MOCK- 2

Name:
Date:
Time: 4 hours
Question 1
Patient has basal cell carcinoma on his upper back. A map was prepared to
correspond to thearea of skin where the excision of the tumor will be performed using
Mohs micrographic surgery technique. There were three tissue blocks that were
prepared for cryostat, sectioned, and removed in the first stage. Then a second stage
had six tissue blocks which were also cut and stained for microscopic examination.
The entire base and margins of the excised pieces oftissue were examined by the
surgeon. No tumor was identified after the final stage of the microscopically controlled
surgery. What procedure codes should be reported?

A.17313, 17314 x 2 C. 17260, 17313,17314B.17313,17315 D. 17313,17314,17315

Question 2:
What code would be used to report a massive debridement of an open abdominal wound,
including subcutaneous tissue and muscle?

a. 11000, S31.119A b. 11004, S31.109A c. 11010, S31.119A d . 11043, S31.109A

Question 3:
64-year-old female who has multiple sclerosis fell from her walker and landed on a
glass table.She lacerated her forehead, cheek and chin and the total length of these
lacerations was 6 cm.her right arm and left leg had deep cuts measuring 5 cm on
each extremity. Her right hand and right foot had a total of 3 cm laceration. The ED
physician repaired the lacerations as follows: the forehead, cheek and chin had
debridement and cleaning of glass debris with the lacerations being closed with 6-0
Prolene sutures. The arm and leg were repaired by 6-0
Vicrylsubcutaneous sutures and Prolene sutures on the skin. The
hand and foot were closed with adhesive strips. Select the appropriate
procedure codes for this visit.

a. 12014,12034-51,12052-51, 11042-51 c. 12014, 12034-51 b.

12053,12034-51,12002-51 d. 12053, 12034-51

Question 4
Indications: 55 -year-old female had a sizeable 1.5 cm basal cell
carcinoma on the right upperlip. She had a 2 cm defect. After excision, it was
reconstructed in a first stage with a nasolabialcheek flap. The margins were clear,
and she is planned for the second stage. Operative Procedure: Under intravenous
sedation, patient in
supine position, the face was prepped and
draped. Division performed to the bridge between the base of the flap of the upper lip.
Unfurled the base of the flap that was excised until it was soft and pliable. It is
defatted and laid back onto the cheek with interrupted 5-0 Monocryl and running 6-0
plain catgut. Similarprocedure was performed on the redundant portion of the flap and
permanently set into theupper lip. Steri-strips applied. Which CPT® should be used?

A. 15758-79
B. 15630-58
C. 15758-76
D. 15630-78

Question 5
7-year-old riding his bike struck a tree stump throwing him off his bike. He received multiple
lacerations.He had a 3 cm dermis laceration on his scalp with two 0.5 cm lacerations on his
face. His right arm had a5 cm laceration and right leg has a 5 cm laceration. The physician
stapled the laceration for the scalp. Physician used Steri-strips (adhesive strips) to close the
wounds on the face. The legs and arms were cleaned by
heavily irrigating them with normal saline and removal of
embedded debris performed on both wounds, followed with
a single layer closure. Select the repair codes to report.

A. 12032, 12032-59, 12011-59, 12002-59

B. 12002, 12002-59, 12011-59, 12002-59
C. 12005, 11042-59
D. 12034, 12002-59

Question 6
With the patient having had a wire localization
performed by radiology, she was taken to the operating room and, under local
anesthesia of the left breast, was prepped and draped in a sterile manner. A breast
line incision was made through the entry point of the wire, and a coreof tissue
surrounding the wire (approximately 1 × 2 cm) was removed using electrocautery
forhemostasis. The specimen, including the wire, was then submitted to radiology,
and the presence of the lesion within the specimen was confirmed. The wound was
checked for hemostasis, and this was maintained with electrocautery. The breast
tissue was reapproximated using 2-0 and 3-0 chromic. The skin was closed using 4-0
Vicryl in a subcuticular manner. Steri Strips were applied. The patient tolerated the
Procedure well and was discharged from the operating room in stable condition. At
the end of the Procedure, all sponges and instruments were accounted for. Pathology
report later indicated: Benign lesion.

A. 11602-LT, D48.62
B. 11400-LT, C50.912
C. 19125-LT, D24.2
D. 19125-LT, D49.3
Question 7
Patient is having ongoing back and hip pain. The physician elects to perform a
sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is
placed prone position. A needle is placed under fluoroscopic guidance into the SI joint
and a mixture of 20mg of Celestone and Marcaine is injected for pain relief. Code the
procedure(s).

A. 27096, 77003-26
B. 20611
C. 20552
D. 27096

Question 8
A patient is given xylocaine, a local anesthetic, by injection into the thigh above the site
to be biopsied. A small-bore needle(percutaneous) is then introduced through skin in
to the muscle,about 3 inches deep, and a muscle
biopsy is taken. What is the CPT code reported for
this service?
A.2020
5
B.2020
6
C.2022
5
D.2732
4

Question 9
25-year-old male has a ruptured distal bicep tendon. An incision is made overlying
the antecubital fossa. The biceps tendon was retrieved and tagged using #1 Vicryl
suture. The second incision made on the superior border of the ulna. The supinator
was incised deep to expose the radial tuberosity. Threaded suture from the anterior
incision through to the posterolateral incision and brought the biceps up to the radial
tuberosity. A drill hole was made followed by a tap and seated 5mm corkscrew into the
radial tuberosity. Two sutures placed in the biceps tendon in horizontal mattress type
fashion separately to tiedown the suture. Closure was then accomplished with sutures
and staples. What is the correct code forthis procedure?
A. 24342, S46.211A
B. 24340, S46.211A
C. 23430, S46.211A
D. 23440, S46.201A

Question 10
A 3-year-old is brought into the ER crying. He cannot bend his left arm after his older
brotherpulled it while they were rough housing. The physician looks at the x ray and
makes a diagnosis of dislocated nursemaid’s elbow. The ER physician reduces the
elbow successfully.The patient is able to move his arm again. The patient is referred
to an orthopedist for followup care. What CPT code should be reported?

A.24640-54,
S53.032A
B.24565-54,
S53.032A
C.24650-54,
S53.032A
D.24600-54,
S53.031A

Question 11
This 45-year-old male presents to the operating room with a painful mass of the right
upper arm. General anesthesia was induced. Soft tissue dissection was carried down
thru the proximal aspect of the teres minor muscle. Upon further dissection a large
mass was noted just distal of the IGHL (inferior glenohumeral ligament), which
appeared to be benign in nature. With blunt dissection and electrocautery, the 4.5 cm
mass was removed en bloc and sent to pathology. The wound was irrigated, and
repair of the teres minor with
subcutaneoustissue was then closed with 3-0
Vicryl. Skin was closed with double-0 Prolene in
a subcuticularfashion. What is the correct
CPT® code for this service?

A. 23076
B. 23066
C. 23075
D. 23077
Question 12
The patient presented for medial meniscal bucket-handle tear left knee.
Arthroscopy withpartial medial meniscectomy left knee and arthroscopic picking
(drilling pick holes) of the lateral femoral condyle left knee was performed. Code
the procedure and diagnosis codes.

A. 29880-LT, 29879-51-LT, S83.212A

B. 29881-LT, 29879-51-LT, S83.212A
C. 29882-LT, 29885-51-LT, S83.282A
D. 29881-RT, 29885-51-LT, S83.242A

Question 13
56-year-old with lung cancer developed an effusion that is suspicious for malignancy.
Needleaspiration is performed to obtain a sample of the fluid for pathological
examination. A needleis inserted between the ribs and into the pleural space, and the
fluid is withdrawn. The specimen is sent to pathology. Choose the CPT® code that
reports the procedure described.

A. 32554
B. 32555
C. 32551
D. 32400

Question 14
The physician performs a selective catheterization of the right renal artery and
renalangiography. The puncture site was the right femoral artery. A. 36251-RT,
36200-51, 75625-26
B. 36245-RT
C. 36215-RT, 36200-51, 75625-26
D. 36251-RT

Question 15
This 25-year-old male presents with deviated nasal septum. After intubation, a left
hemitransfixion incision was made with elevation of the mucoperichondrium. Cartilage
from the bony septum was detached and the nasoseptum was realigned and removed
in a piecemeal fashion from the obstructed perpendicular plate of the ethmoid.
Thereafter, 4-0 chronic was used to approximate mucous membranes. Next,
submucous resection of the middle and inferior turbinates was handled in the usual
fashion by removing the anterior thirdof the bony turbinate and lateral mucosal followed
by bipolar cauterization of the posterior enlarged tip of the inferior turbinate as well as
out fracturing. A small amount of silver nitratecautery was used to achieve hemostasis.
A dressing consisted of a fold of Telfa with a ventilating tube for nasal airway on each
side achieved good hemostasis, patient went to
recovery in good condition. What is the correct
code for this procedure?
A. 30520, J34.2
B. 30420, J34.2
C. 30620, J34.3
D. 30450, J34.2

Question 16
A 67-year-old female has CAD, atrial fibrillation, claudication and several chronic
conditions that have been marginally controlled with medication. The doctor decided
that the benefits outweigh the risks for her having a single vessel cardiopulmonary
bypass using an arterial graft. Her medication Heparin has been stopped for several
days. She was admitted in the hospital a day before the surgery. In the operating
room, general anesthesia was administered. After the chest is opened the patient
begins to hemorrhage and drops in bloodpressure. The decision is made to stop the
procedure and close the chest. How should this service be coded?

A. Service is not coded due to not completing the procedure

B. 33533-52
C. 33533-74
D. 33533-53
Question 17
Mr. Y presents to outpatient surgery for placement of a dual chamber pacemaker after
multiple attempts to manage his bradycardia medically. Atrial and ventricular leads
were placed under fluoroscopic guidance via the subclavian vein. Testing confirmed
appropriate placement and conduction. The left chest was then infiltrated with
Epinephrine and a pocket was opened for placement of the generator. The leads were
attached to the generator and thegenerator was programmed. Appropriate pacing was
confirmed. The skin pocket was closed in layers and dressing placed. Select the
appropriate CPT® codes.

A. 33208
B. 33213, 33217
C. 33235, 33208
D. 33214

Question 18

The patient is a 69 year old white female with 10

year status post dual chamber where
thegenerator is at its end of life. The pacemaker generator is explanted, and the leads
are thenattached to the new generator .what are the CPT codes for this encounter?
A.33213
B.33208
C.33213,332
33D.33228

Question 19
A 67-year-old male patient is referred for a flex sigmoidoscopy exam to remove polyps.
The physician found three polyps in the rectosigmoid junction. They were removed by
hot biopsyforceps. The path report indicated the polyps were benign. Code the
encounter.

A. 45333, D12.7
B. 45315, K63.5
C. 45384, D12.7
D. 45346, D12.7

Question 20
A patient with rectal bleeding underwent a proctosigmoidoscopy that showed she
had two internal hemorrhoids. The anus was prepped and draped. A field block with
Marcaine 0.25%was then placed. There was an internal prolapsing hemorrhoid in the
anterior midline. This was rubber band ligated by applying two bands. In the
posterior midline, there was anotherinternal hemorrhoid that was banded in the same
manner. Code the procedure.

A. 0249T, K64.9
B. 46221, K64.9
C. 46945, K64.9
D. 46930, K64.9

Question 21
A patient comes in for surgery today to address complications from his previous partial
enterectomy performed 5 months ago. Upon reopening the patient’s previous incision
thesurgeon resected the ileum and a portion of the colon. An ileocolostomy was
performed tocomplete the procedure with no complications. The appropriate CPT®
code to report is:

A. 44144
B. 44160
C. 44150
D. 44205

Question 22
What CPT® code(s) describe(s) a cholangiogram via a new access, followed by
brush and alligator forceps biopsy (preliminary pathology for malignancy),
cholangioplasty and metallicstent placement across a mid common hepatic duct
malignant stenosis, followed by placement of an internal/external biliary drainage
catheter through the
stent?

A. 47532, 47534, 47540, 47542, 47543, 47543

B. 47534, 47540, 47542, 47543
C. 47540, 47542, 47543
D. 47540, 47543
Question 23
A physician performs a diagnostic colonoscopy through a stoma. During the colonoscopy
thephysician removes a foreign body from the colon
thro scope.
A. 45379
B. 44390
C. 45378, 45380-51
D. 44388, 44390-51

Question 24
On March 1, a 35-year-old patient with chronic
tonsillitis undergoes a tonsillectomy. Two days later,
the patient experiences severe, delayed bleeding as a
result of the surgery. He returns tothe operating room where the same surgeon
operates to control the oropharyngeal hemorrhage. Code for March 3rd service?

A. 42960 - 78
B. 42962 - 78
C. 42960 - 79
D. 42962 – 79
Question 25
A 55-year-old man with complaints of an elevated PSA of 6.5 presents to the
outpatient surgical facility for prostate biopsies. The patient is placed in the lateral
position. Some calcifications were found in the right lobe, with no obvious
hypoechogenic abnormality. Thebase of the prostate was infiltrated, and random
needle biopsies were performed under ultrasonic guidance by the physician. His
interpretation was reported in the record.

A. 10022
B. 55706
C. 55700, 76942-26
D. 55705, 76942-26

Question 26
Patient is a 55-year-old male with a Mentor inflatable thrbeen causing problems. He
was experiencing issues with prolonged erections while deflatingthe prosthesis. It
was elected to remove the prosthesis and
insert a Duraphase II penile prosthesis.
There was some evidence of infection in the
area, which was irrigated.

A. 54405, 54406-51
B. 54408
C. 54410
D. 54411
Question 27
A neonatal male had an elective circumcision before being discharged home from the
newborn nursery. The physician uses a ring block for the local anesthetic and the
foreskin is placed over the glans. A clamp is selected for the size of the glans and a
constricting circularring is placed over the foreskin to compress and devascularize
the foreskin. The devascularized foreskin is excised with a scalpel and the clamp is
left in place. Which CPT® code should be used?

A. 54150
B. 54160
C. 54161
D. 54150-52

Question 28
A 46-year-old female with history of cervical carcinoma underwent placement of an
ileal conduit, with subsequent development of left hydronephrosis. A retrograde
ureteral catheterwas recently placed. She returns today for catheter exchange.
Patient was placed in the supine position. The ileal conduit was accessed. The
existing catheter was removed over a guidewire and replaced with a similar 10
French 50 cm long locking pigtail catheter. Contrast
was injected for monitoring, confirming good position of the catheter
placement.IMPRESSION: Left retrograde ureteral catheter exchange via the
ileal conduit.

A. 50435
B. 50693
C. 50385
D. 50688, 75984-26

Question 29
A laparoscopic assisted total hysterectomy is planned for a patient who has severe
intramural fibroids. After inserting the laparoscope, extensive adhesions are noted to the
extent that theligaments supporting the uterus cannot be visualized. The physician
decides to convert the procedure to an open abdominal hysterectomy in which the
uterus and cervix are removed. What CPT® code(s) should be reported?

A. 58262, 58570-53
B.
C. 58260, 58550-22
D. 58570

Question 30
Patient has consented for further testing to
determine the extent of her cervical
dysplasia. Acervical cone biopsy of
endocervical tissue was cut using a laser. It was tagged with a single stitch. Dilation
and curettage was performed. Small amount of tissue was obtained and sent to
pathology. Which procedure code(s) should be used? A. 57520, 58120
B. 57461
C. 57520
D. 57500, 57505

Question 31
58-year-old female has lumbar degenerative spondylolisthesis with severe stenosis and
instability. The spinous process of L4 and L5 are decompressed bilaterally by
performing alaminectomies, right-sided foraminotomies and then left-sided facetectomy
completely decompressing the nerve roots as well as the dura. How is this procedure
reported?

A. 63047, 63048
B. 63030-50, 63035-50
C. 63017
D. 63047-50, 63048-50

Question 32
Physician is performing an intracapsular cataract extraction. The anterior chamber of
the eye is entered performing an anterior capsulotomy using forceps. The lens
nucleus was hydro dissected and loosened. Using phacoemulsification unit, the lens
nucleus was divided and emulsified. Cortical and capsular fragments were removed.
The anterior chamber and capsulebag inflated. Using lens inserter an intraocular
lens prosthesis, Cystalens, was inserted and rotated to the horizontal position.
Topical solution applied, conjunctiva repositioned over thewound with wet field
cautery and patch applied. Which CPT® code(s) should be reported?

A. 66984, 66985
B. 66983, 66985
C. 66985
D. 66983

Question 33
5-year-old male has diminished hearing in the left ear due to chronic otitis media. He
has hadhearing aid prosthetic devices in the ear which have resulted in additional
infections. Parentshave decided on an osseointegrated implant to restore hearing.
The mastoid cortex is exposed. Spiral drilling is performed to create a pilot hole. The
stem of the titanium pedestal is placed in the tunnel adjacent to the cochlea and
abutment subsequently secured to the fixture.
Which CPT® code should be used?

A. 69717-LT
B. 69718-LT
C. 69714-LT
D. 69716-LT
Question 34
The physician performs a right thyroid lobectomy. The patient was prepped and
draped. Afteradequate general anesthesia, the neck was incised on the right side
and sharp dissection wasthen used to cut down onto the strap muscles and
sternodcleidomastoid muscles. The strap muscles were separated and transected on
the right side. A small thyroid lobe was visualizedand dissected free. There was no
evidence of a tumor. The wound was closed with 3 -0 interrupted Vicryl for the
platysma, 4-0 Vicryl for the deep tissues and 6-0 fast absorbing gut for the skin.
Code the encounter.

A. 60252-RT
B. 60210-RT
C. 60220-RT
D. 60260-RT
Question 35
An ophthalmologist removes a 6.5-mm section of the lateral rectus muscle of the
patient's lefteye and resects the muscle to strengthen it and correct strabismus. He
then repeats the procedure on the right eye again removing 6.5 mm of the lateral
rectus muscle and then resecting it.

A. 67311-50
B. 67312
C. 67314-50
D. 67316

Question 36
A 42-year-old patient was in the hospital three days ago in which a lumbar puncture
was preformed to find the etiology of the patient’s headaches. Today, he is in the
neurology clinic because after having the lumbar puncture the headaches have
increased in intensity over thepast three days. The neurologist examines the patient
and finds a CSF leak from the lumbar puncture. A blood patch is performed by
epidural injection to repair the leak. Code the
service(s) for today’s visit.

A. 62272
B. 62273
C. 62270, 62273
D. 62270, 62282

Question 37:

The patient is a 35-year-old male who presents to

the emergency department (ED) after several hours of low back pain, nausea, and
chills. The ED physician takes a detailed history and performs a comprehensive
examination. A urinalysis lab and CT of the abdomen is ordered. The results of the
CT show two small kidney stones. The ED physician discusses the results with the
patient and tells him the stones are small and will pass on their own. Medicaldecision
making (MDM) of moderate complexity is made with the patient being discharged,
with a prescription of pain medication, and with a diagnosis of kidney stones. Select
the E/M code and diagnosis code(s).

A. 99285, N20.0, M54.5, R11.2, R68.83

B. 99284, M54.5, R11.2, R68.83, N20.0
C. 99283, N20.0
D. 99284, N20.0

Question 38:
A 55-year-old established patient is coming in for a pre-op visit; he is getting a liver
transplantdue to cirrhosis. The physician performs an expanded problem-focused
history, detailed examination, and moderate MDM. Patient agrees with his
physician’s recommendations andthe transplantation will take place as scheduled.
After the evaluation, the patient expresses a number of concerns and questions for
the prospective liver transplant. Physician spends a total of 60 mins for the E/M
service, in answering questions and addressing his concerns regarding the surgery
and discussing possible outcomes. What CPT® codes should be reported?

A. 99213, 99403
B. 99214, 99354
C. 99213, 99417
D. 99215, 99417

Question 39:

A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to
another physician. The physician documents a detailed history. He has had it for the
past five months.Sleep is disrupted by frequent awakenings and getting worse due to
anxiety and snoring.
Current medication that he is on now is not helping
him. Physician also performs a comprehensive
exam and moderate MDM. What CPT® code
should be reported?

A. 99203
B. 99204
C. 99243
D. 99214

Question 40:

A 62-year-old female returns to a family practice having shortness of breath, nausea

and diaphoresis. It has been two years since her last visit to the practice. An
comprehensive history is documented. A comprehensive general multisystem
examination of eight organ systems is performed. An EKG, chest X - ray and labs are
ordered. The physician also orders tohave her records sent from her cardiologist. The
medical decision making is high. The patientis diagnosed with exacerbation of
congestive heart failure. What is the correct evaluation andmanagement service for
this encounter?

A. 99205
B. 99215
C. 99204
D. 99214
Question 41:

An established, 48-year-old female patient presents with spontaneous dizziness. The

physicianperforms comprehensive History, Exam and MDM of high complexity. The
physician diagnoses the patient with vertigo of unclear etiology. The physician
prescribes and administers medicine to the patient. The clinical staff is required to
monitor and observe the patient for 30mts. How do you code?

A. 99215, + 99415
B. 99214
C. 99215, +99415, +99416
D. 99215

Question 42:

This morning a 48-year-old is placed in observation status from the emergency room
with severe diarrhea and extreme thirst. The physician performs a comprehensive
history, comprehensive examination and determines the patient is suffering from
dehydration. The physician places the patient on IV saline 500 ml and conducts
normal saline hydration for a couple hours. The medical making decision making is of
moderate complexity. Patient is discharged home in the late evening on the same
day and is told to return if symptoms occuragain.
The E/M service(s) for this encounter is:

A. 99285
B. 99222, 99238
C. 99235
D. 99222

Question 43:

The anesthesiologist performed MAC (monitored

anesthesia care) for a patient undergoing anarthroscopy of the right knee.
Code the anesthesia service. A. 01382-AA
B. 01382-AA-QS
C. 01400-AA
D. 01400-AA-QS
Question 44:

General anesthesia is administered to a 9-month-old undergoing a tracheostomy.

Code theanesthesia service.
A. 00320, 99100
B. 00320
C. 00326
D. 00326, 99100

Question 45:

A patient is given general anesthesia by the anesthesiologist for a carpal tunnel nerve
release.After the surgery the anesthesiologist is called to perform an axillary block for
postoperative pain management on the same patient. What are the appropriate
codes?

A. 01829, 64417-59
B. 01840, 64417-59
C. 01810, 64417-59
D. 01830, 64417-59

Question 46:

A healthy 45-year-old is having a needle thyroid

biopsy. The anesthesiologist begins to preparethe
patient for surgery at 09:00 am. The surgery begins
at 09:15 am and ends at 09:45 am.
The anesthesiologist turns over the patient’s care to
the recovery room nurse at 10:00 am.Which is the
appropriate anesthesia code and what is the
anesthesia time? A.00320, One hour
B.00320, 45 minutes
C.00322, 45 minutes
D.00322, One hour

Question 47:
22-year-old driver loss control of her car and crashed into a light pole on the highway.
She arrived to the hospital. She had CT scans without contrast of the brain and chest.
She had X- rays of AP and PA views of her left ribs and AP and PA views of her right
ribs with a posteroanterior view of the chest. The CT scan of the brain showed a
fracture of the skull basewith no hemorrhage of the brain. The CT of the lung showed
no puncture of the lungs. The X- ray showed fractures in the right and left second,
third, and fifth ribs. What CPT® and ICD-10- CM codes should be reported.

A. 70450-26, 71250-26, 71101-26, S02.10XA, S22.43XA, V47.32XA, Y92.411 B.

70460-26, 71260-26, 71110-26, S02.01XA, S22.49XB V47.0XXA, Y92.411 C.
70450-26, 71250-26, 71111-26, 71045-26, S01.10XA, S22.49XA, V47.32XA,
Y92.411
D. 70450-26, 71250-26, 71111-26, S02.10XA, S22.43XA, V47.52XA, Y92.411

Question 48:

A mammography was performed for a patient with a suspicious breast lump. Only
one breastwas studied (two views). The service was provided in a freestanding
women's imaging center owned by a large radiology practice. The study confirmed a
neoplasm. A copy of the radiologyreport was sent back to the patient's primary care
physician. How would the radiology practice's services be reported?

a. 77065 b. 77065-26 c. 77065-TC d. 77066

Question 49:

This patient undergoes a gallbladder sonogram due to epigastric pain. The report
indicates that the visualized portions of the liver are normal. No free fluid noted
within Morison's pouch. The gallbladder is identified and is empty. No evidence of
wall thickening, or surrounding fluid is seen. There is no ductal dilatation. The
common hepatic duct and common bile duct measure 0.4 and 0.8 cm, respectively.
The common bile duct measurementis at the upper limits of normal.

A. 76700-26
B. 76705-26
C. 76775-26
D. 76705

Question 50:
A patient with colon cancer receives five sessions of
radiation treatments. During the course of treatments,
the physician views the port films, reviews the
treatment parameters, and assesses the patient’s
response to the treatment. The patient receives seven
more treatmentsessions when ending the course of
treatment. Code the radiation treatment management.

A. 77427
B. 77431 x 7
C. 77427 x 2
D. 77427, 77431

Question 51:

A primary care physician took a two -view chest x-ray (frontal and lateral views) in
his office. The films were sent to a radiologist (who was not affiliated with the
primary care physician) tobe interpreted. The radiologist billed separately for her
services. How should the radiology- related services provided by the primary care
physician's office be reported?

a. 71045 b. 71046 c. 71046-TC d. 71046-26

Question 52:

A physician interpreted a complete x-ray (four views) of the mandible taken in her office
(thephysician owns the equipment). How should these services be reported?

a. 70110
b. 70110-26
c. 70010
d. 70015

Question 53:
Patrick was sent to a local laboratory for pre-employment drug screening. He
provided a urinesample to the laboratory technologist. The technologist completed a
screening, including oneprocedure for multiple drug classes using TLC methods. The
test was positive for Morphine, aconfirmatory test is ordered, and results were sent
back to the requesting employer. How should
you report this laboratory service?

a. 80306, 80358
b. 80305, 80361
c. 80307, 80361
d. 80305, 80358

Question 54:

22-year-old has had no prenatal care. Fundal

height indicates a term fetus and by dates it is determined she is 38 weeks pregnant.
Few hours prior to admission to Labor and Delivery her membranes ruptured
spontaneously. She does not have fever, but the physician performs a rapid antigen
test for group B strep. An enzyme immunoassay method is performed.
Physicianobtains a lower vaginal swab, then observes that it visually shows the
patient is negative for the antigen. If clinical risk factors appear, intrapartum antibiotics
will be initiated. Which lab test is reported?

A. 87802
B. 87653
C. 86317
D. 87450

Question 55:
Jane presents to the ED with burning micturition & frequency. Dr. Sherlyn performs
an automated dipstick test, which shows elevated Leukocytes. She orders a urine
culture withidentification for each isolate to determine which antibiotic to give to Jane
for his infection.
What are the appropriate lab

codes?A. 81002, 81007

B. 81003, 87088
C. 81001, 87086
D. 81003, 87086

Question 56:

Dr. Robert performs an Acid fast staining procedure for identification of the
organisms presentin the sputum sample of a patient suspected with Tuberculosis.
He sends the report to the Dr.Samuel with his interpretation. How do you describe
the laboratory service?

a. 88313
b. 88312
c. 88312-52
d. 88312, 88313

Question 57:

A surgical specimen was removed from the Ovary &

Fallopian tube during a resection foradenocarcinoma
and was submitted to surgical pathology for gross and
microscopic examination. The correct code for this
service is:

A. 88307
B. 88309
C. 88304
D. 88305

Question 58:

Today, an extended culture of five-day embryos was completed. The transfer tests
will becompleted when the culture test results are confirmed. The culture testing
results are scheduled for return within 48 hours. How should the culture service be
reported?

a. 89272
b. 89250
c. 89258
d. 89255, 89272
Question 59:

The Smith family is present for family psychotherapy treatment concerning their
child's involvement in a drug rehabilitation program with two other families. Code
for the Smithfamily's service:
A) 90791
B) 90849
C) 90849-22
D) 90849 X 3

Question 60:
Left heart catheterization retrograde from the femoral artery with injection
procedures for selective coronary angiography and selective left ventriculography,
including imaging supervision and interpretation with report, are performed. The
cardiologist performed all ofthe services at the
hospital. The CPT® codes are: A. 93458-26
B. 93459-26
C. 93452-26
D. 93460-26

Question 61:

69-year-old female has been having chest

tightness. Cardiologist orders percutaneous
transluminal coronary angioplasty (PCTA) of the
right coronary artery and left anterior descending coronary artery. The procedure
revealed atherosclerosis in the native vessel of theleft anterior descending coronary
artery and right coronary artery. Stents were inserted in both arteries to keep the
arteries opened. Patient was placed under moderate conscious sedation during the
procedure for a total of 30 minutes. What CPT® codes should be reportedfor this
procedure?

A. 92928-LT, 92929-RT
B. 92928-LD, 92929-RC, 99152
C. 92928-LD, 92928-RC, 99152,99153
D. 92928-LD, 92928-RC, 99152

Question 62:

Doctor Smith performs a problem focused exam on an established patient with

MDM of SFcomplexity, a spinal adjustment to the cervical and thoracic regions,
and 10 mts of manual therapy to the right shoulder. The patient also receives
electrical stimulation therapy undersupervision:
A.99212-25, 98940, 97140, 97032
B.99202-25, 98940, 97140, 97014
C.99212-25, 98940, 97140, 97014
D.99212-25, 98940, 97140-52, 97014

Question 63
A 16-year-old patient receives a Tdap and Pro Quad. The provider counsels
the patient andher mother before the vaccinations are given. How are the
administration fees coded?

A. 90471 X 1, 90472 x 1
B. 90460 X1, 90461 X 1, 90710, 90715
C. 90471 X2, 90472 X 5
D. 90460 X 2, 90461 X 5, 90710, 90715

Question 64

Preoperative Diagnosis: Spinal cord stimulator battery

replacement Postoperative Diagnosis: Spinal cord

stimulator battery replacement Operation Performed:

Removal of spinal cord stimulator batteries and

replacement with newBatteries. No complications No

specimens

Indications for Surgery: Patient is a 67-year-old man who had spinal cord stimulator
implantedapproximately five years ago. He comes back because of lack of functioning
in this system.
Decision was made to proceed with removal of the old batteries and replacement
with newones. The patient understands the risks and benefits of the procedure.

Description of Surgery: The patient was placed in supine position and the area where
the batteries were located on the left side was prepped and draped in the sterile
fashion. The patient was infiltrated with lidocaine 1%. It was reopened with a #15
blade, and then the batteries were removed from the pocket and disconnected from
the lead wires. A new batterysystem was reconnected. Wound was closed with #3-0
Vicryl and staples for skin.

A. 61885, T85.193
B. 63664, T85.193
C. 63685, T85.193
D. 63655, T85.192
Question 65

EXAMINATION OF: Right hip.

DIAGNOSIS: Osteoarthritis
right hip.
ONE-VIEW RIGHT HIP: A single frontal view is obtained of the right hip. No
previous studies are available for comparison. Right hip arthroplasty is seen.
Alignment appears grossly unremarkable on this single view. There are skin staples
present. Air is seen in the soft tissues,likely due to recent surgery. There appear to
be two drains present. The tip of one overlies thesoft tissues superolateral to the
greater trochanter. The second one is more inferior. The tip overlies the right
proximal femoral prosthesis.

IMPRESSION: Single view of the right hip with findings consistent with recent right
total hiparthroplasty.

A. 72100
B. 73501-RT
C. 72100-26
D. 73501-26-RT

Question 66

PROCEDURE: Bilateral lumbar medial branch block

under ultrasound guidance for the L3, L4,L5 medial
branches injecting the L4-L5, L5-S1 facets for
diagnostic and therapeutic purposes.

PROCEDURE: The patient was placed in the prone

position and automated blood pressure cuffand pulse
oximeter applied. The skin entry points for
approaching the anatomic target points of the bilateral
segmental medial branches or dorsal ramus of L3, L4,
L5 were identified with a
22.5 degree from an ultrasound view and marked. Following thorough Chloraprep
preparationof the skin and draping and 1% lidocaine infiltration of the skin entry
points and subcutaneoustissues, a 22 gauge 6" spinal needle was placed under
ultrasound guidance for the L4 -L5 and L5-S1 facet joints. At each joint 1 mL
consisting of 0.5% bupivacaine and Depo-Medrol was injected. A total of 80 mg of
Depo-Medrol was given in both sides. Which CPT® codes should be used?

A. 0216T-50, 0217T-50, 0218T-50, 76942-26

B. 64493-50, 64494-50, 64495-50
C. 64493-50, 64494-50, 76942-26
D. 0216T-50, 0217T X 2
Question 67

OPERATION: Dual chamber transvenous implantable pacing cardioverter-defibrillator

systemimplantation with leads.

INDICATIONS: A 67-year-old, white gentleman has significant underlying ischemic

cardiomyopathy with EF of 25 percent, prior infarcts, remote history of syncope, and
at a highrisk for malignant ventricular arrhythmias. He has had a recent T wave
alternans test which was clearly abnormal. He has had episodes of resting
bradycardia, also noted. He meets MaditII criteria for insertion of a transvenous
implantable pacing cardioverter-defibrillator (ICD).

PROCEDURE: After informed consent had been obtained, the patient was brought to
the outpatient hospital lab in the fasting state. The left anterior chest was prepped
and draped ina sterile fashion. Intravenous sedation and local anesthetic were given.
After local anesthetic,a 5 cm incision was made at the left deltopectoral groove. With
blunt dissection and cautery,this was carried down through the prepectoralis fascia.
The cephalic vein was identified and ligated distally. Through the venotomy, a
subclavian venogram was performed to provide a roadmap. The atrial and ventricular
leads were then advanced into the vessel to the level of the right atrium under
fluoroscopic guidance. The ventricular lead was maneuvered to the right ventricular
outflow tract, and then through the RV apex where it was actively fixed.
Good sensing and pacing thresholds were demonstrated. The lead was anchored to
the pre- pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not
result in diaphragmatic capture. The atrial lead was maneuvered to the anterolateral
right atrial wall where it was actively fixed. Good sensing and pacing thresholds were
demonstrated. The leadwas anchored to the pre-pectoralis fascia with interrupted 2-0
Tycron sutures. 10 volt pacing did not result in diaphragmatic capture. A
subcutaneous pocket was created with good hemostasis achieved. The pocket was
subsequently irrigated with solution of Bacitracin. The generator was connected to
the lead, and then placed in the pocket with no tension on the lead. The deep fascial
layer was closed with interrupted 2-0 Vicryl suture. The subcutaneous closure was
made with running 3-0 Vicryl suture. Subcuticular closure was made with running4-0
Vicryl suture. Steri-strips were applied. Ventricular fibrillation was induced with a T
wave shock. This was successfully sensed and terminated with a 15 joule shock to
sinus rhythm.
High voltage impedance was 39 ohms. Dry dressing was placed over the wound. The
patientreturned to the floor in stable condition without apparent complications. Which
of the following codes accurately describes the basic procedure summarized in this
report?

A. 33208
B. 33249, 76000-26
C. 33241, 33243, 33249
D. 33249
Question 68
Name of Procedure: Endoscopic retrograde cholangiopancreatogram
(ERCP) with stentplacement and antral biopsy.

Indications: 50-year-old male who underwent liver transplantation for end-stage liver
diseasesecondary to chronic hepatitis C and hepatocellular carcinoma in 01/2007. The
patient has cholestatic liver enzymes, requiring ERCP before placement of a 7-French
12 cm stent and toevaluate the biliary system.

Description of Procedure: The patient was taken to the fluoroscopy suite in the GI lab
where he was found to be alert and oriented x 3. After discussing risks and benefits of
the procedure,informed consent was obtained. Patient was kept in the semi prone
position. After adequate conscious sedation, an Olympus side-viewing therapeutic
scope was inserted through the mouth all the way to the second portion of the
duodenum. Then, the common bile duct was cannulated, and the cholangiogram was
obtained. After the fluoroscopy evaluation of the cholangiogram a 12 cm stent was
deployed for biliary drainage. A biopsy from the antrum was obtained. The patient
tolerated the procedure well. There were no immediate complications.

Which CPT® codes should be

reported?A.43276, 43261-51
B. 43274, 43261-51
C. 43266, 43239-51
D. 43212, 43202-51

Question 69
OPERATIVE Procedure: Excision of back lesion.
INDICATIONS FOR SURGERY: The patient has an enlarging lesion on the upper
midback. FINDINGS AT SURGERY: There was a 5-cm, upper midback lesion.
OPERATIVE Procedure: Withthe patient prone, the back was prepped and draped in
the usual sterile fashion. The skin andunderlying tissues were anesthetized with 30
mL of 1% lidocaine with epinephrine.

Through a 5-cm transverse skin incision, the lesion was excised. Hemostasis was
ensured. Theincision was closed using 3-0 Vicryl for the deep layers and running 3-0
Prolene subcuticular stitch with Steri-Strips for the skin.
The patient was returned to the same day surgery center in stable postoperative
condition. Allsponge, needle, and instrument counts were correct. Estimated blood
loss is 0 mL. PATHOLOGY REPORT LATER
INDICATED: Dermatofibroma, skin of back.
Assign code(s) for the physician service only.

A. 11406, 12002, D23.5

B. 11424, D21.6
C. 11406, 12032, D23.5
D. 11606, D04.5
Question 70
Operation: Replacement of shunt valves with
medium pressure ventriculo-peritoneal shunt
assembly with in-line 0-25 Aesculap Shunt Assistant Implant ICP Monitor.

Procedure: After obtaining general anesthesia, patient prepped and draped. Right
parietal scalp incision was reopened and shunt catheter identified. The shunt
reservoir was deliveredfrom the wound and the distal catheter freed from it.
Abdominal incision reopened, shunt passer was used to bring the distal catheter
from the head wound to the abdominal wound. The old ventricular catheter was
removed. A new ventricular-catheter was inserted into the tract of the old catheter
and fed, good flow seen. It was then attached to the shunt reservoirthat was then
seated after attaching a 0-25 shunt assistant valve to it. The distal catheter wasthen
fed into the peritoneal cavity. Subcutaneous tissues were closed in multi-layer
fashion and skin with staples. Patient tolerated the procedure well and taken to PICU
in stable condition. Code this procedure.

A. 62223, 62225-51
B. 62258, 62160
C. 62230, 62225-51
D. 62256, 62225-51

Question 71
EMERGENCY DEPARTMENT REPORT CHIEF COMPLAINT: Nasal
bridge laceration.SUBJECTIVE: The patient is a 74-year-old male who
presents to the emergency department with a laceration to the bridge of
his nose. He fell in the bathroom tonight. He recalls the incident. He just
sort of lost his balance. He denies any vertigo. He denies any chest pain
or shortness of breath. He denies any head pain or neck pain. There was
no loss of consciousness. He slipped on a wet floor
in the bathroom and lost his balance; that is how it happened. He has not had
anyblood from the nose or mouth.

PAST MEDICAL HISTORY:

1. Parkinson's.
2. Back pain.
3. Constipation.

MEDICATIONS: See the patient record

for a complete list of medications.
ALLERGIES: NKDA.
REVIEW OF SYSTEMS: Per HPI.
Otherwise, negative.

PHYSICAL EXAMINATION: The exam showed a 74-year-old male in no acute distress.

Examination of the HEAD showed no obvious trauma other than the bridge of the nose,
where there is approximately a 1.5- to 2-cm laceration. He had no bony
tenderness under this.Pupils were equal, round, and reactive. EARS and
NOSE: OROPHARYNX was unremarkable.
NECK was soft and supple. HEART was regular. LUNGS were clear but
slightly diminished in the

bases.

Procedure :The wound was draped in a sterile fashion and anesthetized with 1%
Xylocainewith sodium bicarbonate. It was cleansed with sterile saline and then
repaired using interrupted 6-0 Ethilon sutures (Dr. Barney Teller, first-year resident,
assisted with the suturing).
ASSESSMENT: Nasal bridge laceration, status post fall.

PLAN: Keep clean. Sutures out in 5 to 7 days. Watch for signs of

infection.A. 12051, S01.20XA

B. 12011, S01.20XA
C. 12011, S01.22XA
D. 12011, 11000, S01.22XA

Question 72
This patient returns today for palliative care to her feet. Her toenails have become
elongated and thickened, and she is unable to trim
them on her own. She states that she hashad no
problems and no acute signs of any infection or
otherwise to her feet. She returns today strictly for
trimming of her toenails.

EXAMINATION: Her pedal pulses are palpable

bilaterally. The nails are mycotic, 1 through 4 onthe
left, and 1 through 3 on the right.

ASSESSMENT: Onychomycosis, 1 through 4 on the

left and 1 through 3 on the right. PLAN: Mild
debridement of mycotic nails × 7. This patient is to return to the clinic in 3 to 4months
for follow-up palliative care.

A. 11721 × 7, B48.8
B. 99212-25, 11721, B35.1
C. 11719, B35.1
D. 11721, B35.1

Question 73
Preoperative Diagnosis: Right colon cancer; probable liver
metastasis Postoperative Diagnosis: Cecal cancer, extensive
bilateral liver metastasis

Procedures Performed: Right colectomy and biopsy of right lobe liver nodule
Indications: Patient is a 67-year-old man who presented with anemia. Colonoscopy
demonstrated bleeding cecal carcinoma. CT scan suggested liver metastasis. He
presents now
for a palliative right colectomy and biopsy of liver nodule.

Description: The patient was brought to the operating room and placed in a supine
position. Satisfactory general endotracheal anesthesia was achieved. He was
prepped and draped exposing the anterior abdomen and a lower midline incision was
created sharply through subcutaneous tissues by electrocautery. Linea Alba was
parted and exploration was performed. The right colon was mobilized by dissection in
the avascular plane. The patient had a three to four centimeter cecal cancer. The
right ureter was identified and preserved. The terminal ileum and distal ascending
colon were divided with GIA-60 stapling devices. Theright colic artery and lymph
node tissue were resected back to the origin of the superior mesenteric artery with
clamps and 3-0 silk ties. The specimen was forwarded to pathology. Astapled
functional end-to-end anastomosis was then performed. The antimesenteric edges
were reapproximated with a single fire of GIA-60 stapler. The defect created by the
stapler was then closed with interrupted 3-0 silk Lembert sutures. The mesocolon
was reapproximated with some interrupted 3 -0 silk sutures. Hemostasis was
confirmed. The rightanterior liver nodule was biopsied with a Tru-Cut needle.
Hemostasis was achieved. The midline fascia was closed with running 1 -0 Prolene
suture. The skin was approximated with staples. The wound was dressed. The
procedure was concluded. The patient tolerated the procedure well and was taken to
recovery in stable condition. Estimated blood loss was less than 100 cc. There were
no complications.

Pathology Report:

#1-Right Hemicolectomy: Adenocarcinoma of

cecum#2-Liver Biopsies: Metastatic
adenocarcinoma

A. 44140, 47001
B. 44140, 47000-51
C. 44150, 47001
D. 44150, 47000-51

Question 74
Preoperative Diagnosis: Right hydronephrosis
Postoperative Diagnosis: Right hydronephrosis
Operation: Cystoscopy and right retrograde
pyelogram
Procedure: Patient prepped and draped in the dorsolithotomy position. Placed under
generalanesthesia a 23 French cystoscope was passed into the bladder. No tumors
were visualized. Urine from the bladder was sent for urine cytology. Then a 6 French
access catheter was passed into the right uretal orifice. Contrast was injected and
there were no filling defects noted. There was no fixed tumor and no stone. There
was mild hydroureteral nephrosis against the bladder. There was a narrowing at the
UVJ no abnormalities. Renal pelvis barbotaged with saline and renal pelvis urine sent
to pathology for urine cytology. After the

retrograde pyelogram was performed the access catheter was removed.

A. 52000-RT, 74420-26
B. 52281-RT, 74425-26
C. 52007-RT, 74400-26
D. 52005-RT, 74420-26

Question 75

Preoperative Diagnosis: Uterine fibroids

Postoperative Diagnosis: Multiple uterine fibroids, uterus
-250 g, 2 cm right ovarian cyst Procedure:
Laparoscopic-assisted vaginal hysterectomy with bilateral
salpingo Oophorectomy

Procedure in Detail: The patient was taken to the

operating room and placed in the supine position. After
adequate general anesthesia had been obtained, the
patient was prepped and draped in the usual fashion for
laparoscopic-assisted vaginal hysterectomy. The bladder
was drained. A small infraumbilical skin incision was made with the scalpel, and 10 mm
laparoscopic sleeve and trocar wereintroduced without difficulty. The trocar was removed.
The laparoscope was placed and 2 L of C02 gaswas insufflated in the patient’s abdomen.

A second incision was made suprapubically and a 12-mm laparoscopic sleeve and
trocar were introduced under direct visualization. A 5-mm laparoscopic sleeve and trocar
were placed in the leftlower quadrant under direct visualization. A manipulator was used
to examine the patient’s pelvic organs.

There was a small cyst on the right ovary. Both ovaries were free from adhesions. The ureters
were freefrom the operative field. After measuring the ovarian distal pedicles, the endo-GIA
staple was placed across each round ligament.

At this time, attention was turned to the vaginal part of the procedure. A weighted speculum
was placed in the vagina. The anterior lip of the cervix was grasped with a Lahey tenaculum.
Posterior colpotomy incision was made and the posterior peritoneum entered in this fashion.
The uterosacral ligaments were bilaterally clamped, cut, and Heaney sutured with #1 chromic.
The cardinal ligaments were bilaterally clamped, cut, and ligated. The anterior vaginal
mucosa was then incised with the scalpel, and with sharp and blunt dissection, the bladder
was freed from the underlying cervix. The bladder pillars were bilaterally clamped, cut, and
ligated. The uterine vessels were then bilaterally clamped, cut, and ligated. Visualization was
difficult because the patient had a very narrow pelvic outlet.
In addition, several small fibroids made placement of clamps somewhat difficult. Using the
clamp, cut, and tie method after the anterior peritoneum had been entered with scissors, the
uterus was then left without vascular supply. The fundus was delivered by flipping the uterus
posteriorly; and
through an avascular small pedicle, Heaney clamps were placed across, and the uterus
was thenremoved en bloc with the tubes and ovaries attached.
At this point, the remaining Heaney pedicles were ligated with a free-hand suture of 0 chromic.
Spongeand instrument counts were correct. Avascular pedicles were inspected and found to be
hemostatic.
The posterior vaginal cuff was then closed using running interlocking suture of #1 chromic.
The anteriorperitoneum was then grasped, and using pursestring suture of 0 chromic, the
peritoneum was closed. The vaginal cuff was then closed reincorporating the previously
tagged uterosacral ligaments into the vaginal cuff through the anterior and posterior vaginal
cuff. Another figure-of-eight suture totally closed the cuff. Hemostasis was excellent. Foley
was then placed in the patient’s bladder and clear urine was noted to be draining. At this point,
the laparoscope was placed back through the 10-mm sleeve and the vaginal cuff inspected. A
small amount of old blood was suctioned away, but all areas were hemostatic. The
laparoscopic instruments were removed after the excess gas had been allowed to escape.
The incisions were closed first with suture of 2-0 Vicryl through the fascia of each incision, and
then the skin edges were reapproximated with interrupted sutures of 3-0 plain. Sponge and
instrument counts were correct. The patient was awakened from general anesthesia and
taken to the recovery room in stable condition.
A. 58550, 58661-50, 51
B. 58552 - 50
C. 58552
D. 58550, 58661-51

Question 75

What is orchitis?
A.Inner ear imbalance
B.Lacrimal infection
C.Inflammation of testis
D.Inflammation of an ilioinguinal hernia

Question 76:
The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A
laparoscopyfound several small cysts in the area of the fallopian tubes. These cysts
are called:
A.Follicle cysts
B.Myomas
C.Paratubal cysts
D.Accessory ovary cysts

Question 77:

Which of the following patients might be documented as having

meconiumstaining?
A.Woman with renal failure
B.Teenage boy with sickle cell anemia
C.Newborn with pneumonia
D.Man with alcoholic cirrhosis of liver

Question 78:
Which of the following anatomical sites have septums?
A.Nose, heart
B.Kidney, lung
C.Sternum,
D.Orbit, ovary

Question 79:
Lordosis is a disorder of which anatomical site?
A.Spine
B.Hand
C.Male genitalia
D.Nasal sinus

Question 80:
35-year-old female returns to her primary care provider for follow up of an upper respiratory
infectiondiagnosed the previous week. Her condition has not improved, and her cough has
increased. She has along history of smoking and currently smokes one pack a day. She uses
a bronchodilator for her chronicbronchitis which is caused by her smoking history. The
physician changes her antibiotics to treat both her chronic and acute bronchitis. Provide the
diagnosis code(s) for this visit.

A. J44.9, Z72.0
B. J20.9, J41.0, Z72.0
C. J20.9, Z72.0
D. J41.0, J20.9, Z72.0

Question 81:
Following the MUGA scan, the physician documents that the patient has developed
congestive heartfailure as an adverse affect of the Trastuzumab she received as a treatment
for her breast cancer. Thetrastuzumab antineoplastic antibiotic therapy is being discontinued
while the heart failure management is attempted pharmaceutically. What ICD 10-CM codes
should be reported?
A. I50.9, T45.1X4A, Z85.3
B. I50.9, T45.1X1A, C50.919
C. I50.9, T45.1X5A, C50.919- Adverse effect, 6th character should be “5”
D. I50.9, T45.1X3A, C50.919
Question 82:
The patient has a history of symptomatic HIV and has been treated for an HIV related illness.
A.Z21
B.
C. Z20.6
D. R75
Question
83:
The mother, at 38-weeks gestation, advances to
severe pre-eclampsia during labor. Fetal heart rate
decelerations during contractions are not
improved with the administration of oxygen, so a low
traverse cesarean section is performed in the
hospital. There is evidence of intrauterine
growth retardation. The male infant weighs 1587 gm and has Apgars of 3 and 5. Select the
ICD-10-CM codes forthe newborn's chart.

A. Z37.0, P00.0, P03.811, P05.9

B. Z38.01, P00.0, P03.810, P05.9
C. Z38.01, P00.0, P03.811, P05.9
D. Z37.0, P00.0, P03.810, P05.9
Question 84:
42-year-old male was previously treated with external fixation of an ankle
trimalleolar fracture. He is now presenting with a nonunion fracture of the
trimalleolar. What is the ICD-10-CM code to report?

A. S82.853D
B. S82.853S
C. S82.853K
D. S82.53XA

Question 85:
Mr. Jones is here today to receive an intercostal nerve block(pain management) to
mitigatethe debilitating pain of his malignancy. His treatment is for the cancer that
has metastasizedto his right lung. Select the appropriate ICD-10-CM codes.
A. G89.3, C78.01, C80.1
B. C34.91, G89.3
C. G89.3, C34.91
D. C78.01, G89.3
Question 86:

55-year-old female presents to the office with ongoing history of diabetes which has
been controlled with insulin. During the exam the physician notes that gangrene has
set in due tothe diabetes on her left great toe. Patient is recommended to see a
general surgeon for treatment of the gangrene on her left great toe. Select the
diagnosis codes to report.
A. E10.610, Z79.4
B. E11.52, Z79.4
C. E10.52, Z79.2
D. E11.610, Z79.

Question 87:
70-year-old had fallen breaking her jaw. She
has had difficulty eating after having her jaw
wired. Her doctor ordered a stationary
parenteral nutrition infusion pump for her
TPN. A seven-day supply of a parenteral
home mix nutrition supply kit was also given.
What HCPCSLevel II codes are reported?
A. B9000, B4220 x 7
B. B9004, B4222
C. B9006, B4222 x 7
D. B9006, B4172

Question 88:

A patient has an insulin pump of 100 units. The pump is filled. Which code reports
the supply?A. J1817 loo
B. J1815 x 20
C. J1817 x 2
D. J1835

Question 89:

When coding for a patient who has had a primary malignancy of the thyroid cartilage
that wascompletely excised a year ago, which of the following statements is TRUE?

A.When the cancer is surgically removed with no further treatment provided and
there is noevidence of any existing primary malignancy, code Z85.80.
B.When further treatment is provided and there is evidence of an existing
metastasis, codefirst Z85.80 and then C32.9.
C.Any mention of extension, invasion, or metastasis to another site is coded as
a D49.1,Z85.80.
D.When the cancer is surgically removed but the patient is receiving
chemotherapytreatment report Z85.80.
Question 90:

In order to use the critical care codes, which of the following statements is TRUE?

A.Critical care services can be provided in an internist’s

B.Critical care services provided for more
than 15 minutes but less than 30 minutes
should bebilled with 99291 and modifier 52.
C.Time spent reviewing laboratory test
results or discussing the critically ill patient’s care
withother medical staff in the unit or at the
nursing station on the floor cannot be
included in the determination of critical care
time.- It can be included in CC time
calculation
D.Critical care services are never reported with endotracheal intubation (31500)-
99291 doesnot include 31500 and we can report it separately. Refer the Pg no 33
E.Physician can provide services to another patient during the same time
providing criticalcare services to a critically ill patient

Question 91:

Which of the following statements regarding advanced beneficiary notices (ABN) is

TRUE?

A.ABN must specify only the CPT® code that Medicare is expected to deny.
B.Generic ABN which states that a Medicare denial of payment is possible, or the
internist isunaware whether Medicare will deny payment or not is acceptable. C.An
ABN must be completed before delivery of items or services are provided. D.An
ABN must be obtained from a patient even in a medical emergency when the
services tobe provided are not covered.

Question 92:

Which of the following services are covered by Medicare Part

B? A.Inpatient chemotherapy
B.Minor surgery performed in a physician’s office
C.Routine dental care
D.Assisted living

facilityQuestion 93:
The term paracentesis found in CPT® code 49082 means:
A.A procedure performed to drain fluid that has accumulated in the abdominal cavity
B.Biopsy of an abdominal mass
C.Removal of tissue samples from the abdominal cavity by an open
approach D.Removal of a cyst located in the abdominal
cavityQuestion 94:

Which of the following statements regarding the ICD-10-CM coding conventions is

TRUE?

A.If the same condition is described as both acute and chronic and separate
subentries existin the Alphabetic Index at the same indentation level, code only the
acute condition.
B.Sequela (Late effect) codes are reported for a current acute phase of the injury or
illness
C.An ICD-10-CM code is still valid even if it has not been coded to the full
number ofcharacters required for that code.- ICD 10 reporting is to the
highest specificity
D.Signs and symptoms that are integral to
the disease process should not be assigned
asadditional codes, unless otherwise
instructed

Question 95:

CKD is a disease of which system?

A. Circulatory
B. Genitourinary
C. Digestive
D. Musculoskelet

alQuestion 96:

A person who has nephritis has inflammation in what location?

A. Gallbladder
B. Nerve
C. Uterus
D. Kidne

yQuestion

96:

What is ascites?
A.Fluid in the abdomen
B.Enlarged liver and spleen
C.Abdominal malignancy
D.Abdominal tenderness

Question 97:
Which of the following is a disorder of the facial nerve?
A. Exotropia
B. Tarsal tunnel syndrome
C. Brachial plexis lesions
D. Bell’s

palsyQuestion

98:

Complete this series: Pulmonary, Aortic, Mitral, and are valves of the heart.

A. Tricuspid
B. Superior Vena Cava
C. Carotid
D. Quest

ion 99:

Which of the following terms is one who has

an overload of sodium? A. Hyperkalemia
B. Hyperpotassemia
C. Hypernatremia
D. Hypercalcemia

Question 100:
Which modifier should be append to a CPT®, for which the provider had a patient sign an ABN
form because there is a possibility the service may be denied because the patient’s diagnosis
might not meetmedical necessity for the covered service?
A.GZ
B.GA
C.Gx
D.G
Y