Musculoskeletal System (20000 Series)

1. A patient is given Xylocaine, a local anesthetic, by injection into the thigh above
thesite to be biopsied. A small bore needle is then introduced through the skin into
the muscle, about 3 inches deep, and a muscle biopsy is taken. What is the CPT
code reported for this service?

a) 20205
b) 20206
c) 20225
d) 27324

2. This 45 year-old male presents to the operating room with a painful mass of the
right upper arm. General anesthesia is induced. Soft tissue dissection is carried
down through the proximal aspect of the teres minor muscle. Upon further
dissection a large mass is noted just distal of the IGHL, which appears to be benign
in nature. With blunt dissection and electrocautery, the 4 cm mass is removed en
bloc and sent to pathology.Wound is irrigated, repair of the teres minor with
subcutaneous tissue is then closed with triple-0 Vicryl. Skin is closed with double-0
Prolene in a subcuticular fashion. What is the correct CPT code reported for this
service?

a) 23076-RT
b) 23066-RT
c) 23075-RT
d) 11406-RT

3. The patient has a torn medial meniscus. An arthroscope was placed through the
anterolateral portal for the diagnostic procedure. The patellofemoral joint showed some
grade 2 chondromalacia on the patella side of the joint only, and this was debrided
with the 4.0 mm shaver. The medial compartment was also entered and a complex
posterior horn tear of the medial meniscus was noted. It was probed to define its
borders. A meniscectomy was carried out back to a stable rim. Select the
appropriate CPT code(s) for this service.

a) 29880, 29879-59
b) 29881, 29877-59
c) 29880
d) 29881

4. A 3 year-old is brought into the ER crying. He cannot bend his left arm after his
olderbrother pulled 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 follow-up care. What CPT and ICD-10-CM codes
should be reported?
a) 24640-54, S53.032A, Y93.83
b) 24565-54, S53.032A, Y93.83A
c) 24640-54, S5I.009A, Y93.83
d) 24600-54, S53.006A, Y93.83A

5. A 50 year-old male had surgery on his upper leg one day ago and is presenting
withserous drainage from the wound. He returns to the operating room for an
evaluation of the hematoma resulting from the surgery. His wound is explored and
there is a hematoma at the base of the wound, which is very carefully evacuated,
and the wound irrigated with antibacterial solution. What CPT and ICD-10-CM codes
are reported?

a) 10140-79, M96.840
b) 27603-78, S80.I0XA
c) 10140-76, T8I.4XXA
d) 27301-78, M96.840

6. A 45 year-old presents to the operating room with a right index trigger finger
and left shoulder bursitis. The left shoulder is injected with 1 cc of Xylocaine, 1 cc of
Celestone, and 1 cc of Marcaine. An incision was made over the A1 pulley in the
right distal transverse palmar crease, about an inch in length. This is taken through
skin and subcutaneous tissue. The A1 pulley is identified and released in its entirety.
The wound is irrigated with antibiotic saline solution. The subcutaneous tissue is
injected with Marcaine without epinephrine. The skin is closed with 4-0 Ethilon
suture. Clean dressing is applied. What are the codes for these procedures?

a) 26055-F6, 20610-76-LT
b) 20552-P6, 20605-52-LT
c) 26055-F6, 20610-51-LT
d) 20553-F6, 20611-59-LT

7. Operative Report:

Diagnosis: Idiopathic gout, left knee.

Procedure: Aspiration, left knee

Procedure: The knee was prepped and draped in the usual sterile fashion. After the
skinwas infiltrated with lidocaine, a needle was inserted through the skin into the
joint and 10 mL of slightly cloudy yellow fluid was aspirated from the knee. A sterile
dressing wasapplied. There was good apposition and hemostasis, no complications,
and the patient

tolerated the procedure well. The patient was advised to keep the dressing clean and
dry. Instructions were given for signs and symptoms of infection (such as increased
pain, swelling, redness, puss, heat or fever). Patient was told to return immediately if
any of these developed. Ace bandage was placed.

Fluid showed glucose 156, WBC 100. These findings did not seem to indicate septic
joint. The patient will be treated with Keflex and Vicodin. She is to ice, rest, and
elevate the left knee. She is to contact her doctor on Monday and follow up. She is
to return for any fever, redness of the left knee. She understands these instructions
and agrees to follow up.

What CPT and ICD-10-CM codes are

reported?a) 20600, M10.9

b) 20610, M10.062
c) 20611, M10.9
d) 20550, M10.062

8. Operative Report

Preoperative Diagnosis: Lipoma of right back.

Postoperative Diagnosis: Lipoma of right back.

Procedure Performed: Excision of lipoma. right back (6 cm diameter).

Description of Procedure: The patient was placed on the operating table in the lateral
position with the right side elevated. The location of the lipoma had been marked in
thepreoperative area. It was at the superior edge of the right iliac crest. The area was
prepped with Betadine and sterile drapes were applied.

A transverse incision was made directly over the lipoma. Subcutaneous tissues were
incised. The lipoma was identified and found to be smooth, multilobulated, yellow,
and discrete. It was completely excised down to the muscle overlying the iliac crest.
Bleedingwas controlled with electrocautery. The subcutaneous tissues were
approximated with acontinuous subcuticular 3-0 plain catgut suture. Benzoin, Steri-
Strips, and dry gauze dressings were applied.

Blood loss was negligible and the final sponge count was reported as correct. Thepatient was sent to the
recovery room in stable condition. What CPT and ICD-10-CM codes are reported?

a) 27047, D17.1
b) 21931, D17.1
c) 21930, C44.509
d) 11606, C44.509

9. A 55 year-old patient complains of an injury to his right hip leading to a

probable dislocation that occurred one hour prior to arrival. The patient states he
was sleeping in bed, fell off, and landed on his right side. Patient denies numbness
or tingling. Patient denies any further injury. No additional complaints or
 treatments prior to arrival. Intervention: IV: normal saline; Pulse Ox: 98 percent on
room air, X-ray right hip: Positivehip dislocation. Dr.Thompson was notified of the
patient’s physical exam findings and test results The patient was prepared and
agreed to conscious sedation to include placement on continuous EKG monitoring,
02, suction and bag-valvemask ready, pulse oximetry in place. Fentanyl 50 mg IV
and Versed 2 mg IV were given by Dr.Miller who supervised the MCS for 30
minutes. The patient's right hip was easily reduced using gentle traction by
Dr.Thompson. Post reduction X-ray showed right hip in good location with no
obvious fracture The patient tolerated the procedure very well.

What procedure code(s) is/are reported by both

physicians?a) 27257-RT, 99156, 99157

b) 27257-RT
c) 27250-RT, 01200
d) 27250-RT, 99156, 99157

10. Jeff is a 13-year-old boy who fractured his left radius and ulna while
snowboarding. Three weeks after the physician placed a long arm cast on Jeff, he
was skateboarding and crushed the cast (without further injury to the arm). The
physician replaces the castwith a short-arm fiberglass cast. How would you code
the services provided after the skateboard accident?

a) No code
b) 29065-58
c) 29075-58
d) 29125-58

11.A patient amputated her thumb in an automobile accident. A surgeon performed a replacementof
the thumb, including carpometacarpal joint to the MP joint. How would you report this procedure?

a. 20824
b. 20827
c. 20822
d. 20808, 20824-59
12.A patient underwent a right surgical arthroscopic medial meniscal transplant, which required a
remnant of the meniscus to be removed. How would you report this procedure?
a. 29866, 29868-59
b. 29868-RT
c. 29868
d. 29870-RT

13.A patient had four artificial cervical discs removed by total disc arthroplasty in an anterior
approach. How would you code this procedure?

a. 22527 x 3
b. 0095T x 3
c. 22534 x 3
d. 22585 x 3

14.When coding for spinal procedures, how is segmental instrumentation defined?

a. Fixation at each end of the construct and no additional interposed bony attachment
b. Fixation at each ends of the construct and may span four vertebral segments with attachment to
the intervening segments
c. Fixation at each end of the construct and at least one additional interposed bony attachment.
d. Fixation at each ends of the construct and may span a several vertebral segments without
attachment to the intervening segments.

15.What is the appropriate code for the application of body cast including one thigh?a.

29035
b. 29450
c. 29044
d. 29000

16.A patient underwent a percutaneous repair of an Achilies tendon with graft. How would you
report this?

a. 27680, 20824-59
b. 27654
c. 27652, 20824
d. 27652

17.While shopping at the mall, Renee dislocated her patella when she fell from the escalator. The
surgeon documented an open dislocation and performed an open treatment with total
patellectomyto repair the patella. How would you code this treatment and diagnosis?

a. 27840, 27562-51, S83.006A, Y92.513

b. 27566, S83.006A, W10.0XXA, Y92.59
c. 27562, S81.009A, W10.0XXA, Y92.59
d. 27566, 27560-51, S81.009A, W10.0XXA, Y92.59

18.A patient suffered a penetrating wound to his abdomen when he fell into a plane glass window. A
surgeon performed wound exploration with enlargement, debridement and removal of glass from
 the site. The surgeon decided a laparotomy procedure was not necessary at his time.
How would this procedure be reported?

a. 20102
b. 49000, 97602-51, 20102-59
c. 20100, 49000-59
d. This procedure is bundled with the laparotomy

19.Dr Robert’s patient suffering an open fracture to his left elbow was repaired surgically with several pins.
Two weeks after the repair, Dr Robert had to re reduce fracture. Which modifier woulddescribe the re-
reduction procedure?

a. -76
b. -78
c. -58
d. -52

20.Tom suffered a burst fracture to his lumbar spine when he fell from a ladder at work. Dr Bill performed
a partial corpectomy to 12 by a transperitoneal approach, followed by anterior arthrodesis of L1-L3. He
also positioned anterior instrumentation and placed a structural allograft toL1-L3. How would Dr Bill
report this procedure?

a. 22558, 22858-51, 22845-51, 20931-59

b. 63085, 22533, 22585-51, 22808-59
c. 22612 x 2, 22808, 22840,- 51, 20931
d. 63090, 22558-51, 22585, 22845, 20931
ANSWERS

1 B
2 A
3 D
4 A
5 D
6 C
7 B
8 B
9 D
10 C
11 A
12 B
13 B
14 C
15 C
16 D
17 B
18 A
19 A
20 D

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