Anatomy

1. Which one of the following records the electrical activity of muscle tissue in determining the
strength of muscle contractions as the muscle is stimulate

A.Sonomyography

B.Dectromyography

C.Pyelography

D.Myelogram

2. A thoracoscopy is performed.

What is this type of procedure?

A.An instrument that measures changes in gas volume and pressure during respiration

B .Examination of the pleural cavity through an endoscope

C..Biopsy of the kung through an endoscope

D.Examination of the colon and stomach through an endoscope

3. In medical terminology, suffixes indicate the procedure, condition, disorder, of disease Which
term contains a suffix?

A.hypotension

B.ambidextrous

C.neuralgia

D.malarse

4. Provider documents the patient has pruritus. This means:

A.Pus that is draining

B.Scar formaton

C.Profuse sweating

D.Localized or generalized itching

1. The spleen is in what organ system?

A.Lymphatic

B.Digestive

C.Nervous

D.Endocrine

2.A colposcopy is a surgical technique for repairing what organ system?

A.Female genital

B.Pulmonary

C.Musculoskeletal

D.Cardiovascular

Compliance questions

1. Which CPT modifier can be used to bypass an NCCI edit in certain circumstances when
appropriate?

A 51

B 59

C 22

D 76

2. What does HIPAA stand for?

A .Health Insurance Prospective and Accountability Act

B .Health Insurance Portability and Accountability Act

C.Health Insured Payment and Accountable Act

D.Health Insured Patient and Accountable Act

3. Which is a TRUE statement for Place of Service (POS) codes for professional claims?

A .Place of service codes are three-digit alpha numeric codes.

B.Place of service codes are found in the Tabular List of the ICD-10-CM code book.

C.Reporting an incorrect POS in where a physician's service was provided may result in a denial
of a claim

D.Place of service codes only denote if a patient is admitted to the intensive care unit in a
hospital

GUIDELINES

1. According to CPT coding guidelines for obstetrical ultrasounds, which code

represents a "quick look" exam?

A.76815

B.76816

C.76801

D.76805

2 The CPTS code book provides full descriptions of medical procedures, with some
descriptions requiring the use of a semicolon to distinguish among closely related
procedures.

What is the full description of CPTS code 358607

A.Exploration for postoperative hemorrhage, thrombosis or infection, neck, chest,

abdomen, and/or extremity

B.Exploration for postoperative hemorrhage, thrombosis or infection, neck and/or

extremity

C.Exploration for postoperative hemormape, thrombosis or infection, extremity

D.Exploration for postoperative hemorrhage, thrombosis or infection, excluding

extremity
3.Which punctuation is used in the ICD-10-CM Tabular List to denote synonyms,
alternative wording, or explanatory phrases?

A.Semicolon

B.Parentheses

C.Brackets

D.Colons

4. A surgeon performs a percutaneous balloon angioplasty and atherectomy in the

femoral/popliteal artery

According to the endovascular revascularization CPT guidelines, what is reported?

A.37225

B.37224

C 37224,377225

D.37227

5. According to the ICD-10-CM Guidelines, what code is reported as an additional code

when the blood pressure of a patient with hypertension remains above goal in spite of
the use of antihypertensive medications?

A.A code from category I16, Hypertensive crisis

B.I1A0, Resistant hypertension.

C. I10. Essential (primary) hypertension

D.A code from category 127, Other pulmonary heart diseases.

6. Which statement is FALSE in reporting a personal history ICD-10-CM code?

A.A personal history code can be reported as a first listed code when the reason for
encounter is for a screening

B.A personal history code D can be reported with follow-up codes.

C.A personal history code is reported when the patient's condition is no longer present
or being treated regardless of the reason of the visit

D.A personal history code is acceptable on any medical record

7. Which modifier should be reported for an unusual or complicated excision of a benign

lesion?

A.Modifier 78

B.Modifier 22

C.Modifer 59

D.Modifier 62

ICD..
1. A 58-year-old with type 1 Diabetes Mellitus comes in for comprehensive eye
examination. She is diagnosed with nonproliferative diabetic retinopathy with macular
edema in the right eye.

How would this patient's condition and treatment be coded?

A.E10.311

B.E10.3519

C.E10 3211

D.E10.3511

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

According to ICD-10-CM guidelines, how is this reported?

A.1200, R06.02

B.121.3. R06.02

C.R0602
D.120.0
3. A 58-year-old male suffered an acute STEMI of the inferolateral wall
while running a marathon on June 15 and had received treatment. Three
weeks later, the patient presents to the ED complaining of SOB and left arm
pain. An EKG is performed as well as blood tests. Patient is admitted for
further evaluation.

What diagnosis code is reported for this encounter?

A.I22.2

B.I21.29

C.I21.19

D.I21.3

4.A 52-year-old male patient with known AIDS saw his orthopedic physician
today for severe pain in the right knee. The physician documents that his
knee pain is due to a flare up of posttraumatic osteoarthritis and he gives
him a cortisone injection in the right knee joint. The osteoarthritis is not
related to AIDS.

What ICD-10-CM codes are reported for this encounter?

A.Z21. MC8.861

B.M17.11 B20

C.M17.31, B20

D.B20, M.17.31

5. A patient with third-degree burns to the chest wall, with systemic

inflammatory response syndrome (SIRS), develops acute kidney failure.

What diagnosis codes are reported?

R65.20, N17.9

A41.9.T21.31ΧΑ, Ν17.9

T21.31XA R65.11, N17.9

A41.9 R65.10, T21.31XA, N17.9

Integumentary system
1. A physician performed as debridement of partial thickness (second
degree) burns on the right forearm totaling at of the total body surface area

What CPT and ICD-10-CM codes are reported?

A.01952 ,T22.611A T31.0

B.16025 ,T22.211A. T31.0

C.16030 T22.611A T31.0

D.16030 T22.211A T31.0

2.A female patient is having a mastectomy for malignant lesion in the

upper-outer quadrant of the right breast. A surgeon performed a right
radical mastectomy with removal of the pectoral muscles and axillary
lymph nodes.

What CPT and ICD-10-CM codes are reported?

A.19305 RT C50.411

B.19305-RT, C44.501

C.19306-RT C44.501

D.19306 RT, C50.411

3.A patient presents with keratosis lesions on her left cheek, above the left
eyebrow, and on the chin area. The dermatologist treats those areas by
lightly sanding the surface of a total of 5 lesions.
What CPT coding is reported?

A.15786, 15787x4

B.15786x5

C.15786 15787

D.15787x5

4 .A patient presents to the ER from a nursing home after the patient was
found to have foul smelling, large sacral pressure ulcer during daily nursing
rounds. The ER provider swabbed the wound for culture (which measured
at 7cm in largest diameter), then cleaned the site before painting with
povidone around the entire sacrum to reduce cutaneous bacterial load. The
provider made an elliptical excision with 3mm margins around the outer
edge of the ulcer and removed the lesion in its entirety. Further examination
revealed deep tissue damage, prompting muscle and segmental bone
removal. The wound was then closed using a layered skin flap closure

What CPT coding and ICD-10-CM coding is reported?

A.15935 L89.156

B.15931 L89.153

C. 15933 L89.153

D.15937 L89.156

5. A patient presents to the ER after sustaining injuries in a bicycle accident.

The orthopedic surgeon performs an ORIF and debridement of
subcutaneous tissue of an open, displaced, left bimalleolar fracture of the
ankle.

What CPT codes are reported?

A.27814-LT, 11010-LT
B.27810 LT, 11011-LT

C.27810-LT, 11012-LT

D.27814 LT. 11042-LT

6. A surgeon performed Mohs micrographic surgery on a lesion

on the right foot. This required two stages. Stage one had six
tissue blocks and stage two had three tissue blocks.

What CPT codes are reported for the Mohs surgery?

A.17313, 17315

B.17313,17314,17315

C.17311, 17312, 17315

D .17311,17315

Musculoskeletal system
1. A patient had surgery a year ago to repair one flexor tendon in
his wrist. He is in surgery for a secondary repair for the Tendon
without a free graft.

What CPT coding is reported?

A.25263

B.25272x2

C.25263×2
D.25270

2. A patient with an abnormal curvature of the spine will have T3-

T7 vertebral segments fused via anterior approach to secure
different vertebrae to one another.

What CPT code is reported?

A.22810

B.22808

C.22800

D.22802

3. An elderly patient presents to the surgical suite from the ER

after a fall from standing height. This resulted in a displaced
fracture to the greater trochanter of the right femur. During the
exam, the patient was found to have age related osteoporosis,
which is documented as the cause of the fracture. Final diagnosis
is pathological femur fracture due to osteoporosis. A procedure is
performed to treat the trochantenc femur fracture via open
treatment repair by inserting an internal fixation

What CPT and ICD-10-CM codes are reported for the surgery?

A.27246-RT, S72.111A, WO1.0XXA

B.27246-RT, M80.051A WO1.OXXA

C.27248-RT, S72. 111A, W19.XXXA

D.27248 RT, M80.051A W19 XXXA

4. Margo presents to her primary care physician for management

of her degenerative osteoarthritis in her right wrist. The physician
performs an injection of 1 mg Synvisc in the right wrist joint.

What CPT and ICD-10-CM codes are reported?

A.20606, M19. 231

B.20605 M19. 031

C.20551, M19.231

D.20526, M19 .031

5. A patient is diagnosed with compression fractures of the L4, L5

and S1 vertebrae. The patient agrees to have vertebroplasty. Bone
cement is injected in the vertebral space until each of the two
whole vertebral body is filled. The procedure is performed
bilaterally What CPT coding is reported?

A.22511-50 .22512-50x2

B.22514. 22515

C.22514-50 ,22515-50

D.22511. 22512×2
6. What CPT code is used for incision and drainage (I&D) of
superficial hematoma of the elbow?

A.23931

B.10160

C.23930

D.10140

Respiratory And Cardio

1. A 37-year-old has adenoma of the liver. The tumor is invading
the diaphragm. Electrocautery is used to resect part of the
diaphragm and closed it using a local muscle flap.

What CPT code is reported?

A.39560

B.39540

C.39545

D.39561
2.The cardiothoracic surgeon takes a patient to the operating
room to perform and open balloon angioplasty of the femoral
popliteal artery with atherectomy.

What CPT coding is reported?

A.37224. 37227

B.37224 37225

C. 37225

D.37227

3. A 63-year-old patient requires extracorporeal membrane

oxygenation (ECMO) for acute respiratory syndrome. The cannula
insertion is through and open approach via surgical incision in the
chest.

What CPT codes are reported?

A.33954

B.33956

C.33956, 32100

D.33954,32100
4. A 65-year-old with lymphoma is having an insertion of a central
venous catheter via the right subclavian vein. The catheter is
inserted just below the right clavicle. Under fluoroscopic
visualization the catheter tip was placed in the superior vena cava
above the right atrium. Dissection of the deltopectoral area was
performed with cautery down to the pectoralis fascia and blunt
digital dissection to create a pocket at the fascial level. The
central venous catheter was then tunneled from the insertion site
to the pocket and attached to a port, which was placed in the
pocket. The incision site was then closed.

What central venous access procedure code is reported?

A.36558

B.36556

C.36561

D.36569

5.An Air bag deployed when a driver lost control of the car and
crashed into a guardrail on the side of the highway. The driver
suffers partial impact resulting in a skull fracture of the anterior
cranial base. The fracture is diagnosed using the MRI scanner and
cerebrospinal fluid is noted dripping via the sphenoid sinus into
the right nasal passage. The patient requires a surgical nasal
sinus endoscopy to assess and repair the injury.

What is the correct procedure and diagnosis coding combination

to report this service?

A.31291,S02 19XA, V47.SXXA, Y92.411

B. 31287.S02. 19XA, V47.5XXA, 192.411

C. 31235,S02.91XA, V47,5XXA, Y92.411

D .31291 31231-59, S02 109A, V47.5XXA, 192.411

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

What CPT coding is reported?

A.32671

B.32663, 32601-51

C.32663

D.32666

Digestive system
1. A patient undergoes esophagus dilation in which the provider
expands the narrowed area with an unguided bougie with five
passes.

What is the correct CPT code?

A .43453×5
B.43450×5

C.43453

D.43450

2.A 30-year-old female patient had gastric lap-band surgery six

months ago. Her last band fill was unsuccessful due to a
malfunctioning subcutaneous port. The port component will be
removed and replaced today via open procedure

What CPT code is reported?

A .43774

B.43772

C .43837

D .43888

3. A 32-year-old is in the outpatient clinic for an esophagoscopy

due to increased difficulty swallowing with his eosinophilic
esophagitis The flexible scope is inserted in the mouth and into
the esophagus. Examination of the esophagus noted narrowing in
the distal esophagus. Following an injection of Kenalog, a
transendoscopic balloon dilation was performed in the area of
stenosis. Inflation was repeated eventually reaching 18 mm in
diameter. What CPT coding is reported for this procedure?

A.43214, 43201

B.43220, 43201
C.43220 43204

D.43220 43200-59

4. A 63-year-old male presents to the operating room for open

surgery on a recurrent incarcerated, incisional hernia repair with
insertion of a prosthetic mesh. The size of the hernia is 12 cm.

What CPT and ICD-10-CM codes are reported?

A.49596 15778 K43.0

B.49518, K43.0

C.49596, K43.2

D.49518, 15778, K43.2

5. A colonoscopy is performed on a patient The physician

removes 3 polyps by snare technique in the ascending colon after
injecting the base of each with epinephrine. In the transverse
colon a miniscule polyp is ablated with the tip of the hot biopsy
forceps.

What CPT coding is reported?

A.45382, 45385 x 3, 45380-51

B.45385×3 45384-51

C 45388 45385-59, 45381-59

D.45385 45384-59, 45381-59

6.An 18-year-old female's adenoids has grown back after the
primary procedure performed three years ago.

A.42836

B.42821

C.42826

D 42831

Urinary Male female system

1.Mr. Jones was recently seen by his provider for severe pain in
his left testes. After further testing, the provider diagnosed him
with testicular cancer. A radical inguinal left orchiectomy via
inguinal approach is performed to eliminate the possible spread
of the cancer.

A.54520 LT

B.54530-LT

C. 54535-LT

D. 54522-LT

2. Patient with erectile dysfunction is presenting for same day

surgery in removal and replacement of an inflatable perile
prosthesis

A.54417
B.54401

C.54400.

D .54416

3.An 8-day old newborn, weighing 3 kilograms, is seen for a

circumcision. The infant is placed on a restraining board and a
numbing cream is applied. A circumferential incision is made at
the top of the penis and the foreskin was excised with scalpel The
penis was wrapped in gauze.

A.54150

B.54150-52

C.54160

D.54160-63

4.A 42-year-old male is diagnosed with a left renal mass. A

laparoscope is inserted and advanced to the operative site. The
left kidney is removed, along with the entire left ureter.

A.50543

B.50220

C.50548

D.50546
5.56-year-old female is postmenopausal with abnormal vaginal
bleeding. Ob-gyn provider performs a hysteroscopy to examine
the uterine cavity.

A.58558

B.50579

C.58578

D.58555

6 .A 44-year-old female patient came in for a planned

laparoscopic total abdominal hysterectomy for endometriosis of
the uterus. The surgeon attached the trocars, a scope is inserted
examining the uterus, abdominal wall, bilateral ovaries, and
fallopian tubes. The surgeon decided to convert the laparoscopic
procedure to an open total hysterectomy because of the
extensive amount of adhesions that need to be removed. A total
hysterectomy was performed and due to removal of the extensive
adhesions the surgery took longer than normal of 2 hours.

A.58150-78, N80 .9 N99.4

B .58150- 22 N80.N73.6

C.58571-78, N80.9, N73.6

D.58571-22, N80 00 N99.4

Endocrine Auditory Eye system
1. There is a malfunction of a vagus nerve electrode array. The
surgeon removes the arra and pulse generator.

A.64569

B.61888

C.64568

D.64570

2.Procedure: The patient was taken to the minor procedure room

where his left eye was prepped with Betadine and draped in the
usual fashion. A lid speculum was placed in the palpebral fissure.
A small amount of 2% lidocaine with epinephrine was injected
with a 30- gauge needle subconjunctivally in the superior temporal
quadrant. A 30-gauge needle was inserted into the anterior
chamber of the eye and 0.05 mL of aqueous was removed. The
eye was soft, and the wound was sealed. Light pressure was
placed on the injection site with a Q-tip soaked in povidone-iodine.
The lid speculum was removed without difficulty, and the patient
recovered from the procedure without difficulty.

A.65800-LT

B.65810-LT

C.67120-LT

D.66184-LT
3.The evisceration of ocular contents was performed using a
surgical microscope for enhanced visualization. The procedure
was performed on the left eye and an implant was not placed in
the ocular cavity

A.65093-LT

B.65091-LT, 69990-51

C.65093-LT 69990

D.65091 LT

4. A patient has chronic cholesteatoma in the right middle ear.

The otolaryngologist performed a tympanoplasty with a radical
mastoidectomy, removing the middle ear cholesteatoma. Grafting
technique was used to repair the eardrum without ossicular chain
reconstruction.

A.69642

B.69645

C.69643

D .69641
5. A 45-year-old female had a closed fracture of the L2-L4 vertebrae 15
years ago and now has displacement of the lumbar intervertebral disc
between L3 and L4. The surgeon will decompress the spinal cord, involving
one segment of the lumbar spine. The surgeon performs the surgery by
going through the pedicle on the side of the disc's bulge to reach the
herniated disc. The lamina and facet joint are removed, along with disc
fragments.
A.63056
B.63101 63103
C.63056 63057
D.63101
6. A 53-year-old male arrived at the ER due to severe ocular
trauma to the right eye. He was at work on a metal drilling
machined metallic item penetrates his right eyeball. A foreign
body is in the posterior segment of the eye and corneal laceration
posterior perforated sites were noted. He is brought back to the
surgical suite. The surgeon removes the metallic foreign body
large retinal forceps. The laceration of the cornea is sutured and
the provider also performs a pars plana lensectomy

A.65235 RT, 66852-51-RT, 65280-51-RT S05 31XA, W31.0XXA

B.65265 RT, 66852-51-RT. 65280-51-RT, SO5.51XA, W31 1XXA

C.65265-RT, 66852-51-RT, 65275-51-RT S0531XAW31 0XXA

D.65235 RT, 66852-51-RT. 65275-51-RT S05 51XA, W31 1ΧΑ

Radiology
1.Patient has a recurrent left shoulder dislocation. He is sent to a
radiology center to have a CT scan of the upper extremity it is
performed first to see the current angulation of the dislocation to
reduce the dislocation appropriately. A computer tomographic
imaging of the upper extremity is performed first without using
contrast and again after injecting contrast material What CPT
code is?

A.73202

B.73200

C.73201

D.73206

2.A patient has frontal lobe brain cancer. The physician performs
nuclear diagnostic imaging of the brain using a small amount of
gamma-emitting radioactive tracers to examine the function of
the brain. Four static views of the brain are taken.

A.78605

B.78600×4

C.78605×4

D .78600

3.A patient in a radiology facility has an X-ray examination of her

entire spine after falling down the stairs and experiencing
peripheral paresthesia. A radiologist takes a total of 8 views of
the lumbar spine, thoracic spine, the cervical spine (including
atlas and and base of the skull

A.72114

B .72020

C.72081×8

D.72084

4. A patient with jaundice was seen by the physician to obtain liver

biopsies. A needle biopsy was taken using ultrasound guidance
for needle placement. The physician obtained two core biopsies,
which were then sent to pathology.

A.47000 76942

B.47001 77002

C.47000 47001 76942

D.47000 77012

5. Mrs. Wildet presents with right and left leg swelling. Venous
thrombosis imaging of each leg is done and shows deep venous
embolism and thrombosis in each leg.
A.74858-50 I82.401,I82.402

B.78457-50,I32.403

C.78457-RT, 78457-LT I82.401, 182.402

D.78458,I82.403

6.A patient is having X-ray imaging of his abdomen following a

traumatic episode. A decubitus, supine, and erect views are
performed on the abdomen.

A.74021-26

B .74019-26

C .74018-26

D .74022-26

Lab and pathology

1.What coding scenario is reported for code 82272

A.Patient has tarry stools and sister was just recently diagnosed
for colon cancer.

B.Patient had removal of polyps one year ago and personal

history of descending colon cancer.

C.Patient has bleeding ulcer and the test is performed for

diagnostic purposes to rule out Crohn's disease

D.Screening of the colon due to bloody stools and family history

of colon cancer.

2. The provider orders a bilirubin test for a patient that has bowel
flora disturbance. Lab analyst determines the presence of
bilirubin in the fecal sample. What CPT® code is reported for the
test?

A.82239

B.82248

C.82247

D.82252

3. A physician orders an obstetric panel that includes syphilis

screening using the non-treponemal antibody approach, an
automated CBC with manual differential WBC count, HBsAg,
rubella antibody, a serum antibody screen, and ABO and Rh blood
typing.

A.85027,85007, 87340, 86762, 86780, 86850, 86900, 86901

B.80055

C.80081,86780

D.80055 85027,85007, 87340, 86762, 86780, 86850, 86900,

86901

4.A physician orders a basic metabolic panel which includes total

calcium and an electrolyte panel. Applying CPT guidelines for
Organ or Disease-Oriented Panels.
A.80047

B.80048

C.80048, 80051

D.80047,80051

5.A patient with pneumonia has a sputum culture and blood

drawn to test for fungus.

A.87101 87103

B.87102, 87103

C.87106,87107

D.87040,87070

6.

A patient is having X-ray imaging of his abdomen following a

traumatic episode. A decubitus, supine, and erect views are
performed on the abdomen.

What CPT is reported? Radio chapter qes

74021-26

74019-26
74018-26

74022-26

6.A patient had a vaginal hysterectomy for endometrial

hyperplasia. This condition is not a cancer or a prolapse.
Specimens from the uterus were sent to pathology for gross and
microscopic examination. The results of the pathology were sent
to the surgeon.

A.88305

B.80302

C.88309

D.88307

Medicine
1. An 8-year-old patient is placed under general anesthesia for
treatment of a right orbital fracture due to a traumatic fall to the
nose and face from a swing set. An on-call otolaryngologist is
asked to perform a general otolaryngologic examination to
evaluate the patient. A mild nasal fracture is the diagnosis given
by the otolaryngologist.

A.92512

B.21310 , 92502-51

C.21310
D.92502

2.Mrs. Banfield has bradycardia and had a multiple lead

pacemaker implanted two years ago. Today she returns to the
clinic for evaluation of the function of the device and any
necessary reprogramming.

What CPT code is reported?

A.93283

B.93280

C. 93284

D .93281

3. A left heart catheterization will be performed because the

patient has a history of circumflex stent and new exertional
dyspnea with abnormal nuclear stress test showing lateral
ischemia. Initially access was achieved via the right radial
approach, however due to severe subclavian and aortic tortuosity,
adequate angiograms could not be obtained and therefore
procedure was transitioned to right femoral artery approach
where only a ventriculography was performed.

What CPT code is reported?

A.93451

B.93453
C .93458

D.93452

4.A 70-year-old patient with chronic bilateral lower leg pain and
suspected DVT presents for a preoperative bilateral duplex scan
of the lower extremity veins. The patient is scheduled to undergo
endovenous lazer varicose vein surgery the following week. The
duplex scan reveals bilateral thrombophlebitis of the great
saphenous vein.

What is the CPT and ICD-10-CM codes?

A.93970 I80.03

B.93925 I80.03

C.93970, I80.01 I80.02

D.93925 I80.01,I80.02

5.A patient visits her allergist for a series of allergy tests involving
venoms, three weeks after fully recovering from an adverse
reaction to a spider bite. The allergist performs a total of 22 tests
that include & scratch tests, & puncture tests, and 6 intradermal
tests.

What CPTe coding is reported?

A.95017

B.95018 ×22

C.95017 ×22

D.95018
6.A 4-year-old is seen by her pediatrician for vaccinations. The
pediatrician counsels the mother about the importance of the
vaccinations and administers the influenza IIV4 (1 component) by
intramuscular route and MMR (3 component combination vaccine)
by subcutaneous route.

According to the CPT guidelines, what CPT codes are reported?

A.90460 90461×3 90685 90707

B.90460 90461 90685 90707

C.90460×2 90685 90707

D.90460×2 90461×2 90685 90707

Evaluation And Management

2 .A 46-year-old female is admitted to the hospital by her urologist
for a left ureteral calculus. The urologist visits her again on day
two and performs a low for number and complexity of problems
addressed, minimal for amount and/or complexity of data to be
reviewed and analyzed, and moderate for risk of complications.

What E/M service is reported for day two?

A.99231

B .99233

C.99232
D.99221

3 .A patient presents to the physician's office for the first time

with coughing and shortness of breath. The patient has a history
of asthma and esophageal reflux. The physician performs a
medically appropriate history and exam. The physician assesses
the patient with moderate persistent asthma with acute
exacerbation and esophageal reflux. The patient was told to take
Tums for the reflux.

What CPT and ICD-10-CM codes are reported for this service?

A.99202 J45.901. K21.00

B.99203. J45.41, K21.9

C.99204, J45.991, K21.00

D.99205 J45.41, K21.9

4.Dr. Winston sees a patient with abdominal pain in the

observation unit in the hospital. This is his first visit with this
patient during this stay. He spent a total of 85 minutes on that
patient on that date of service, including review of the observation
admission, labs, X-Rays, and EKG results and examining the
patient with a moderate level of medical decision making.

What CPT coding is reported?

A.99222 99418

B.99223. 99418

C.99223
D.99222

5. A new patient in a group home is seen by the group home's

physician for coughing and shortness of breath. Patient has a
history of asthma. On the exam patient is wheezing. A lung
function test is performed. Patient is given a treatment of
albuterol. The physician calls in a prescription for prednisone. The
physician's assessment is acute asthma exacerbation.

What E/M and ICD-10-CM codes are reported for this service?

A.99342 J45.41

B.99344 J45.901

C.99304 J45.901

D.99305, J45.41

6. A 2-year-old boy is brought to the ER in cardiac arrest. The

emergency room physician spends 75 minutes with the critically
ill patient. He performs CPR, emergency endotracheal intubation,
and inserts a non-tunneled central venous catheter to stabilize
patient. The ER physician makes a notation that the 75 minutes
does not include the time for other separate billable services.

How does the emergency room physician code this service?

A.99471-25 ,92950, 36555, 31500

B.99471

C.99291-25.92950, 36555, 31500

D.99291-25, 99292-25, 92950, 36555,31500

Hcpcs questions
1. A wheelchair bound resident of a skilled nursing facility is seen
in the physician's office. The physician's office makes
arrangements with a social worker to take the patient back to the
skilled nursing facility. What is HCPCS Level II transportation
service code?

A.A0120

B.A0100

C.A0130

D.A0160

2. A 68-year-old Medicare patient with Parkinson's disease is seen

by the physician in the clinic for a left arm laceration. The
physician repairs a 2.3 cm superficial laceration on the left arm
with only tissue adhesive Dermabond.

What coding is billed for the laceration repair?

A.12031, G0168

B.G0168

C.12001

D. 12001,G0168

3. What is the correct HCPCS Level II code for a standard

wheelchair, fixed full length arms, and swing away detachable
footrests?
A.K0002

B.K0010

C.K0001

D.E1130

Anesthesia
1.A CRNA is personally performing a case without supervision of
an anesthesiologist. What modifier is reported for the CRNA
services?

A.Qs

B.Qz

C .Qx

D.QY

2.A 64-year-old patient has right pleural effusion which could not
be drained by thoracentesis. Right thoracotomy is performed to
evacuate the pleural effusion.
What anesthesia coding is reported for when the anesthesiologist
is medically directing one CRNA?

A.00524-QX

B.00520-QY

C .00540-QΥ

D .00541-QX

3.A 57-year-old woman with a physical status of 3 received

general endotracheal anesthesia for a removal of an abnormal
mass within the muscle layer beneath the abdominal wall. The
anesthesiologist is directing 3 CRNA providing anesthesia care
concurrently.

What CPT coding is reported for the anesthesia?

A.00800-QK-P3

B .00800 AA-P3

C .00802-AA-P3

D.00802-QX P3

4. A patient who has deep vein thrombosis in the left forearm

receives monitored anesthesia, personally performed by the
anesthesiologist for a thrombectomy. The anesthesiologist
documents P4.

What anesthesia coding is reported?

A.01840 AA-QS-P4
B .01840-AA-Q8 P4

C.01850-AA-QS-P4

D.01850 AA G8 P4

Case study
1).Operative Report

Preoperative Diagnosis: Basal cell carcinoma

Postoperative Diagnosis: Same

Anesthesia: 1% Xylocaine solution with epinephrine warmed and

buffered and injected slowly through a 30-gauge needle for the
patient's comfort

Location: Right cheek

Size of Excision: 5cm

Procedure: The patient was taken to our surgical suite, placed in a

comfortable position, prepped and draped, and locally
anesthetized in the usual sterze fashion. A #15 scalpel blade was
used to excise the basal cell carcinoma plus a margin of normal
skin in a circular fashion in the natural relaxed skin tension

1. What is the appropriate CPT coding for this patient?

A.14040

B.14040,11646, 12052

C.14040 11646

D.11646, 12052

2) Postoperative Diagnosis: Fracture of cervical vertebrae C6-C7

Procedure Performed: Placement of Halo Device

Anesthesia: General

Procedure: Patient's head prepped, draped and in supine position.

The halo ring is selected and positioned around the skull The ring
is aligned around the upper frontal area of skull and four pins are
placed just above the eyecrow's. The pins are tightened to the
desired depth of the skull bone and vest was secured to the
patient. The patient was then monitored for sensory-evoked
potential There were no changes throughout the case. A two-view
cervical spine Xray from confirmed acceptable alignment at C6-
C7

2 What CPT and ICD-10-CM codes are reported?

20661 S13.170A

20660, S12.501A S12.601A

20664, S12.9XXA

20661 S12.500A, S12 600A

Case 3

Procedure:Returning to the OR for chest exploration for

hemorrhaging and evacuation of blood clot

Description of Procedure:The patient was prepped and draped in

the supine posion. The stethotomy is re-opened Tamponade is
obvious. A large amount of clot is removed from the heart, which
is circumferential. There is diffuse oozing frorn all surgical sites.
An additional suture is placed at both the proximal anastornotic
sites and reinforced with xenograft. Clot is evacuated from the
left pleural space. Two additional 24 French atrium drains are
placed. Xeroform gauze is placed over the anterior surface of the
heart and then placed in the mediastinum Kerlix gauze which is
soaked in Ancef. Then a Vidrape is placed over with a red rubber
catheter for decompression. The patient tolerated the procedure
well and was transferred to recovery.

Refer to the bowiemental plamañon when answering the question

3. What is the procedural coding?

A.35820-78

B.33020-58

C.32120-58

D.32658-78

4) Procedure: Upper GI endoscopy with gastrostomy tube

placement and band ligation of esophageal varices

Findings: No evidence of gastric outlet obstruction on EGD and

PEG tube in good position in the body of the stomach neat the
lesser curve

Description of Procedure: The patient was placed in a

semirecumbent position

in her ICU bed. Oxygen monitoring and ventilator were in place. IV

sedation was administered without complications. Bite block was
placed and lubricated Olympus GIF 130 video gastroscope was
advanced transorally into the esophagus, then stomach into the
second portion of the duodenum with difficulty. Findings were as
noted above. There is evidence of gastric vances. A small elastic
O rubber ring was placed around the base of the varix. The
stomach was inflated, and transabdominal indentation of the
anterior wall was noted in the middle of the endoscope picture
and this site was prepped and draped and local anesthesia was
infiltrated in the skin and subcutaneous

4 What is the CPT coding for the surgeon's service?

43244, 43243

43235 43244

43244, 43246

43235 43246

Case 6

6. A 25-year-old male comes to the doctor's office with a

complaint of his big toe with pain and sweling. The physician
examines the toe and it is an ingrown toe nail that hes caused a
painful blister. The blister has popped on its own and discharging
pus. The physician cleans the wound and bandages it. A
prescription of Keflex 500 mg is Given to be filled at the pharmacy.

What is the level of the MDM for Risk of Complications and/or

Morbidity or Mortality ED Patient Management?

A.Minimal

B.Low

C.Moderate

D.High

Case 7

Preoperative Diagnosis: Left Pilon Fracture, closed

Postoperative Diagnosis: Same

Operation: Application of uniplanar external fixation left ankle

Anesthesia: General provided by the anesthesiologist

ASA- II

Estimated Blood loss 10cc

Wound Class: Class 1-Clean

Specimen(s) None

Complications: None

7. What anesthesia, and ICD-10-CM codes are reported?

A.01464-AA P2, S82.872A

B.01486 AA P2, S82 892A

C.01480-AA-P2, S82.872A

D.01490 AA P2, S82.892A

Case 8

New Patient Office Visit

Patient presents for initial 1-week well-child visit. Had jaundice

since birth but now is rescived. Mother does not have any current
concerns, but wants to talk about blood work. Baby has home
health nurse x 1 visit to date Baby eating well approximately 15
minutes each breast. Having BM qd. Urination: Normal.

Patient accompanied by both parents and older sister; parents

have no specific concerns

Newborn screening is normal.

Diet: Breastfeeds q 2 to 3 hrs. Breastfeeding is going well overall.

Patient is interested in nursing. Awakens to nursing regularly, left
side 15 minutes, right sade 15 minutes. Audible signs of milk
transfer. Patient appears satisfied after breastfeeding is
alternating breasts. Mother does not use feeding supplement
Patient experiencing 6 to 8 wet diapers per day. Stools appear
yellow glow and

8.What E/M code is reported?

A.99381

B.99391

C.99203

D. 99213

Case 9

CC Shortness of breath

HPI: 16-year-old *female comes into the ED for shortness of

breath for* the last two days She is an asthmatic Current
medications being used to treat symptoms is Advair, which is not
working and breathing is getting worse. Does not feel that Advair
has been helping Patient tried Albuterol for persistent coughing, is
not helping. Coughing 10-15 minutes at a time, Patient has used
the Albuterol 3x in the last 16 hrs. ED

physician admits her to observation status.

ROS: No fever, no headache. No purulent discharge from the eyes.

No earache No nasal discharge or sore throat. No swollen glands
in the neck. No palpitations. Dyspnea and cough. Some chest pain.
No nausea or vomiting. No abdominal pain, diarrhea, or
constipation.

PMH: Asthma

9. What E/M code is reported?

A.99285

B.99221

C.99284

D.99222