20k answers

1. A

2. C

3. C

4. A

5. C

6 C The injection of is being performed in a joint, eliminating multiple choice answers B and D. The
injection was performed on the sacroiliac joint with imaging confirmation eliminating multiple choice
answer A. Arthrography was not performed; therefore, fluoroscopic guidance is reported with
77003-26 as noted in the notes below 27096.

7 C The mass growing turned out to be a lipoma found in the subcutaneous tissue of the flank. In the
ICD-9-CM alphabetic index, look up Lipoma/subcutaneous tissue. You are referred to code 214.1,
eliminating multiple choice answers A and D. Since the 4 cm tumor was found in the subcutaneous
tissue code 21931 is the correct code to report.

8 D 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.

9 C To start narrowing the correct arthrodesis code to report, you first need to determine the
approach. The scenario tells us that the patient was placed in prone position (lying face down) and a
lumbar incision was made indicating a posterior approach, eliminating multiple choices B and D. The
next bit of information to look for is the technique that was used for the arthrodesis, which was the
interbody fusion technique guiding you to code 22630.

10 D To start narrowing down your choices was the procedure an open procedure or performed
with an arthroscope? It was performed with an arthroscope, eliminating multiple choice answers A
and B. The diagnostic arthroscopy (29805) is a separate procedure, and 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”. Meaning
code 29806 already includes the diagnostic arthroscopy code, so you would only report code 29806.
Code 29806 represents suturing of the capsule (capsulorrhaphy); however, this was not the
procedure performed. The procedure performed was a lysis of adhesions for a frozen shoulder
(29825) noted in multiple choice answer D.

11 B In the beginning of the procedure note it documents, “the fracture was manipulated”,
eliminating multiple choice answer A. Was the fracture treatment opened or closed? There is no
indication in the op note that an incision was made for internal fixation, eliminating multiple choice
answer D. The key words to choose the correct code between B and C is “external fixator” where
pins are connected to bone and to an external fixator to help the fracture heal. The fixator was a
uniplane system as only one external fixator was applied in one plane (20690).

12 A Patient had an open reduction, meaning an incision was made to get to the fracture,
eliminating multiple choice answer B. The fracture site was the scaphoid of the wrist (carpal),
eliminating multiple choices C and D.

13. A The patient is having a fasciectomy, eliminating multiple choice answers C and D. The
fasciectomy was performed on the hand as noted in “the fascial attachments to the flexor tendon
sheath were released” and “subtotal palmar fasciectomy” The op note also mentions the middle
finger where diseased fascia was also excised.

14 D Your keywords in the scenario to narrow your choices down to code 27485 are: “genu valgum”
and “hemiepiphysiodesis”

15 C For this op note scenario only the meniscus was performed on, eliminating multiple choice
answers A and D. There are two ways to choose the correct codes for this op note. One way, is
procedure 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.” 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. Debridement was performed in the
lateral and patellofemoral compartments; therefore, it is reported with 29822. Modifier -59 is
appended to show a different compartment from the compartment for the meniscectomy. The
diagnosis of chondromalacia (733.92) for the fibrillated articular cartilage of the tibial plateau and
patella (717.7) are report with the debridement. The other way to choose the correct code for this
procedure is by the diagnoses. The patient had a meniscus tear, but the op 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”, indexed in the ICD-9-CM as Tear/meniscus/medial/posterior
horn/old.

16. D. 26676-F1 reports the percutaneous skeletal fixation of a finger (carpometacarpal) with
manipulation. The modifier -F1 indicates the second digit, left hand the index finger.
17. A. 27524-RT is an open surgical procedure ("...the area was opened...") that includes the
placement of internal fixation ("The remaining patella fractures were wired") with -RT to indicate
right side. 822.0 is a closed fracture of the patella; no indication was made that the fracture was
open (the bones sticking through the skin). If not stated as open or closed, the fracture is reported as
closed. E880.1 reports a fall on or from a sidewalk or curb.

18. C. 27756-RT reports the percutaneous skeletal fixation of the shaft of the tibia by means of
screws and pins. The modifier -RT indicates the right side. S82.201A Unspecified fracture of shaft of
right tibia, and W10.8XXA indicates Fall (on) (from) other stairs and steps, initial encounter.

19. B. 21435 reports an open treatment of a craniofacial separation, referred to as a LeFort III type,
that includes wiring and may include internal fixation. The halo device is included in the code (see
code description for full text) and is not reported separately.

20. C. 20692-LT reports the application of a unilateral multiplane external fixation device, with LT to
indicate the left side. 823.80 is assigned to report a tibial fracture when the exact site on the tibia is
not specified in the record. E828.2 is assigned to report a rider thrown from a horse.

21. A. 20650-LT reports the skeletal insertion of pins or wires to affix a traction device to stabilize a
fracture temporarily. This code includes the later removal of the device.

22. D. 20612-LT reports the first injection and 20612-59-LT reports the second injection. See the CPT
instructional notes regarding the use of these codes. Modifier LT is correctly used to indicate the left
side. As per the note following 20612, -59 is used to indicate multiple injections. 727.42 is assigned
to a ganglion cyst of the tendon sheath.

23. A. 29040 is assigned to report the application of a fiberglass body cast that goes from the hips to
the head.

24. C. 24515-LT. Open treatment of humeral shaft fracture with plates/screws with LT to indicate the
left side; 812.30, open fracture of humerus, site not specified; and E887 fracture, cause not specified
in report.

25. C. 27301-LT indicates an incision and drainage of a deep abscess of the thigh or knee region.
L03.116 is cellulitis of the left leg.
26. D. 27096 is the correct code because a steroid injection (Celestone and Marcaine) is placed
into the sacroiliac (SI) joint. Fluoroscopic and computed tomography (CT) guidance is included and is
not reported separately. There is a parenthetical note under the code description that states: (27096
is to be used only with CT or fluoroscopic imaging confirmation of the intra-articular needle
positioning).

27. C. The fracture of the lateral condyle is closed because the scenario does not mention that it
is open fracture or documents that a piece of bone has broken through the skin and is exposed. In
the ICD-10-CM Index to Diseases and Injuries, look for Fracture, traumatic/humerus/lower
end/condyle/lateral (displaced). You are referred to code S42.45-. Go to the Tabular List to report
the seventh character extender.The seventh character extenders for this code are listed under
category code S42. The fracture is closed you have eliminated multiple choice answers A and D.

a. The next step is to figure out if the CPT fracture care is an opened or closed treatment. Hint:
The surgeon made "an incision" to get to the fracture site. Code 24579 is the correct code because
this was an open treatment due to the surgeon making an incision to get to the fracture site and
performing an internal fixation (two pins). Open reduction reduction and internal fixation (ORIF) is
also an indication that an open approach is used to perform the surgery.

28. C. The keyword in this op note is “discectomy,” which in this scenario is a removal of the
herniated disk in the cervical spine (neck). Eliminating multiple choice B. There is no documentation
of the vertebrae being fused together (arthrodesis), eliminating Multiple choice D. The scenario
documents end plates were decorticated to insert an artificial disk (Kineflex-C device) to replace the
cervical disk that was removed, guiding you to code 22856.

29. A. Tenodesis is suturing of the end a tendon to a bone. There is a ruptured distal biceps
tendon at the proximal end of the radius which is a tendon injured around the elbow joint,
eliminating multiple choice B. This also eliminates multiple choice C, a long tendon bicep runs over
the top of the humerus bone (upper arm) and attaches to the top of the shoulder. There is no
documentation of a resection or transplantation of a bicep tendon, eliminating multiple D.

30. D. Trigger point is your key term in this scenario, eliminating choice C. Trigger points are
coded by the number of muscles that the injections are performed on, not by the number of trigger
point injections. The scenario tells you that six trigger points were injected into four muscle groups
which lead you to the procedure code 20553

31. B. One way to start finding the correct answer is to look up the diagnosis in the ICD-10-CM
codebook. It is indexed under Fracture, traumatic/femur/shaft/which refers you to code S72.30-. In
the Tabular List the complete code is S72.301B, for right femur, type 1 open fracture eliminating
codes C and D. The only difference between choices A and B are the second procedure codes. Code
11012 is the correct code because extensive debridement was performed all the way to the bone on
an open fracture.
32. A. This patient is having a mass removed from the shoulder area, eliminating multiple choice
B, which is a biopsy. This is not a radical resection because that includes removal of the entire tumor
along with large surrounding tissue, including adjacent lymph nodes. The size of the mass that was
excised was 4.5 cm, which leads you to code 23076.

33. A. This surgery is being performed by arthroscopy, eliminating multiple choice answer C,
which is an open procedure code without using any type of scope. Our next clue is that a
“subacromial decompression” with release of the coracoacromial ligament was performed, which
leads you to code 29826. The scenario does not mention that the physician lyses and resects
adhesions, eliminating multiple choice answers B and D. 29824 is performed when the physician
grinds off (technique used to remove) 10 mm of “distal clavicle” due to a cyst.

34. B. One way to narrow down the choices is to code for the diagnosis first, which is a medial
meniscus tear of the left knee. In the ICD-10-CM Index to Diseases and Injuries, look for
Tear/meniscus/medial/bucket-handle; you are referred to code S83.21-. Complete code in the
Tabular List, S83.212A. You eliminated choices C and D. 29881 (medial OR lateral) is the correct
procedure code, since the menisectomy (removing torn fragments) was performed on the medial
meniscus only.

35. A. Codes are 27758 and 27759 are not reported with this scenario because the fracture is
not an acute traumatic fracture. The physician is repairing a nonunion tibia fracture (failure of two
ends of a fracture to completely heal). Eliminating multiple choices B and D. To select the correct
choice you need to find out what type of graft was used. Your hints are “bone grafting” and “iliac
crest,” which leads you to the code 27724. The bone graft was harvested from the iliac crest, and
then the graft is placed at the fracture site of the tibia compressing it for desired position and
alignment and the screws were used to stabilize the fracture. In the ICD-10-CM Index to Diseases
and Injuries, look for Nonunion/fracture-see Fracture, by site. Look for Fracture,
traumatic/tibia/upper end referring you to code S82.10-. Compete code in the Tabular List,
S82.102N. ICD-10-CM Coding Guideline, I.C.19.c.1, indicates Care of complications of fractures, such
as malunion and nonunion, should be reported with the appropriate 7th character for subsequent
care with nonunion (K, M, N) or subsequent care with malunion (P, Q, R).