and no palpablemasses are found. The colonoscopy proceeds from anus to cecum without difficulty. Thelumen of the colon is visualized. There are 6 mm and 5mm polyps in the lining of thetransverse colon which is snared. There is a 7 mm polyp in the descending colon which isremoved in its entirety with hot biopsy forceps. There is a single internal group of 1st degreeinternal hemorrhoids in the upper anal canal. These are apparently the cause of the rectalbleeding and are excised. The colonoscopy was withdrawn. The patient tolerated theprocedure well.

What are the appropriate CPT® codes?


46255, 45385-51, 45384-51-59

46255-52, 45378-51, 45385-51, 45384-51-59

46255-52, 45385-51, 45384-51-59

46255, 45379-51 X 2

Points: 0 out of 1

Feedback:

Surgical endoscopy always includes diagnostic endoscopy and is not reported separately. Per CPT®guidelines, the intravenous sedation is included in these procedures, so it is inappropriate to report theadministration of sedation separately. In the CPT® Index, look up colonoscopy/ Removal / Polyp andyou are directed to 45384 - 45485. We need both codes: Code 45384, Colonoscopy flexible, proximal tosplenic flexure; with removal of tumor(s), polyp(s), other lesion(s) by hot biopsy forceps or bipolarcautery; and 45385, Colonoscopy flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s),other lesion(s) by snare. Multiple techniques used on different lesions or polyps may be codedseparately. Codes 45384 and 45385 define different techniques and can be used only once for a singlecolonoscopy procedure regardless of whether the technique is employed on multiple polyps or multipletimes on a single polyp. Append modifier 59, Distinct procedural service, to the second procedure codeto indicate the removal of a separate lesion from a separate site.

Also, code for the excision of the internal hemorrhoids. Look up in the CPT® index, Hemorrhoidectomy /simple which points to 46255. Hemorrhoidectomy, internal and external, single column/group. There



A)

B)

C)

D)

were only internal hemorrhoids removed so Modifier 52 in appended.

Question 36 of 50

A 34 year old patient with a primary malignant neoplasm of the urachus presents for surgery.Dr. Clark prepared the abdominal area with povidone-iodine. Under general anesthesia, acystotomy is done. An incision was made just 2 cm above the pubic symphysis. The skin isexposed and dissection of the local tissues is done to locate the bladder. The bladder wasthen checked by inserting a syringe and draining out the urine. The neoplastic tumor waslocated, and fulguration is used to burn the malignant tissue, but could not totally bedestroyed. To complete the procedure, radioactive material was inserted. Dr. Clark inserteda drainage tube in the bladder, so the urine could drain before suturing the bladder wall andthe abdominal area. What is the proper CPT® code(s) for this procedure?


53220

51020

51030

53852

Points: 0 out of 1

Feedback:

A cystotomy is done to destroy the malignant tissue in the urachus. If you do not know that the urachusis part of the urinary bladder, you could use the ICD-9-CM neoplasm table. Look up urachus to find thecode for malignant neoplasm of the urachus, 188.7. Verifying in the Tabular, we find that all the codesfor 188 are for malignant neoplasms of the bladder. In the CPT® index, look up Incision/ bladder / withDestruction which points to 51020 - 50130. Code 51030 is for cyrosurgical destruction which was notdone. Code 51020 describes by fulguration and insertion of radioactive material which is the correctcode.

Question 37 of 50

Dr. Rodgers received a new patient who was 37 weeks pregnant. The woman recentlymoved from her previous home in Virginia back to NYC. This was her second pregnancy; thefirst child was delivered 3 years ago by C-sect. She opted to try VBAC with this pregnancy.However, the placenta separated prematurely with delivery, and Dr. Rodgers performed anemergency C-sect. A healthy baby girl was delivered. Another obstetrician provided herantepartum care in her former town, and Dr. Rodgers provided post-operative care. Whatare the CPT® and ICD-9-CM codes reported for this service?




A)

B)

C)

D)

A)

B)

C)

D)

59614, 654.23, V27.0

59620, 59622, 641.21, 654.21, V27.0

59622, 641.21, 654.21, V27.0

59515, 654.21, V27.0

Points: 0 out of 1

Feedback:

This patient has a previous history of Cesarean delivery and is attempting to deliver her second childvaginally (VBAC). Due to her placenta separating, the vaginal delivery was changed to a Cesareandelivery. This procedure is located in the CPT® Index under Cesarean Delivery/Delivery after attemptedvaginal delivery / Delivery Only and Postpartum Care leading to 59620 and 59622, respectively. Code59622 includes the Cesarean delivery, following attempted vaginal delivery after previous Cesareandelivery including postpartum care, and is the correct code. The first listed diagnosis will reflect the separation of the placenta during labor. In the ICD-9-CMAlphabetic Index, look up Delivery/complicated/separation/placenta (premature) guiding you to code641.2, your fifth digit being a "1" - delivered, with (or without) mention of antepartum condition (641.21).Your second code to report is for the previous Cesarean delivery. This is indexed underDelivery/cesarean/previous/cesarean delivery, section guiding you to code 654.2x, the fifth digit being a"1". The last code to report is the outcome of the delivery. Look up, in the ICD-9-CM Alphabetic Index,Outcome of delivery/ single/ live born, which points to code V27.0.

Question 38 of 50

A patient with varicosity of the scrotal veins undergoes a closed procedure for ligation ofspermatic veins. What is the correct CPT® code for this procedure?


55559

55550

55535

55530

Points: 0 out of 1

Feedback:

In the CPT® Index, look up Scrotal Varices and it says "see Varicocele" which points you to 55530 -55540. Verifying in the Index, we see those codes are for open procedures. Following these codes,there are codes for Laparoscopy for the spermatic cord. Code 55550 is for surgical laparoscopy withligation of spermatic veins for varicocele, which is a closed procedure, and the correct code.



A)

B)

C)

D)

A)

B)

C)

D)

Question 39 of 50

A 4-year old boy is diagnosed with left eye monocular exotropia with A pattern. The boy hasbeen unsuccessfully treated with alternative methods for 18 months. After being informed ofthe risks and benefits of surgery the parents have consented to surgical treatment. Thepatient undergoes resection of the left lateral rectus and the left inferior rectus muscles. Bothmuscles were reattached to the sclera by adjustable sutures. What are the CPT® and ICD-9-CM codes?


67311-LT, 67314-LT, 67335-LT, 378.12

67311-50, 378.10

67312-LT, 67335-51, 378.12

67312-LT, 67314-LT, 378.12

Points: 1 out of 1

Feedback:

This is strabismus surgery. The patient had the lateral rectus (horizontal) and the inferior rectus (vertical)muscle resected. So we need to code for 1 horizontal and one vertical muscle. In the CPT® Index, lookup Strabismus/ repair/ one horizontal muscle and /one vertical muscle. We are referred to 67311 and67314, respectively. Adjustable sutures were used, so look up Strabismus/ Repair/ Adjustable Sutureswhich points to 67335. Modifier LT should be appended to the procedures to indicate that they wereperformed on the left side. In the ICD-9-CM Alphabetic Index, look up Exotropia / monocular / with Apattern which points to 378.12. Verify all codes in the Tabular.

Question 40 of 50

A 43-year old woman has been diagnosed with an intracranial abscess which is to beremoved.Dr. Goodwin, a surgeon, uses an orbitocranial zygomatic approach to the cavernous sinuswhich included the osteotomy of zygoma, craniotomy, and extradural elevation of temporallobe and then performed the excision of the extradural abscessed lesion in the cavernoussinus. Repair is by myocutaneous flap with microvascular anastomosis under operatingmicroscope. What are the CPT® codes for this procedure?


61584. 61600-51, 15758-51

61584. 61600-51, 15756-51, 69990

61608, 61592-51, 15758-51, 69990

61607, 61592, 15756-51



A)

B)

C)

D)

Points: 0 out of 1

Feedback:

This is a surgery of the skull base. We need to determine codes for the Approach, Definitive Procedure,and the closure. Codes for various approaches are in the range 61580 - 61598. Code 61584 is fororbitocranial approach of the anterior cranial fossa, and 61592 is for the orbitocranial zygomaticapproach to middle cranial fossa. Cavernous sinus is mentioned for 61592, and the rest of thedescription is appropriate for this documented approach that was performed. We can eliminate answersA and B which contain 61584. Code 61607 is for resection or excision of neoplastic, vascular orinfectious lesion of cavernous sinus, extradural, and 61608 is for intradural. We need the extraduralcode, 61607, so it appears D is our answer. Code 15756, is needed for the free myocutaneous flap.There is a note under 15756 that says that 69990 should not be reported with 15756.

Question 41 of 50

A 34-year old woman has a thyroid neoplasm of unspecified nature on the right lobe, andsome suspicious looking nodules on the upper left node. Her physician has counseled herand she has consented to have the right side of the thyroid removed and a partial lobectomyon the left including removal of the isthmus. What is the CPT® code(s) for this procedure?


60212

60220

60225

60252

Points: 0 out of 1

Feedback:

Code 60212 is a partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, includingisthmusectomy, but this the patient was having the entire right side of the thyroid removed, not just apartial lobectomy, so answer A is incorrect. Code 60220 is Total thyroid lobectomy, unilateral; with orwithout isthmusectomy but does not include the partial lobectomy on the left, so answer B is incorrect.Code 60252, is a total or subtotal thyroidectomy, but it is for malignancy, and an unspecified naturewhich the type of neoplasm that was diagnosed so we cannot use this code, and answer D is incorrect.Code 60225, is for a total thyroid lobectomy on one side with contralateral subtotal lobectomy, includingisthmusectomy, and therefore is the correct code for the documented procedure.

Question 42 of 50

A patient with endomyocardial fibrosis undergoes cardiac blood pool imaging (planar) usingthe first pass technique. Four studies are performed, two at rest and two on a treadmill.Included is a wall motion study plus ejection fraction.



A)

B)

C)

D)

A)

B)

C)

D)


78472 X 4

78494

78454

78483

Points: 0 out of 1

Feedback:

In CPT® Index, look up Blood Pool Imaging / Cardiac which points to 78472 - 78473, 78481 - 78483,78494 - 78496. Code 78472 is for planar, but not first pass technique and therefore, answer A can beeliminated. Code 78494 is for SPECT and this eliminates answer B. Code 78454, answer C, is formyocardial perfusion imaging, not blood pool imaging, and can be eliminated. Code 78483 is for multiplestudies (cardiac blood pool imaging, planar), and therefore should be chosen as the CPT® code asthere were four studies.

Question 43 of 50

Radiation treatment delivery is provided f by a radiation treatment facility for a patient withanaplastic large cell lymphoma for a single intrathoracic lymph node using a single port withno block at 8 MeV. What is the appropriate CPT® code for this procedure?


77403

77408-TC

77405

77422

Points: 1 out of 1

Feedback:

In the CPT® index, look up Radiation Therapy / Treatment Delivery / Single Area which points to 77402 -77406, 77422. The level we need is 8 MeV, or 77403 which is for 6 - 10 MeV, which is answer A. Notethat 77422 is for high energy neutron radiation treatment delivery which is different than radiationtreatment delivery, eliminating answer D. Code 77408, answer B, is for 2 treatment areas and isincorrect. Modifier TC is not needed because as the note for 77401 - 77416 says these codes recognizethe technical component (so no modifier is needed to specify the technical component).



A)

B)

C)

D)

A)

B)

C)

D)

Question 44 of 50

An 8 month old boy with symptoms of hydromyelia undergoes MRI of the lumbar spinal canalwith and without contrast.


72148, 72149, 742.53

72197, 742.53

72158, 742.53

72159, 742.53

Points: 0 out of 1

Feedback:

In the CPT® index, look up Magnetic Resonance Imaging / Spine / Lumbar which points you to 72148 -72149 , 72158. Answer A, listing both 72148 and 72149 is incorrect because there is a note stating thefor lumbar spinal canal imaging without contrast material followed by contrast material, use 72158,answer C. Code 72197 (answer B) is for the pelvis, not the lumbar spinal canal, and is eliminated. Code72159, answer D, is for magnetic resonance angiography, and is eliminated.

Question 45 of 50

A physician orders electrolyte tests for chloride, potassium, and sodium, and a glutathionetest. What CPT® code(s) are reported?


80051-52, 82979

80051, 82978

82435, 84132, 84295, 82978

82374, 84132, 84295, 82979

Points: 0 out of 1

Feedback:

The panel codes may not be used unless the exact tests specified in the code have been performed. Ifany test is left out, code each test individually. In the CPT® Index, look up Blood Tests / Panels/Electrolyte with points to 80051. Inspecting the description, we notice that the carbon dioxide (82374)was not performed; therefore we cannot use the electrolyte panel code (80051). The individual testsmust be coded: chloride (82435), potassium (84132), sodium (84295) and glutathione (82978).Glutathione reductase (82979) was not mentioned and cannot be coded.



A)

B)

C)

D)

A)

B)

C)

D)

Question 46 of 50

To find out the percentage of the volume of whole blood that is made up of red blood cells,the physician would the following test(s):


85041

85014

85018

all of the above

Points: 0 out of 1

Feedback:

Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up ofred blood cells. It is code 85014, and therefore the answer. Hemoglobin is a protein inside red bloodcells that carries oxygen throughout the body. A hemoglobin test (85018) reveals how much hemoglobinis in a person's blood. Code 85041 is a blood count test for red blood cell, automated.

Question 47 of 50

A patient has a knee arthrotomy on the left knee. A synovial cyst and cartilage shavings areremoved in the process. Both specimens are examined by the pathologist. What CPT®code(s) are reported?


88305, 88304

88304 x 2

88304-LT

88305 x 2

Points: 0 out of 1

Feedback:

In the CPT® Index, look up Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam whichpoints you to 88302-88309. Read these codes to determine the correct code. Both of these specimens(synovial cyst and cartilage shavings) are coded under 88304. Answer B is correct because 88304 is



A)

B)

C)

D)

A)

B)

C)

D)

coded for each of the specimens.

Question 48 of 50

A 15 month old is brought to his physician's office for a DTaP injection. His mother receivesphysician counseling. What CPT® code(s) are reported?


90715, 90461 X 3

90715, 90460, 90461 x 2

90700, 90460, 90461 x 2

90700, 90460

Points: 0 out of 1

Feedback:

In the CPT® Index, look for Vaccine and search for the DTaP vaccination, which is indicated to be forDiphtheria, Tetanus, Acellular Pertussis , 90700. Note that there are 3 components to this particularvaccination, namely, Diphtheria, Tetanus and Acellular Pertussis. According to the guidelines forVaccines and Toxoids, an administration code from 90460-90474 is also reported. Because counselingwas included, a code from 90460-90461 should be used for the administration. According to theguidelines, 90460 is reported for the 1st component, and 90461 is reported for the other 2 components.Note that Code 90715 is incorrect because it is for TdaP, for individuals 7 years or older.

Question 49 of 50

A 6 month old baby with pneumonia due to streptococcus group B received circadianrespiratory pattern recoding for 12 hour continuous recording. An EEG and EKG were alsodone. What CPT® code(s) and ICD-9-CM codes are reported?

Correct answer: D)You chose: B)

94772, 041.02, 484.8

94774, 486

94774, 041.02, 484.8

94772, 482.32

Points: 0 out of 1



A)

B)

C)

D)

Feedback:

In the ICD-9-CM index, look up pneumonia / streptococcal /Group / B which points to 482.32. Note thatthe combined code 482.32 should be used, as opposed to individual codes for streptococcus Group B(041.02) or pneumonia in other infectious diseases classified elsewhere (484.8). In CPT® index, look upRespiratory Pattern Recording/ Infant which points to 94772. Verify all codes in the Tabular.

Question 50 of 50

A patient with advanced adrenocortical carcinoma presents for chemotherapy administrationat the infusion center. The infusion was started with 1000 cc of normal saline. LiposomalDoxorubincin HCl at 50mg was added and then cisplatin, 100 mg, was added and infused 2hours. At the end of the 2 hours, the IV was disconnected and the patient was discharged.What codes are reported?

Correct answer: A)You chose: B)

96413, 96415, J9002 x 5, J9060 x 10, V58.11, 194.0

96413, 96415, J9002 x 5, J9060 x 5, V58.12, 198.7, 199.1

96413, 96415, 96360-51, 96361, J9002 x 5, J9060 x 10, J7050 x 2, V58.11, 194.0

96415, 96360-59, J9002, J9060, J7050, V58.0, 198.7, 199.1

Points: 0 out of 1

Feedback:

Chemotherapy infusion administration is reported as 96313 for the 1st hour and 96315 for eachadditional hour. In the Index, see Chemotherapy/Intravenous/Infusion. The chemotherapy ran for 2 hours;report 96413 & 96415. The chemotherapy drugs are listed in the HCPCS Level II Appendix 1 - Table ofDrugs and Biologicals. Liposomal doxorubicin hydrochloride, J9002, is packaged in 10 mg units,therefore 5 units should be coded for the 50 mg administered. Cisplatin, J9060, is packaged in 10 mgunits, therefore 10 units should be coded for the 100 mg administered. In the ICD-9-CM AlphabeticIndex, look for Chemotherapy/encounter which points to V58.11. Report also the reason for thechemotherapy. In this case, it is carcinoma of the adrenalcortex. In the ICD-9-CM Alphabetic Index lookup Neoplasm, Adrenal cortex, malignant, which is 194.0. Note that according to the guidelines foundpreceding code 96401 "the fluid used to administer the drug(s) is considered incidental hydration and isnot separately reportable" so we cannot code 96360, 96361 or J7050.

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