CPC PRACTICE EXAM 3 A GRADED EXAM NEW ACTUAL TEST SOLUTION

CPC PRACTICE EXAM 3 (A GRADED EXAM) NEW ACTUAL TEST SOLUTION

Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area of skin where the excisions 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 of tissue were examined by the surgeon. No tumor was identified after the final stage of the microscopically controlled surgery. What procedure codes are reported?

A. 17313, 17314, 17314

B. 17313, 17315

C. 17260, 17313, 17314

• 17313,17314, 17315 - CORRECT ANSWER Patient is having Mohs Micrographic Surgery

being performed only, eliminating multiple choice answer C. Mohs codes are based on the anatomic grouping by code, the number of stages taken, and number of blocks per stage. The surgery was on the back reporting code 17313 for stage 1 with three blocks, add-on code 17314 is for stage 2 with five blocks, and add-on code 17315 is for the sixth block in stage 2. Answer D

45 year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported?

A. 14060

B. 11642, 14060

C. 11642, 15115

• 15574 - CORRECT ANSWER An adjacent tissue transfer (advancement flap) was used to

repair a defect on the nose due to an excision of a malignant lesion, eliminating multiple choice answers C and D. The section guidelines in the CPT® codebook for Adjacent Tissue or Rearrangement indicate that the excision of a benign lesion (11400-11446) or a malignant lesion (11600-11646) is included in codes for adjacent tissue transfer (14000-14302), and are not separately reported. This eliminates multiple choice answer B. Answer A

24 year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline

moistened gauze and pads were placed on top of this. The correct CPT® code is:

A. 56405

B. 10061

C. 11004

• 11042 - CORRECT ANSWER The abscess had already burst, with no need to perform an

incision to open it, eliminating multiple choice answers A and B. The difference between multiple choice answers C and D, is that the patient is having the debridement performed due to a soft tissue infection in the perineum area. The correct code is 11004 for debridement of necrotized infected tissue on the external genitalia. Answer C

76 year-old female had a recent mammographic and ultrasound abnormality in the 6 o'clock position of the left breast. She underwent core biopsies which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hookwire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o'clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, we performed a generous excisional biopsy around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology. Once hemostasis was assured, digital palpation of the depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound was closed in 2 layers with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local anesthetic was infiltrated for postoperative analgesia. What CPT® and ICD-10-CM codes describe this procedure?

A. 19100, N63

B. 19285, C50.912

C. 19120, R92.8

• 19125, D24.2 - CORRECT ANSWER You can narrow your choices down by the diagnosis.

The beginning of the operative note documents that core biopsies showed "papilloma". In the ICD-10-CM Alphabetic Index, look for Papilloma-see also Neoplasm, benign, by site. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/breast/Benign (column) refers you to code D24.-. Turn to the Tabular List to complete the code, D24.2.

Procedure code 19125 is correct because preoperative placement of radiologic marker (preoperative needle localization with hookwire needle injection with methylene blue) was used to excise the lesion. Answer D

The patient is a 66 year-old female who presents with Dupuytren's disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren's disease right ring digit and palm. An extensile Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code(s) is (are) used?

A. 26123-RT, 26125-F7

B. 26121-RT

C. 26035-RT

• 26040-RT - CORRECT ANSWER The patient is having a fasciectomy, eliminating

multiple choice answers C and D. The fasciectomy was performed on the right hand supported by the documentation that states: "the fascial attachments to the flexor tendon sheath were released" and "subtotal palmar fasciectomy." Documentation also indicates the right middle finger ( modifier F7) had diseased fascia excised.Answer D

This is a 32 year-old female who presents today with sacroilitis. On the physical exam there was pain on palpation of the left and right sacroiliac joint and fluoroscopic guidance was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 mL of bupivacaine at 0.5% was injected into the left and right sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. The correct CPT®

code(s) is (are):

A. 20611

B. 27096-50, 77012

C. 27096-50

• 27096, 27096-51, 77012 - CORRECT ANSWER The injection is being performed in the

sacroiliac joint, eliminating multiple choice answer A. Fluoroscopic guidance is included and should not be reported separately because the code description for code 27096 includes imaging, eliminating multiple choice answers B and D. There is parenthetical note under code 27096 that indicates to use modifier 50 for bilateral procedure (left and right). Answer C

PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE

DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee The patent was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra- articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper.The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact.The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope.The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT® and ICD-10-CM codes should be reported?

A. 29880-RT, M23.203, M65.80, M94.261, M22.41

B. 29881-RT, M23.211, M65.861, M94.261, M22.41

C. 29881-RT, M23.221, M65.861, M94.261, M22.41

• 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41 - CORRECT ANSWER For

this operative note the anatomic location is the knee, specifically with just the medial meniscus performed on, eliminating multiple choice answers A and D. A limited synovectomy (29875) was performed; however, it was performed in the medial compartment of the knee along with the medial meniscectomy; therefore, is not reported. Also, code 29875 is a separate procedure, according to CPT® Surgery Guidelines: The codes designated as "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is

considered an integral component. Debridement was performed in the lateral and patellofemoral compartments which is included in code 29881; code 29877 is not reported separately.Synovitis (M65.861), chondromalacia (M94.261) for the fibrillated articular cartilage of the tibial plateau and patella (M22.41) are reported. The patient had a meniscus tear, but the operative note indicates a more specific area of the tear. It documents that, "An upbiting basket was introduced to transect the base of the posterior horn flap tear", look in the ICD-10-CM Alphabetic Index for Tear/meniscus/old-see Derangement, knee, meniscus due to old tear.Look for Derangement/knee/meniscus/medial/posterior horn M23.22-. Go to the Tabular List to complete the code, M23.221. Answer C

A 61 year-old gentleman with a history of a fall while intoxicated suffered a blow to the forehead and imaging revealed a posteriorly displaced odontoid fracture. The patient was taken into the Operating Room, and placed supine on the operating room table. Under mild sedation, the patient was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy was performed to gently try to reduce the fracture. It did reduce partially without any change in the neurologic examination. More manipulation would be necessary and it was decided to intubate and use fiberoptic technique. The anterior neck was prepped and draped and an incision was made in a skin crease overlying the C4-C5 area. Using hand-held retractors, the ventral aspect of the spine was identified and the C2-C3 disk space was identified using lateral fluoroscopy.Using some pressure upon the ventral aspect of the C2 body, we were able to achieve a satisfactory reduction of the fracture. Under direct AP and lateral fluoroscopic guidance, a Kirschner wire was advanced into the C2 body through the fracture line and into the odontoid process. This was then drilled, and a 42 millimeter cannulated lag screw was advanced through the C2 body into the odontoid process. What procedure code is reported?

A. 22505

B. 22326

C. 22315

• 22318 - CORRECT ANSWER The procedure performed is the reduction of an odontoid

fracture, by incising (open treatment) the anterior neck (anterior approach) to reduce the fracture and placement of internal fixation (Kirschner wire and lag screw). Gardner-Wells tongs (20660) were applied originally to try to reduce the fracture with axial traction; however, this procedure is listed as a separate procedure and it should not be reported during the same session for reduction of the fracture. Answer D

The patient is a 51 year-old gentleman who has end-stage renal disease. He was in the OR yesterday for a revision of his AV graft. The next day the patient had complications of the graft failing. The patient was back to the operating room where an open thrombectomy was performed on both sides getting good back bleeding, good inflow. Select the appropriate code

for performing the procedure in a post-operative period:

A. 36831-76

B. 36831

C. 36831-78

• 36831-58 - CORRECT ANSWER Modifier needs to be appended to procedure code 36831

because the patient returned to surgery within the postoperative period, eliminating multiple choice answer B. Appendix A lists the modifiers needed to append to the procedure codes. The patient did not have a planned return to surgery, eliminating multiple choice answer D. Nor did the patient have a repeat procedure on the same day of service, eliminating multiple choice