Question 1

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
D. 17313,17314, 17315
Question 2
A 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
D. 15574
Question 3
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
D.
11042
Question 4
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. A 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
D. 26040-RT
Question 5
This is a 32-year-old female who presents today with sacroiliitis. 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. What CPT® coding is reported?
A. 20611
B. 27096-50, 77012
C. 27096-50
D. 27096, 27096-51,
77012
Question 6
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
D. 36831-
58
Question 7
The patient is a 77-year-old white female who has been having right temporal pain and headaches with
some visual changes and has a sed rate of 51. She is scheduled for a temporal artery biopsy to rule out
temporal arteritis. A Doppler probe was used to isolate the temporal artery and using a marking pen the
path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade scalpel
the skin was opened in the preauricular area and dissected down to the subcutaneous tissue where the
temporal artery was identified in its bed. It was a medium size artery and we dissected it out for a length
of approximately 4 cm with some branches. The ends were ligated with 4-0 Vicryl, and the artery was
removed from its bed and sent to Pathology as specimen. What CPT® code is reported?
A.
37609
B. 37605
C. 36625
D.
37799
Question 8
A 50-year-old female has recurrent lymphoma in the axilla. Ultrasound was used to localize the lymph
node in question for needle guidance. An 11 blade scalpel was used to perform a small dermatotomy. An
18 x 10 cm Biopence needle was advanced through the dermatotomy to the periphery of the lymph node.
A total of 4 biopsy specimens were obtained. Two specimens were placed an RPMI and 2 were placed in
formalin and sent to laboratory. The correct CPT® code(s) is (are):
 A. 10005
B. 38500, 77002-26
C. 38505, 76942-26
D. 38525, 76942-
26
Question 9
Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower quadrant
transverse incision was made upon entry to the abdomen. In the right lower quadrant there was a large
amount of pus consistent with a right lower quadrant abscess. Intraoperative cultures anaerobic and
aerobic were taken and sent to microbiology for evaluation. Irrigation of the pus was performed until clear.
The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was taken
down and tied using 0-Vicryl ties and the appendix fell off completely since it was already ruptured with
tissue paper thin membrane at the base. There was no appendiceal stump to close or to tie, just an
opening into the cecum; therefore, the appendiceal opening area into the cecum was tied twice using
figure of 8 Vicryl sutures. Omentum flap was tacked over this area and anchored in place using
interrupted 3-0 Vicryl sutures to secure the repair. What CPT® and ICD-10-CM codes are reported?
A. 44950, K35.890
B. 44960, 49905, K35.33
C. 44950, 49905-51,
K35.20
D. 44970, K37
Question 10
A 15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils.
A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was digitalized.
No significant adenoid tissue was felt. The tonsils were then removed bilaterally by dissection. The uvula
was a huge size because of edema, a part of this was removed and the raw surface oversewn with 3-0
chromic catgut. Which CPT® code(s) is (are) reported?
A. 42821
B. 42825, 42104-
51
C. 42826, 42106-
51
D. 42842
Question 11
A 34-year-old male developed a ventral hernia when lifting a 60 pound bag. The patient is in surgery for a
ventral herniorrhaphy. The abdomen was entered through a short midline incision revealing the fascial
defect. The hernia sac and contents were able to easily be reduced and a large plug of mesh was placed
into the fascial defect. The edge of the mesh plug was sutured to the fascia. What procedure code(s) is
(are) reported?
A. 49560
B. 49561, 49568
C. 49652
D. 49560,
49568
Question 12
A 25-year-old female in the OR for ectopic pregnancy. Once the trocars were place a pneumoperitoneum
was created and the laparoscope introduced. The left fallopian tube was dilated and was bleeding. The
left ovary was normal. The uterus was of normal size, shape and contour. The right ovary and tube were
normal. Due to the patient’s body habitus the adnexa could not be visualized to start the surgery. At this
point the laparoscopic approach was terminated. The pneumoperitoneum was deflated, and trocar sites
were sutured closed. The trocars and laparoscopic instruments had been removed. Open surgery was
performed incising a previous transverse scar from a cesarean section. The gestation site was bleeding
and all products of conception and clots were removed. The left tube was grasped, clamped and removed
in its entirety and passed off to pathology. What CPT® code(s) is (are) reported for this procedure?
A. 59150,
59120
B. 59151
C. 59121
D. 59120
Question 13
A 23-year-old who is pregnant at 39-weeks and 3 days is presenting for a low transverse cesarean
section. An abdominal incision is made and was extended superiorly and inferiorly with good visualization
of the bladder. The bladder blade was then inserted and the lower uterine segment incised in a transverse
fashion with the scalpel. The bladder blade was removed and the infant's head delivered atraumatically.
The nose and mouth were suctioned with the bulb suction trap and the cord doubly clamped and cut. The
placenta was then removed manually. What CPT® and ICD-10-CM codes are reported for this procedure?
A. 59610, O34.211, Z37.0, Z3A.39
B. 59510, O64.1XX0, Z37.0,
Z3A.39
C. 59514, O82, Z37.0, Z3A.39
D. 59515, O82, Z37.0, Z3A.39
Question 14
A 55-year-old female has a symptomatic rectocele. She had been admitted and taken to the main OR. An
incision is made in the vagina into the perineal body (central tendon of the perineum). Dissection was
carried underneath posterior vaginal epithelium all the way over to the rectocele. Fascial tissue was
brought together with sutures creating a bridge and the rectocele had been reduced with good support
between the vagina and rectum. What procedure code should be reported?
A.
45560
B. 57284
C. 57250
D.
57240
Question 15
A craniectomy is being performed on a patient who has Chiari malformation. Once the posterior inferior
scalp was removed a C-1 and a partial C-2 laminectomy was then performed. The right cerebellar tonsil
was dissected free of the dorsal medulla and a gush of cerebrospinal fluid gave good decompression of
the posterior fossa content. Which CPT® code is reported?
A.
61322
B. 61345
 C. 61343
D.
61458
Question 16
Under fluoroscopic guidance an injection of a combination of steroid and analgesic agent is performed on
T2-T3, T4-T5, T6-T7 and T8-T9 on the left side into the paravertebral facet joints. The procedure was
performed for pain due to thoracic root lesions. What are the procedure codes?
A. 64479, 64480 x 3, 77003
B. 64490, 64491, 64492 x 2, 77003
C. 64520 x 4, 77003
D. 64490, 64491, 64492
Question 17
An entropion repair is performed on the left lower eyelid in which undermining was performed with
scissors of the inferior lid and inferior temporal region. Deep sutures were used to separate the eyelid
margin outwardly along with stripping the lateral tarsus to provide firm approximation of the lower lid to the
globe. The correct CPT® code is:
A. 67914-
E4
B. 67924-E2
C. 67921-E2
D. 67917-
E1
Question 18
CC: Follow up on Atrial Fibrillation

History: A 62-year-old is here today to follow-up on her atrial fibrillation. She is a patient of my partner Dr.
J, but he is out of the office today. She had no new problems. No chest pressure, fluttering or shortness of
breath.

Physical Exam
Constitutional: BP 125/85 T 98.6F PR 72
Chest: Clear
Cardiac: Normal sinus rhythm
Assessment: F/U on atrial fibrillation
Plan: Continue with meds prescribed by Dr. J. Follow-up in the next 3 months.

What E/M code is reported for this service?

A.
99202
B. 99203
C. 99212
D.
99213
Question 19
CC: Osteoarthritis flare ups in both knees
History: Patient is here today with continued pain in both knees due osteoarthritis. The left knee bothers
her a more that her right knee. She has been having this issue for over a year. She is requesting a
steroid injection. She uses one over-the-counter ibuprofen daily. No weakness or numbness.

Exam: Weight is 167 Lbs. Blood pressure is 118/60 Pulse is 72 beats/min. There is some pain but not in
distress. There is crepitus at the knees with some tenderness with flexion and extension of the knees
which is mildly noted today. No effusion is clearly noted. No warmth of the knees noted. There are some
flexion contractures of the fingers as noted before. Elbow flexion contracture noted on the left side.

Assessment: As above with what appears to be continued progression of primary osteoarthritis of the
knees.

Prescription of Celebrex given. Note given for work today as well.

What is the overall E/M for this office visit?

A.
99215
B. 99214
C. 99213
D.
99212
Question 20
A 2-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician
performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician
documents a total time of 30 minutes on this critical infant in which the physician already subtracted the
time for the other billable services. Select the E/M service and procedures to report for the ER physician?
A. 99291-25, 36555, 31500
B. 99291-25, 36556, 31500,
82803
C. 99285-25, 36556, 31500,
82803
D. 99475-25, 36556
Question 21
Cardiologist Office Visit – New Patient
CC: CHEST ACHES-tightness
History: Patient has chest pain. Describes it as being tight. Shortness of breath and fatigue.
Occasional pain in both arms. Started with these symptoms a month ago. Has been under a lot of
pressure from work.
Family History: Sister with Wolf-Parkinson-White syndrome.
Review of Systems
Constitutional: Positive for fatigue
Respiratory: Positive for dyspnea
Cardiovascular: Negative for edema, orthopnea, PND; positive for chest pain, dyspnea,
palpitations
PHYSICAL EXAM
Vital Signs: BP 120/86 sitting, left arm
General/Constitutional: No apparent distress. Well-nourished and well developed.
Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions.
Neck/Thyroid: Supple, without adenopathy or enlarged thyroid.
Respiratory: Normal to inspection. Lungs clear to auscultation.
Cardiovascular: Regular rhythm. No murmurs gallops or rubs.
Assessment/Plan
Chest pain consistent with anxiety. Will need to order further tests to confirm.
EKG ordered. CBC ordered. Chest CT scan ordered.
Prescription given of isosorbide dinitrate (tablets) to relieve the chest pain.
What is the E/M visit and ICD-10-CM codes to report?
A. 99203,
R07.9
B. 99203, F41.9
C. 99204, F41.9
D. 99204,
R07.9
Question 22
A very large lipoma is removed from the chest measuring 8 sq cm and the defect is 12.2 cm requiring a
layered closure with extensive undermining. MAC is performed by a medically directed Certified
Registered Nurse Anesthetist (CRNA). Code the anesthesia service.
A. 00400-QX-
QS
B. 00400-QS
C. 00300-QS
D. 00300-QX-
QS
Question 23
PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE
DIAGNOSIS: Multivessel coronary artery disease. NAME OF PROCEDURE: Coronary artery bypass
graft x 3, left internal mammary artery to the LAD, saphenous vein graft to the obtuse marginal,
saphenous vein graft to the diagonal. The patient is placed on heart and lung bypass during the
procedure. Anesthesia time: 6:00 PM to 12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct
anesthesia code and anesthesia time?
A. 00567, 6 hours
B. 00566, 6 hours
C. 00567, 5 hours and 30 minutes
D. 00566, 5 hours and 30 minutes
Question 24
A CT density study is performed on a post-menopausal female to screen for osteoporosis. Today’s visit
the bone density study will be performed on the spine. Which CPT® code is reported?
A.
77075
 B. 77080
C. 77078
D.
72081
Question 25
The patient is 15-weeks pregnant with twins coming back to her obstetrician to have a transabdominal
ultrasound performed to reassess anatomic abnormalities of both fetuses that were previously
demonstrated in the last ultrasound. What ultrasound code(s) is (are) reported?
A. 76815
B. 76816, 76816-
59
C. 76801, 76802
D. 76805, 76810
Question 26
A patient is undergoing an aortogram in which the left femoral artery was cannulated with a catheter
advanced into the infrarenal abdominal aorta. Contrast medium was injected, and films were taken by
serialography. What CPT® codes are reported for the professional component?
A. 36200, 75625-26
B. 36200, 75630-26
C. 36200, 75605-26
D. 36200, 75635-26, 75716-
26
Question 27
A 53-year-old woman with ascites consented to a procedure to withdraw fluid from the abdominal cavity.
Ultrasonic guidance was used for guiding the needle placement for the aspiration. What CPT® coding is
reported?
A. 49083
B. 49180, 76942-26
C. 49082, 77002-26
D. 49180, 76998-
26
Question 28
Cells were taken from amniotic fluid for analyzation of the chromosomes for possible Down’s syndrome.
The geneticist performs the analysis with two G-banded karyotypes analyzing 30 cells. Select the lab
code(s) for reporting this service.
A. 88248
B. 88267, 88280, 88285
C. 88273, 88280, 88291
D. 88262, 88285
Question 29
Sperm is being prepared through a washing method to get it ready for the insemination of five oocytes for
fertilization by directly injecting the sperm into each oocyte. Choose the CPT® codes to report this
service.
 A. 89257,
89280
B. 89260, 89280
C. 89261, 89280
D. 89260,
89268
Question 30
A pathologist performs a comprehensive consultation and report after reviewing a patient’s records and
specimens from another facility. The correct CPT® code to report this service is:
A.
88325
B. 99244
C. 88323
D.
88329
Question 31
Patient with hemiparesis on the dominant side due to having a CVA lives at home alone and has a
therapist at his home site to evaluate meal preparation for self-care. The therapist observes the patient’s
functional level of performing kitchen management activities within safe limits. The therapist then teaches
meal preparation using one handed techniques along with adaptive equipment to handle different kitchen
appliances. The total time spent on this visit was 45 minutes. Report the CPT® and ICD-10-CM codes for
this encounter.
A. 97530 x 3, I67.89, G81.91
B. 97535 x 3, G81.90,
I69.959
C. 97530 x 3, I69.959, I67.89
D. 97535 x 3, I69.959
Question 32
A 10-year-old patient had a recent placement of a cochlear implant. She and her family see an audiologist
to check the pressure and determine the strength of the magnet. The transmitter, microphone and cable
are connected to the external speech processor and maximum loudness levels are determined under
programming computer control. Which CPT® code should be used?
A.
92601
B. 92603
C. 92604
D.
92562
Question 33
A cardiologist pediatrician sends a four week-old baby to an outpatient facility to have an echocardiogram.
The baby has been having rapid breathing. He is sedated and a probe is placed on the chest wall and
images are taken through the chest wall. A report is generated and sent to the pediatrician. The
interpretation of the report by the pediatrician reveals the baby has an atrial septal defect. Choose the
CPT® code the cardiologist pediatrician should report.
A. 93303
 B. 93315-
26
C. 93303-
26
D. 93315
Question 34
Glomerulonephritis is an inflammation affecting which system?
A. Digestive
B. Nervous
C. Urinary
D. Cardiovascular
Question 35
When a patient has fractured the proximal end of his humerus, where is the fracture located?
A. Upper end of the arm
B. Lower end of the leg
C. Upper end of the leg
D. Lower end of the
arm
Question 36
What is another term for when a physician performs a reduction on a displaced fracture?
A. Casting
B. Manipulation
C. Skeletal traction
D. External
fixation
Question 37
What does oligospermia mean?
A. Presence of blood in the
semen
B. Deficiency of sperm in semen
C. Having sperm in urine
D. Formation of spermatozoa
Question 38
Thoracentesis is removing fluid or air from the:
A. Lung
B. Chest cavity
C. Thoracic
vertebrae
D. Heart
Question 39
An angiogram is a study to look inside:
 A. Female Reproductive
System
B. Urinary System
C. Blood Vessels
D. Breasts
Question 40
When a person has labyrinthitis what has the inflammation?
A. Inner ear
B. Brain
C. Conjunctiva
D. Spine
Question 41
Patient is going back to the OR for a re-exploration L5-S1 laminectomy for a presumed cerebrospinal fluid
leak following a decompression procedure. A small partial laminectomy was slightly extended, however
revealed no real evidence of leak. Valsalva maneuver was performed several times, no evidence of leak.
There was a hematoma, which was drained. What ICD-10-CM code(s) is (are) reported by the physician?
A. G96.00
B. G97.61
C. G96.8
D. G96.00,
T81.4XXA
Question 42
A patient that has hypertensive heart disease with congestive heart failure is coded:
A. I11.0, I50.9
B. I13.0
C. I13.0, I11.0, I50.9
D. I50.9, I11.0
Question 43
A 10-year-old-male sustained a Colles’ fracture in which the pediatrician performs an application of short
arm fiberglass cast. Select the HCPCS Level II code that is reported for the cast.
A.
Q4012
B. A4580
C. A4570
D.
Q4024
Question 44
If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial
infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines?
A. As unspecified AMI
B. As a subendocardial
AMI
 C. As STEMI
D. As a NSTEMI
Question 45
Which place of service code is reported on the physician’s claim for a surgical procedure performed in an
ASC?
A.
21
B. 22
C. 24
D.
11
Question 46
A 35-year-old-female is getting a Levonorgestrel implant system with supplies. The HCPCS Level II code
for the implant is:
A. S4989
B. J7306
C.
A4264
D. J7301
Question 47
Local Coverage Determinations (LCD) are published to give providers information on which of the
following?
A. Information on modifier use with procedure codes
B. CPT® codes that are bundled
C. Fee schedule information listed by CPT® code
D. Reasonable and necessary conditions of coverage for an item or service
Question 48
PREOPERATIVE DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of Breast

PROCEDURE: Automated Stereotactic Biopsy Left Breast

INDICATIONS: Lesion is located in the lateral region, just at or below the level of the nipple on
the 90 degree lateral view. There is a subglandular implant in place. I discussed the procedure
with the patient today including risks, benefits and alternatives. Specifically discussed was the
fact that the implant would be displaced out of the way during this biopsy procedure. Possibility
of injury to the implant was discussed with the patient. Patient has signed the consent form and
wishes to proceed with the biopsy.
PROCEDURE DESCRIPTION: The patient was placed prone on the stereotactic table; the left
breast was then imaged from the inferior approach. The lesion of interest is in the anterior
portion of the breast away from the implant which was displaced back toward the chest wall.
After imaging was obtained and stereotactic guidance used to target coordinates for the biopsy,
the left breast was prepped with Betadine. 1% lidocaine was injected subcutaneously for local
anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling
needle. The SenoRx needle was then placed into the area of interest. Under stereotactic guidance
we obtained 9 core biopsy samples using vacuum and cutting technique. The specimen
radiograph confirmed representative sample of calcification was removed. The tissue marking
clip was deployed into the biopsy cavity successfully. This was confirmed by final stereotactic
digital image and confirmed by post core biopsy mammogram left breast. The clip is visualized
projecting over the lateral anterior left breast in satisfactory position. No obvious calcium is
visible on the final post core biopsy image in the area of interest. The patient tolerated the
procedure well. There were no apparent complications. The biopsy site was dressed with Steri-
Strips, bandage and ice pack in the usual manner. The patient did receive written and verbal post-
biopsy instructions. The patient left our department in good condition.
IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT BREAST
CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP
INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD
CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT
IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE RECEIVE THE
PATHOLOGY REPORT.
What CPT® coding is reported?
A. 19081
B. 19283
C. 19081, 19283
D. 19100,
19283
Question 49
PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee
POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial
synovial plica, right knee

PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right
knee.

ANESTHESIA: General

PROCEDURE DESCRIPTION: Patient placed in the supine position. 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
D. 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41
Question 50
Preoperative Diagnosis: Displaced odontoid fracture
Postoperative Diagnosis: Displaced odontoid fracture

Procedure: Open reduction of odontoid fracture

Indications: 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.

Procedure Description: 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
D.
22318

Question 51
A 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 hook wire 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, N63.20
B. 19285, C50.912
C. 19120, R92.8
D. 19125, D24.2
Question 52
A 53-year-old male is in the dermatologist's office for removal of 2 lesions located on his lower lip and
nose. Lesions were identified and marked. The lower lip lesion of 4 mm in size was shaved to the level of
the superficial dermis. Utilizing a 3-mm punch, a biopsy was taken of the left supratip nasal area. What
are the CPT® codes for these procedures?
A. 40490, 11104-59
B. 11310, 11104-59
C. 17000, 17003
D. 11440, 11105-59
Question 53
A 76-year-old has dermatochalasis on bilateral upper eyelids. The condition does not interfere with the
function of the eyelids. The patient agrees to surgery. The patient is here for a bilateral blepharoplasty. A
lower incision line was marked at approximately 5 mm above the lid margin along the crease. Then using
a pinch test with forceps the amount of skin to be resected was determined and marked. An elliptical
incision was performed on the left eyelid and the skin was excised. In a similar fashion the same
procedure was performed on the right eye. The wounds were closed with sutures. What CPT® coding is
reported?
A. 15822, 15823-51
B. 15823-50
C. 15822-50
D. 15820-LT, 15820-RT
Question 54
A 42-year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the
glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes,
about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was
inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The
rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted. Adhesions were destroyed with electrocautery and the
Bovie. The superior glenohumeral ligament, the middle glenohumeral ligament and the tendinous portion
of the subscapularis were released. The arthroscope was placed anteriorly, adhesions were destroyed
and the shaver was used to debride some of the posterior capsule and the posterior capsule was
released in its posterosuperior and then posteroinferior aspect. What CPT® code(s) is (are) reported?
A. 23450-LT
B. 23466-LT
C. 29805-LT, 29806-51-LT
D. 29825-LT
Question 55
After adequate anesthesia was obtained the patient was turned prone in a kneeling position on the spinal
table. A lower midline lumbar incision was made and the soft tissues divided down to the spinous
processes. The soft tissues were stripped away from the lamina down to the facets and discectomies and
laminectomies were then carried out at L3-4, L4-5 and L5-S1. Interbody fusions were set up for the lower
three levels using the Danek allografts and augmented with structural autogenous bone from the iliac
crest. The posterior instrumentation of a 5.5 mm diameter titanium rod was then cut to the appropriate
length and bent to confirm to the normal lordotic curve. It was then slid immediately onto the bone screws
and at each level compression was carried out as each of the two bolts were tightened so that the
interbody fusions would be snug and as tight as possible. Select the appropriate CPT® codes for this
visit?
A. 22612, 22614 x 2, 22842, 20938, 20930
B. 22533, 22534 x 2, 22842
C. 22630, 22632 x 2, 22842, 20938, 20930
D. 22554, 22632 x 2, 22842
Question 56
Patient has lung cancer in his upper right and middle lobes. Patient is in the operating suite to have a
video-assisted thoracoscopy surgery (VATS). A 10-mm-zero-degree thoracoscope is inserted in the right
pleural cavity through a port site placed in the ninth and seventh intercostal spaces. Lung was deflated.
The tumor is in the right pleural. Both lobes were removed thoracoscopically. Port site closed. A chest
tube was placed to suction and patient was sent to recovery in stable condition. Which CPT® code is
reported for this procedure?

A. 32482
B. 32484
C.
32670
D.
32671
Question 57
The patient is a 58-year-old white male, one month status post pneumonectomy. He had a post
pneumonectomy empyema treated with a tunneled cuffed pleural catheter which has been draining the
cavity for one month with clear drainage. He has had no evidence of a block or pleural fistula. Therefore a
planned return to surgery results in the removal of the catheter. The correct CPT® code is:
A. 32440-78
B. 32035-58
C. 32036-79
D. 32552-58
Question 58
This 67-year-old man presented with a history of progressive shortness of breath. He has had a diagnosis
of a secundum atrioseptal defect for several years, and has had atrial fibrillation intermittently over this
period of time. He was in atrial fibrillation when he came to the operating room, and with the patient
cannulated and on bypass, the right atrium was then opened. A large 3 x 5 cm defect was noted at fossa
ovalis, and this also included a second hole in the same general area. Both of these holes were closed
with a single pericardial patch. What CPT® and ICD-10-CM codes are reported?
A. 33675, Q21.0
B. 33647, Q21.1, R06.02
C. 33645, Q21.2, R06.02
D. 33641, Q21.1
Question 59
An 82-year-old female had a CAT scan which revealed evidence of a proximal small bowel obstruction.
She was taken to the Operating Room where an elliptical abdominal incision was made, excising the skin
and subcutaneous tissue. There were extensive adhesions along the entire length of the small bowel. The
omentum and bowel were stuck up to the anterior abdominal wall. Time consuming, tedious and spending
an extra hour to lysis the adhesions to free up the entire length of the gastrointestinal tract from the
ligament to Treitz to the ileocolic anastomosis. The correct CPT® code is:
A. 44005
B. 44180-22
C. 44005-22
D. 44180-59
Question 60
55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a
catheter placement. The endoscope is passed through the cricopharyngeal muscle area without difficulty.
Esophagus is normal, some chronic reflux changes at the esophagogastric junction noted. Stomach
significant distention with what appears to be multiple encapsulated tablets in the stomach at least 20 to
30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged due to
high grade narrowing in the pyloric channel, the duodenum was not examined. It seems to be a high
grade outlet obstruction with a superimposed volvulus. A repeat examination is not planned at this time.
What code should be used for this procedure?
A. 43246-
52
B. 43241-
52
C. 43235
D. 43191
Question 61
The patient is a 78-year-old white female with morbid obesity that presented with small bowel obstruction.
She had surgery approximately one week ago and underwent exploration, which required a small bowel
resection of the terminal ileum and anastomosis leaving her with a large inferior ventral hernia. Two days
ago she started having drainage from her wound which has become more serious. She is now being
taken back to the operating room. Reopening the original incision with a scalpel, the intestine was
examined and the anastomosis was reopened , excised at both ends, and further excision of intestine.
The fresh ends were created to perform another end- to-end anastomosis. The correct procedure code is:
A. 44120-78
B. 44126-79
C. 44120-76
D. 44202-58
Question 62
A 5-year-old male with a history of prematurity was found to have a chordee due to congenital
hypospadias. He presents for surgical management for a plastic repair in straightening the abnormal
curvature. Under general anesthesia, bands were placed around the base of the penis and incisions were
made degloving the penis circumferentially. The foreskin was divided in Byers flaps and the penile skin
was reapproximated at the 12 o’clock position. Two Byers flaps were reapproximated, recreating a
mucosal collar which was then criss- crossed and trimmed in the midline in order to accommodate
median raphe reconstruction. This was reconstructed with use of a horizontal mattress suture. The shaft
skin was then approximated to the mucosal collar with sutures correcting the defect. Which CPT® code
should be used?
A.
54304
B. 54340
C. 54400
 D.
54440
Question 63
A 22-year-old is 14 weeks pregnant and wants to terminate the pregnancy. She has consented for a D&E.
She was brought to the operating room where MAC anesthesia was given. She was then placed in the
dorsal lithotomy position and a weighted speculum was placed into her posterior vaginal vault. Cervix was
identified and dilated. A 6.5-cm suction catheter hooked up to a suction evacuator was placed and
products of conception were evacuated. A medium size curette was then used to curette her
endometrium. There was noted to be a small amount of remaining products of conception in her left
cornua. Once again the suction evacuator was placed and the remaining products of conception were
evacuated. At this point she had a good endometrial curetting with no further products of conception
noted. Which CPT® code should be used?
A.
59840
B. 59841
C. 59812
D.
59851
Question 64
A 37-year-old female has menorrhagia and wants permanent sterilization. The patient was placed in Allen
stirrups in the operating room. Under anesthesia the cervix was dilated and the hysteroscope was
advanced to the endometrium into the uterine cavity. No polyps or fibroids were seen. The Novasure was
used for endometrial ablation. A knife was then used to make an incision in the right lower quadrant and
left lower quadrant with 5-mm trocars inserted under direct visualization with no injury to any abdominal
contents. Laparoscopic findings revealed the uterus, ovaries and fallopian tubes to be normal. The
appendix was normal as were the upper quadrants. Because of the patient's history of breast cancer and
desire for no further children, it was decided to take out both the tubes and ovaries. This had been
discussed with the patient prior to surgery. What are the codes for these procedures?
A. 58660, 58353-
51
B. 58661, 58563-51
C. 58661, 58558-51
D. 58662, 58563-
51
Question 65
MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical
laminectomy at C3 through C6 and fusion. The edges of the laminectomy were then cleaned up with a
Kerrison and foraminotomies were done at C4, C5, and,C6. The stenosis is central; a facetectomy is
performed by using a burr. Nerve root canals were freed by additional resection of the facet, and
compression of the spinal cord was relieved by removal of a tissue overgrowth around the foramen.
Which CPT® code(s) is (are) used for this procedure?
A. 63045-50, 63048-50
B. 63020-50, 63035-50, 63035-
50
C. 63015-50
D. 63045, 63048 x 2
Question 66
An extracapsular cataract removal is performed on the right eye by manually using an iris expansion
device to expand the pupil. A phacoemulsification unit was used to remove the nucleus and irrigation and
aspiration was used to remove the residual cortex allowing the insertion of the intraocular lens. What
CPT® code is reported?
A.
66985
B. 66984
C. 66982
D.
66983
Question 67
An infant who has chronic otitis media in the right and left ears was placed under general anesthesia and
a radial incision was made in the posterior quadrant of the left and right tympanic membranes. A large
amount of mucoid effusion was suctioned and then a ventilating tube was placed in both ears. What
CPT® and ICD-10-CM codes are reported?
A. 69436-50, H65.33
B. 69436-50, H66.43
C. 69433-50,
H65.113
D. 69421-50, H65.33
Question 68
A 50-year-old patient is coming to see her primary care physician for hypertension. The patient
also discusses with her physician that the OBGYN office had just told her that her Pap smear came back
with an abnormal reading and is worried because her aunt had passed away with cervical cancer. The
physician documents she spent 55 minutes face-to-face counseling on the awareness, other screening
procedures and treatment if it turns out to be cervical cancer. What E/M code(s) is (are) reported for this
visit?
A. 99215,
99417
B. 99213, 99358
C. 99214, 99354
D. 99213
Question 69
A patient was admitted yesterday to the hospital for possible gallstones. The following day the physician
who admitted the patient performed a detailed history, a detailed exam and a medical decision making of
low complexity. The physician tells her the test results have come back positive for gallstones and is
recommending having a cholecystectomy. What code is reported for this evaluation and management
service for the following day?
A.
99253
B. 99221
C. 99233
D.
99234
Question 70
A patient came into the ER with wheezing and a rapid heart rate. The ER physician documents a
comprehensive history, comprehensive exam and medical decision of moderate complexity. The patient
has been given three nebulizer treatments. The ER physician has decided to place him in observation
care for the acute asthma exacerbation. The ER physician will continue examining the patient and will
order additional treatments until the wheezing subsides. Select the appropriate code(s) for this visit.
A. 99284,
99219
B. 99219
C. 99284
D. 99235
Question 71
A 6-month-old patient is administered general anesthesia to repair a cleft palate. What anesthesia code(s)
is (are) reported for this procedure?
A. 00170,
99100
B. 00172
C. 00172, 99100
D. 00176
Question 72
A 50-year-old female had a left subcutaneous mastectomy for cancer. She now returns for reconstruction
which is done with a single TRAM flap. Right mastopexy is done for asymmetry. Select the anesthesia
code for this procedure.
A.
00404
B. 00402
C. 00406
D.
00400
Question 73
A patient is having knee replacement surgery. The surgeon requests that in addition to the general
anesthesia for the procedure that the anesthesiologist also insert a continuous lumbar epidural infusion
for postoperative pain management. The anesthesiologist performs postoperative management for two
postoperative days.
A. 01400-AA, 62326, 01996 x
2
B. 01402-AA, 62327, 01966 x 2
C. 01402-AA, 62326, 01996 x 2
D. 01404-AA, 62327
Question 74
A 35-year-old male sees his primary care physician complaining of fever with chills, cough and
congestion. The physician performs a chest X-ray taking lateral and AP views in his office. The physician
interprets the X-ray views and the patient is diagnosed with walking pneumonia. Which CPT® code is
reported for the chest X-rays performed in the office and interpreted by the physician?
A. 71046-26
 B. 71047-26
C. 71046
D. 71045-26-
TC
Question 75
This gentleman has localized prostate cancer and has chosen to have complete transrectal
ultrasonography performed for dosimetry purposes. Following calculation of the planned transrectal
ultrasound, guidance was provided for percutaneous placement of 1-125 seeds. Select the appropriate
codes for this procedure.
A. 55920, 76965-
26
B. 55876, 76942-26
C. 55860, 76873-26
D. 55875, 76965-
26
Question 76
A 76-year-old female had a ground level fall when she tripped over her dog earlier this evening in her
apartment. The Emergency Department took X-rays of the left wrist in oblique and lateral views which
revealed a displaced distal radius fracture, type I open left wrist. What radiological service and ICD-10-
CM codes are reported?
A. 73100-26, S52.502B, W18.31XA,
Y92.039
B. 73110-26, S52.602A, W18.31XA,
Y92.039
C. 73115-26, S52.502A, W18.31XA,
Y92.039
D. 73100-26, S52.602B, W18.31XA,
Y92.039
Question 77
An 18-year-old female with a history of depression comes into the ER in a coma. The ER physician orders
a drug screen on antidepressants, phenothiazines, and benzodiazepines. The lab performs a screening
for single drug class using an immunoassay in a random access chemistry analyzer. Presence of
antidepressants is found and a drug confirmation is performed to identify the particular antidepressant.
What correct CPT® codes are reported?
A. 80307, 80338
B. 80305, 80338
C. 80306 x 3, 80332
D. 80307 x 3,
80333
Question 78
A patient uses Topiramate to control his seizures. He comes in every two months to have a therapeutic
drug testing performed to assess serum plasma levels of this medication. What lab code(s) is (are)
reported for this testing?
A. 80305
 B. 80375
C. 80201
D. 80306,
80375
Question 79
Patient that is a borderline diabetic has been sent to the laboratory to have an oral glucose tolerance test.
Patient drank the glucose and five blood specimens were taken every 30 to 60 minutes up to three hours
to determine how quickly the glucose is cleared from the blood. What code(s) is (are) reported for this
test?
A. 82947 x 5
B. 82946
C. 80422
D. 82951, 82952 x
2
Question 80
A patient with severe asthma exacerbation has been admitted. The admitting physician orders a blood
gas for oxygen saturation only. The admitting physician performs the arterial puncture drawing blood for a
blood gas reading on oxygen saturation only. The physician draws it again in an hour to measure how
much oxygen the blood is carrying. Select the codes for the blood gas testing.
A. 82805, 82805-
51
B. 82810, 82810-91
C. 82803, 82803-51
D. 82805, 82805-
90
Question 81
A new patient is having a cardiovascular stress test done in his cardiologist’s office. Before the test is
started the physician documents a medically appropriate history, examination, and moderate complexity
medical decision making. The physician will be supervising and interpreting the stress on the patient’s
heart during the test. What procedure codes are reported for this encounter?
A. 93015-26, 99204-25
B. 93016, 93018, 99204-
25
C. 93015, 99204-25
D. 93018-26, 99204-25
Question 82
A cancer patient is coming in to have a chemotherapy infusion. The physician notes the patient is
dehydrated and will first administer a hydration infusion. The infusion time was 1 hour and 30 minutes.
Select the code(s) that is (are) reported for this encounter?
A. 96360
B. 96360, 96361
C. 96365, 96366
D. 96422
Question 83
A patient that has multiple sclerosis has been seeing a therapist for four visits. Today’s visit the therapist
will be performing a comprehensive reevaluation to determine the extent of progress. There was a revised
plan assessing the changes in the patient's functional status. Initial profile was updated to reflect changes
that affect future goals along with a revised plan of care. A total care of 30 minutes were spent in this re-
evaluation. What CPT® and ICD-10-CM codes should be reported?
A. 97168, Z51.89,
G35
B. 97164, Z56.89, G35
C. 97167, G35
D. 97163, Z56.9, G35
Question 84
What is the term used for inflammation of the bone and bone marrow?
A.
Chondromatosis
B. Osteochondritis
C. Costochondritis
D. Osteomyelitis
Question 85
The root word trich/o means:
A. Hair
B. Sebum
C. Eyelid
D.
Trachea
Question 86
Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________.
A. Medulla lobe
B. Occipital
lobe
C. Middle lobe
D. Inferior lobe
Question 87
A patient is having pyeloplasty performed to treat an uretero-pelvic junction obstruction. What is being
performed?
A. Surgical repair of the bladder
B. Removal of the kidney
C. Cutting into the ureter
D. Surgical reconstruction of the renal pelvis
Question 88
A 27-year-old was frying chicken when an explosion of the oil had occurred and she sustained second-
degree burns on her face (5%), third degree burns on both hands (5%). There was a total of 10 percent of
the body surface that was burned. Select which ICD-10-CM codes are reported.
A. T20.20XA, T23.301A, T23.302A, T31.10, X10.2XXA,
Y93.G3
B. T23.301A, T23.302A, T20.20XA, T31.11, X10.2XXA, Y93.G3
C. T23.301A, T23.302A, T20.20XA, T31.10, X10.2XXA, Y93.G3
D. T23.601A, T23.602A, T20.60XA, T31.10, X10.2XXA,
Y93.G3
Question 89
A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic
esophageal varices. The ICD-10-CM codes are reported:
A. I85.01,
K74.69
B. I85.11, K74.60
C. K74.60, I85.11
D. I85.00,
K74.69
Question 90
A 55-year-old-patient had a fracture of his left knee cap six months ago. The fracture has healed but he
still has staggering gait in which he will be going to physical therapy. What ICD-10-CM codes are
reported?
A. S82.002A,
R26.81
B. R26.0, S82.002A
C. S82.092S, R26.0
D. R26.0, S82.002S
Question 91
Which statement is TRUE about Z codes:
A. Z codes are never reported as a primary code.
B. Z codes are only reported with injury codes.
C. Z codes may be used either as a primary code or a secondary
code.
D. Z codes are always reported as a secondary code.
Question 92
Patient with corneal degeneration is having a cornea transplant. The donor cornea had been previously
prepared by punching a central corneal button with a guillotine punch. This had been stored in Optisol
GS. It was gently rinsed with BSS Plus solution and was then transferred to the patient’s eye on a Paton
spatula and sutured with 12 interrupted 10-0 nylon sutures. Select the HCPCS Level II code for the
corneal tissue.
A.
V2790
B. V2785
C. V2628
D.
V2799
Question 93
The patient presents to the office for an injection. Joint prepped using sterile technique. Muscle group
location: gluteus maximus. Sterilely injected with 40 mg of Kenalog-10, 2 cc Marcaine and 2 cc lidocaine
2%. Sterile bandage applied. Choose the HCPCS Level II code for this treatment.
A. J3301 x 4
B. J3301
C. J3300 x 40
D. J3300
Question 94
Which health plan does NOT fall under HIPAA?
A. Medicaid
B. Medicare
C. Workers’
compensation
D. Private plans
Question 95
Which statement is an example in which a diabetes-related problem exists and the code for diabetes is
NEVER sequenced first?
A. If the patient has an underdose of insulin due to an insulin pump malfunction.
B. If the patient is being treated for secondary diabetes.
C. If the patient is being treated for Type 2 diabetes and uses insulin.
D. If the patient is diabetic with an associated condition.
Question 96
Which of the following is an example of electronic data?
A. A digital X-ray
B. An explanation of benefits
C. An advance beneficiary notice
D. A written prescription
Question 97
Guidelines from which of the following code sets are included as part of the code set requirements under
HIPAA?
A. CPT® Category III
codes
B. ICD-10-CM
C. HCPCS Level II
D. ADA Dental Codes
Question 98
PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna.
POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna.

PROCEDURE: Reduction with application of an external fixation system, left wrist fracture

INDICATIONS: The patient is a 46 year-old right-hand-dominant female who fell off stairs 4 to 5 days ago
sustaining an impacted distal radius fracture with possible intraarticular component and an associated
ulnar styloid fracture. Today in surgery, fracture was reduced anatomically and an external fixation system
was applied.

PROCEDURE DESCRIPTION: Under satisfactory general anesthesia, the fracture was manipulated and
C-arm images were checked. The left upper extremity was prepped and draped in the usual sterile
orthopedic fashion. Two small incisions were made over the second metacarpal and after removing soft
tissues including tendinous structures out of the way, drawing was carried out and blunt-tipped pins were
placed for the EBI external fixator. The frame was next placed and the site for the proximal pins was
chosen. Small incision was made. Subcutaneous tissues were carried out of the way. The pin guide was
placed and 2 holes were drilled and blunt-tipped pins placed. Fixator was assembled. C-arm images were
checked. Fracture reduction appeared to be anatomic. Suturing was carried out where needed with 4-0
Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings were applied.
Vascular supply was noted to be satisfactory. Final frame tightening was carried out.

What CPT® coding is reported?

A. 25600-LT, 20692-51
B. 25605- LT, 20690-
51
C. 25606-LT
D. 25607-LT
Question 99
Preoperative Diagnosis: Syncope. Symptomatic Bradycardia.
Postoperative Diagnosis: Bradycardia

Procedure: Insertion DDD Pacemaker

Anesthesia: Moderate Sedation

Procedure Description: Left subclavian venipuncture was carried out. A guide wire was passed through
the needle, and the needle was withdrawn. A second subclavian venipuncture was performed, a second
guide wire was passed and the second needle was withdrawn. An oblique incision in the deltopectoral
area incorporating the wire exit sites. A subcutaneous pocket was created with the cautery on the
pectoralis fascia. An introducer dilator was passed over the first wire and the wire and dilator were
withdrawn. A ventricular lead was passed through the introducer, and the introducer was broken away in
the routine fashion. A second introducer dilator was passed over the second guide wire and the wire and
dilator were withdrawn. An atrial lead was passed through the introducer and the introducer was broken
away in the routine fashion. Each of the leads were sutured down to the chest wall with two 2-0 silk
sutures each, connected the leads to the generator, curled the leads, and the generator was placed in the
pocket. We assured hemostasis. We assured good position with the fluoroscopy.

What CPT® coding is reported?

A. 33208
B. 33212
C. 33226
D. 33235, 71090-
26
Question 100
PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula
POST OPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula

PROCEDURE: Hartmann procedure, which is a sigmoid resection with Hartmann pouch and colostomy.
DESCRIPTION OF THE PROCEDURE: Patient was prepped and draped in the supine position under
general anesthesia. Prior to surgery patient was given 4.5 grams of Zosyn and Rocephin IV piggyback. A
lower midline incision was made, abdomen was entered. Upon entry into the abdomen, there was an
inflammatory mass in the pelvis and there was a large abscessed cavity, but no feces. The abscess cavity
was drained and irrigated out. The left colon was immobilized, taken down the lateral perineal
attachments. The sigmoid colon was mobilized.

There was an inflammatory mass right at the area of the sigmoid colon consistent with a diverticulitis or
perforation with infection. Proximal to this in the distal left colon, the colon was divided using a GIA stapler
with 3.5 mm staples. The sigmoid colon was then mobilized using blunt dissection. The proximal rectum
just distal to the inflammatory mass was divided using a GIA stapler with 3.5 mm staples. The mesentery
of the sigmoid colon was then taken down and tied using two 0 Vicryl ties. Irrigation was again performed
and the sigmoid colon was removed with inflammatory mass.

The wall of the abscessed cavity that was next to the sigmoid colon where the inflammatory mass was,
showed no leakage of stool, no gross perforation, most likely there is a small perforation in one of the
diverticula in this region. Irrigation was again performed throughout the abdomen until totally clear. All
excess fluid was removed. The distal descending colon was then brought out through a separate incision
in the lower left quadrant area and a large 10 mm 10 French JP drain was placed into the abscessed
cavity. The sigmoid colon or the colostomy site was sutured on the inside using interrupted 3-0 Vicryl to
the peritoneum and then two sheets of film were placed into the intra- abdominal cavity. The fascia was
closed using a running #1 double loop PDS suture and intermittently a #2 nylon retention suture was
placed. The colostomy was matured using interrupted 3-0 chromic sutures. I palpated the colostomy; it
was completely patent with no obstructions. Dressings were applied. Colostomy bag was applied.

Which CPT® code is reported?

A.
44140
B. 44143
C. 44160
D.
44208