MOCK TEST 3

1. OPERATIVE REPORT
OPERATIVE PROCEDURE: Excision of back lesion.
INDICATIONS FOR SURGERY: The patient has an enlarging lesion on the upper midback. FINDINGS AT
SURGERY: There was a 5-cm, upper midback lesion. OPERATIVE PROCEDURE: With the patient prone, the
back was prepped and draped in the usual sterile fashion. The skin and underlying tissues were
anesthetized with 30 mL of 1% lidocaine with epinephrine. Through a 5-cm transverse skin incision, the
lesion was excised. Homeostasis was ensured. The incision was closed using 3-0 Vicryl for the deep layers
and running 3-0 Prolene subcuticular stitch with Steri-Strips for the skin. The patient was returned to the
same-day surgery center in stable postoperative condition. All sponge, needle, and instrument counts
were correct. Estimated blood loss is 0 mL. PATHOLOGY REPORT LATER INDICATED: Follicular cyst,
infundibular type, skin of back.
A.11406, 12002 B.11424 C.11406, 12032 D.11606

2. EMERGENCY DEPARTMENT REPORT CHIEF COMPLAINT: Nasal bridge laceration.

SUBJECTIVE: The patient is a 74- year-old male who presents to the emergency department with a
laceration to the bridge of his nose. He fell in the bathroom tonight. He recalls the incident. He just sort of
lost his balance. He denies any vertigo. He denies any chest pain or shortness of breath. He denies any
head pain or neck pain. There was no loss of consciousness. He slipped on a wet floor in the bathroom and
lost his balance; that is how it happened. He has not had any blood from the nose or mouth.PAST
MEDICAL HISTORY:
1. Parkinson’s
2. Back pain
3. Constipation
MEDICATIONS: See the patient record for a complete list of medications.
ALLERGIES: NKDA.
REVIEW OF SYSTEMS: Per HPI. Otherwise, negative.
PHYSICAL EXAMINATION: The exam showed a 74-year-old male in no acute distress. Examination of the
HEAD showed no obvious trauma other than the bridge of the nose, where there is approximately a 1.5-
to 2-cm laceration. He had no bony tenderness under this. Pupils were equal, round, and reactive.
EARS and NOSE: OROPHARYNX was unremarkable. NECK was soft and supple. HEART was regular.
LUNGS were clear but slightly diminished in the bases.
PROCEDURE: The wound was draped in a sterile fashion and anesthetized with 1% Xylocaine with
sodium bicarbonate. It was cleansed with sterile saline and then repaired using interrupted 6-0 Ethilon
sutures (Dr. Barney Teller, first-year resident, assisted with the suturing).
ASSESSMENT: Nasal bridge laceration, status post fall.
Plan: Keep clean. Sutures out in 5 to 7 days. Watch for signs of infection.
A.12051, S01.20XA B.12011, S01.20XA
C.12011, S01.23XA D.12011, 11000, S01.23XA

3. SAME-DAY SURGERY
DIAGNOSIS: Inverted nipple with mammary duct ectasia, left. OPERATION: Excision of mass deep to left
nipple. With the patient under general anesthesia, a circumareolar incision was made with sharp
dissection and carried down into the breast tissue. The nipple complex was raised up using a small
retractor. We gently dissected underneath to free up the nipple entirely. Once this was done, we had the
nipple fully unfolded, and there was some evident mammary duct ectasis. An area 3 X 4 cm was excised
using electrocautery.Hemostasis was maintained with the electrocautery, and then the breast tissue deep
to the nipple was reconstructed using sutures of 3-0 chromic. Subcutaneous tissue was closed using 3-0
chromic, and then the skin was closed using 4-0 Vicryl. Steri-Strips were applied. The patient tolerated
the procedure well and was returned to the recovery area in stable condition. At the end of the procedure,
all sponges and instruments were accounted for.
A.19120-RT, N60.49 B.11404-LT, N60.39
C.19112, N60.49 D.19120-LT, N60.49
4. This patient returns today for palliative care to her feet. Her toenails have become elongated and
thickened, and she is unable to trim them on her own. She states that she has had no problems and no
acute signs of any infection or otherwise to her feet. She returns today strictly for nail debridement to her
feet.
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EXAMINATION: Her pedal pulses are palpable bilaterally. The nails are mycotic, 1 through 4 on the left,
and 1 through 3 on the right.
ASSESSMENT: Onychomycosis, 1 through 4 on the left and 1 through 3 on the right.
PLAN: Mild debridement of mycotic nails X7. This patient is to return to the clinic in 3 to 4 months for
follow-up palliative care.
A.11721 X7, B48.8 B.99212, 11721, B35.1
C. 11719, B35.1 D.11721, B35.1

5. OPERATIVE REPORT
With the patient having had a wire localization performed by radiology, she was taken to the operating
room and, under local anesthesia of the left breast, was prepped and draped in a sterile manner. A breast
line incision was made through the entry point of the wire, and a core of tissue surrounding the wire
(approximately 1 2 cm) was removed using electrocautery for hemostasis. The specimen, including the
wire, was then submitted to radiology, and the presence of the lesion within the specimen was confirmed.
The wound was checked for hemostasis, and this was maintained with electrocautery. The breast tissue
was reapproximated using 2-0 and 3-0 chromic. The skin was closed using 4-0 Vicryl in a subcuticular
manner. Steri-Strips were applied. The patient tolerated the procedure well and was discharged from the
operating room in stable condition. At the end of the procedure, all sponges and instruments were
accounted for. Pathology report later indicated: Benign lesion.
A.11602-LT, D24.1 B.11400-LT, D24.2
C.19125-LT, D24.2 D.19125-LT, D24.1

6. The patient is brought to surgery for an open wound of the left thigh, the total extent measuring
approximately 40 X 35 cm.
DESCRIPTION OF PROCEDURE: The legs were prepped with Betadine scrub and solution and then draped
in a routine sterile fashion. Split-thickness skin grafts measuring about a 10,000th inch thick were taken
from both thighs, meshed with a 3:1 ratio mesher, and stapled to the wounds. The donor sites were
dressed with scarlet red, and the recipient sites were dressed with Xeroform, Kerlix fluffs, and Kerlix roll,
and a few ABD pads were used for absorption. Estimated blood loss was negligible. The patient tolerated
the procedure well and left surgery in good condition.
A.15120, 15121 X 12, B.15100, 15101, 11010,
C.15220, 15221 X 13, D.15100, 15101 X 13,

7. Carl Ostrick, a 21-year -old male, slipped on a patch of ice on his sidewalk while shoveling snow. When
he fell, his left hand was wedged under his body and his carpometacarpal joint was dislocated. After
manipulating the joint back into normal alignment, the surgeon fixed the dislocation by placing a wire
percutaneously through the carpometacarpal joint to maintain alignment.
A.26608-F1 B.26650-FA C.26706-LT D.26676-LT

8. John, an 84-year-old male, tripped while on his morning walk. He stated he was thinking about
something else when he inadvertently tripped over the sidewalk curb and fell to his knees. X-ray
indicated a fracture of his right patella. With the patient under general anesthesia, the area was opened
and extensively irrigated. The left aspect of the patella was severely fragmented, and a portion of the
patella was subsequently removed. The remaining patella fractures were wired. The surrounding tissue
was repaired, thoroughly irrigated, and closed in the usual manner.
A.27524-RT, S82.001A B.27520-RT, S82.009A
C.27524-RT, S82.009A D.27524-RT, S82.002A

9. Maryann received a blow to her right tibial shaft while moving a large stuffed chair up a flight of stairs
when the person in front of the chair slipped and released his hold on the chair. The full weight of the
chair was pushed against her; when she was unable to hold the chair in place, both she and the chair fell
to the landing a dozen steps below. The chair tipped on its side and landed on her tibia. On x -ray, the
right tibia shaft was fractured in three places. Percutaneous screws and pins were placed to secure the
fracture sites.
A.27750-RT, S82.209A B.27756-RT, S82.202A
C.27756-RT, S82.201A D.27750-RT, S82.201A
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 MOCK TEST 3

10. Darin was a passenger in an automobile rollover accident and was not wearing a seat belt at the time.
He was thrown from the automobile and was pinned under the rear of the overturned vehicle. He
sustained craniofacial separation that required complicated internal and external fixation using an open
approach to repair the extensive damage. A halo device was used to hold the head immobile.
A.21435, 20661 B.21435 C.21432 D.21436, 20661

11. Libby was thrown from a horse while riding in the ditch; a truck that honked the horn as it passed her
startled her horse. The horse reared up, and Libby was thrown to the ground. Her left tibia was fractured
and required insertion of multiple pins to stabilize the defect area. A unilateral multiplane external
fixation system was then attached to the pins. Code the placement of the fixation device and diagnosis
only.
A.20661-LT, S82.201A B.20692-LT, S82.202A
C.20692-LT, S82.201A D.20690-LT, S82.209A

12. A small incision was made over the left proximal tibia, and a traction pin was inserted through the
bone to the opposite side. Weights were then affixed to the pins to stabilize the tibial fracture temporarily
until fracture repair could be performed.
A.20650-LT B.20663-LT C.20690-LT D.20692-LT

13. OPERATIVE REPORT

Code only the operative procedure and diagnosis (es).
PREOPERATIVE DIAGNOSIS:
1. Hypoxia
2. Pneumothorax
POSTOPERATIVE DIAGNOSIS:
1. Hypoxia
2. Pneumothorax
PROCEDURE: Chest tube placement
DESCRIPTION OF PROCEDURE: The patient was previously sedated with Versed and paralyzed with
Nimbex. Lidocaine was used to numb the incision area in the midlateral left chest at about nipple level.
After the lidocaine, an incision was made, and we bluntly dissected to the area of the pleural space,
making sure we were superior to the rib. On entrance to the pleural space, there was immediate release of
air noted. An 18-gauge chest tube was subsequently placed and sutured to the skin.There were no
complications for the procedure, and blood loss was minimal. DISPOSITION: Follow-up, single-view, chest
x-ray showed significant resolution of the pneumothorax except for a small apical pneumothorax that was
noted.
A.32551, R09.2, J93.9 B.32036, 71045, R09.01, J93.9
C.32551, J93.9, R09.02 D.32422, R09.01, 512.0

14. OPERATIVE PROCEDURE

PREOPERATIVE DIAGNOSIS: 68-year-old male in a coma. POSTOPERATIVE DIAGNOSIS: 68-year-old male
in a coma.
PROCEDURE PERFORMED: Placement of a triple lumen central line in right subclavian vein. With the
usual Betadine scrub to the right subclavian vein area and with a second attempt, the subclavian vein was
cannulated and the wire was threaded. The first time the wire did not thread right, and so the attempt
was aborted to make sure we had good identification of structures. Once the wire was in place the needle
was removed and a tissue dilator was pushed into position over the wire. Once that was removed, then
the central lumen catheter was pushed into position at 17 cm and the wire removed. All three ports were
flushed. The catheter was sewn into position, and a dressing applied.
A.36011, R40.1 B.36011, R40.20 C.36556, R40.22 D.36556, R40.20

15. What code would you use to report the percutaneous insertion of a dual-chamber pacemaker by
means of the subclavian vein?
A.33249 B.33217 C.33208 D.33240
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 MOCK TEST 3

16. Patient is a 40-year-old male who was involved in a motor vehicle crash. He is having some pulmonary
insufficiency.
PROCEDURE: Bronchoscope was inserted through the accessory point on the end of the ET tube and was
then advanced through the ET tube. The ET tube came pretty close down to the carina. We selectively
intubated the right mainstem bronchus with the bronchoscope. There were some secretions here, and
these were aspirated. We then advanced this selectively into first the lower and then the middle and
upper lobes. Secretions were present, more so in the middle and lower lobes. No mucous plug was
identified. We then went into the left mainstem and looked at the upper and lower lobes. There was really
not much in the way of secretions present. We did inject some saline and aspirated this out. We then
removed the bronchoscope and put the patient back on the supplemental O2 We waited a few minutes.
The oxygen level actually stayed pretty good during this time. We then reinserted the bronchoscope and
went down to the right side again. We aspirated out all secretions and made sure everything was clear.
We then removed the bronchoscope and pulled back on the ET tube about 1.5 cm. We then again placed
the patient on supplemental oxygenation.
FINDINGS: No mucous plug was identified. Secretions were found mainly in the right lung and were
aspirated. The left side looked pretty clear.
A.31646, J95.2 B.32654, J95.2
C.31645, J98.4 D.31645-RT, 31622-51-LT, J98.4

17. This 52-year-old male has undergone several attempts at extubation, all of which failed. He also has
morbid obesity and significant subcutaneous fat in his neck. The patient is now in for a flap tracheostomy
and cervical lipectomy. The cervical lipectomy is necessary for adequate exposure and access to the
trachea and also to secure tracheotomy tube placement.
A.31610, 15839-51 B.31610
C.31610, 15838 D.31603, 15839-51

18. This patient returns to the operating room for placement of an additional chest tube for an anterior
pneumothorax due to a contusion lung injury. The same physician had just placed a chest tube 4 days
earlier.
A.32551, S27.0XXA B.32550, S27.0XXA
C.32551-58, S27.1XXA D.32551, S27.2XXA

19. What code would you use if the physician performs a pyloroplasty and vagotomy in the same surgical
session?
A.43865 B.50400 C.43635 D.43640

20. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Leaking from intestinal anastomosis. POSTOPERATIVE DIAGNOSIS: Leaking
from intestinal anastomosis.
PROCEDURE PERFORMED: Proximal ileostomy for diversion of colon. Oversew of right colonic fistula.
OPERATIVE NOTE: This patient was taken back to the operating room from the intensive care unit. She
was having acute signs of leakage from an anastomosis I performed 3 days previously. We took down
some of the sutures holding the wound together. We basically exposed all of this patient's intestine. It was
evident that she was leaking from the small bowel as well as from the right colon. I thought the only thing
we could do would be to repair the right colon. This was done in two layers, and then we freed up enough
bowel to try to make an ileostomy proximal to the area of leakage. We were able to do this with great
difficulty, and there was only a small amount of bowel to be brought out. We brought this out as an
ileostomy stoma, realizing that it was of questionable viability and that it should be watched closely.
With that accomplished, we then packed the wound and returned the patient to the intensive care unit.
A.44310 B.44310-78 C.45136 D. 45136-78

21. This patient is taken to the operating room from the intensive care unit (ICU). The area of the stoma
appears to be necrotic, and on this basis the surgeon indicates that the patient has been taken back to the
operating room. The surgeon performing the revision is not the same surgeon that originally placed the
stoma, nor is the stoma being revised during the postoperative period of any previous procedure.
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 MOCK TEST 3

PROCEDURE PERFORMED: Revision ileostomy stoma.

OPERATIVE NOTE: With the patient moved onto the operating table, the abdomen was prepped and
draped. The segment of bowel that was serving as the ileostomy was freed up. Going in through this large
open wound, we were able to identify which segment of bowel this was. We resected the end of the bowel
that was necrotic and freed up enough of the distal small bowel so that we could bring it out through a
new stoma that was placed lateral to the original stoma. The stoma was created, the bowel was brought
out, and the mucosa was sewn onto the skin. With this accomplished, we appeared to have a viable stoma.
The patient tolerated this procedure and was returned to the ICU in stable condition.
A.44310 B.45136 C.44312 D.44314

22. This patient is brought back to the operating room during the postoperative period by the same
physician to repair an esophagogastrostomy leak, transthoracic approach, done 2 days ago. The patient is
status post esophagectomy for cancer. Code the procedure.
A.43320-78 B.43340-78 C.43341 D.43415-78

23. The physician is using an abdominal approach to perform a proctopexy combined with a sigmoid
resection:
A.45540 B.45541 C.45550 D.45541

24. OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Melena.

POSTOPERATIVE DIAGNOSIS: Normal endoscopy.
PROCEDURE: The video therapeutic endoscope was passed without difficulty into the oropharynx. The
gastroesophageal junction was seen at 40 cm. Inspection of the esophagus revealed no erythema,
ulceration, varices, or other mucosal abnormalities.The stomach was entered and the endoscope
advanced to the second duodenum. Inspection of the second duodenum, first duodenum, duodenal bulb,
and pylorus revealed no abnormalities. Retroflexion revealed no lesions along the curvature. Inspection
of the antrum, body, and fundus of the stomach revealed no abnormalities.
The patient tolerated the procedure well.
A.45378 B.43235 C.49320 D.43255

25. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Missed abortion with fetal demise, 11 weeks. POSTOPERATIVE DIAGNOSIS:
Missed abortion with fetal demise, 11 weeks. PROCEDURE: Suction D&C.
The patient was prepped and draped in a lithotomy position under general mask anesthesia, and the
bladder was straight catheterized; a weighted speculum was placed in the vagina. The anterior lip of the
cervix was grasped with a single-tooth tenaculum. The uterus was then sounded to a depth of 8 cm. The
cervical os was then serially dilated to allow passage of a size 10 curved suction curette. A size 10 curved
suction curette was then used to evacuate the intrauterine contents. Sharp curette was used to gently
palpate the uterine wall with negative return of tissue, and the suction curette was again used with
negative return of tissue. The tenaculum was removed from the cervix. The speculum was removed from
the vagina. All sponges and needles were accounted for at completion of the procedure. The patient left
the operating room in apparent good condition having tolerated the procedure well.
A.59812, O03.1 B.59812, O03.0 C.59820, O02.1 D.59856, O02.1

26. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Right ureteral stricture. POSTOPERATIVE DIAGNOSIS: Right ureteral
stricture. PROCEDURE PERFORMED: Cystoscopy, right ureteral stent change.
PROCEDURE NOTE: The patient was placed in the lithotomy position after receiving IV sedation. He was
prepped and draped in the lithotomy position. The 21-French cystoscope was passed into the bladder,
and urine was collected for culture Inspection of the bladder demonstrated findings consistent with
radiation cystitis, which has been previously diagnosed. There is no frank neoplasia. The right ureteral
stent was grasped and removed through the urethral meatus; under fluoroscopic control, a guide wire
was advanced up the stent, and the stent was exchanged for a 7-French 26-cm stent under fluoroscopic
control in the usual fashion. The patient tolerated the procedure well.
A.51702-LT, N13.5 B.52005-RT, N13.4
C.52332-RT, N13.4 D.52332-RT, N13.5
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27. This patient is a 52-year-old female who has been having prolonged and heavy bleeding.
SURGICAL FINDINGS: On pelvic exam under anesthesia, the uterus was normal size and firm. The
examination revealed no masses. She had a few small endometrial polyps in the lower uterine segment.
DESCRIPTION OF PROCEDURE: After induction of general anesthesia, the patient was placed in the
dorsolithotomy position, after which the perineum and vagina were prepped, the bladder straight
catheterized, and the patient draped. After bimanual exam was performed, a weighted speculum was
placed in the vagina and the anterior lip of the cervix was grasped with a single toothed tenaculum. An
endocervical curettage was then done with a Kevorkian curet. The uterus was then sounded to 8.5 cm.
The endocervical canal was dilated to 7 mm with Hegar dilators. A 5.5-mm Olympus hysteroscope was
introduced using a distention medium. The cavity was systematically inspected, and the preceding
findings noted the hysteroscope was withdrawn and the cervix further dilated to 10 mm. Polyp forceps
was introduced, and a few small polyps were removed. These were sent separately. Sharp endometrial
curettage was then done. The hysteroscope was then reinserted, and the polyps had essentially been
removed. The patient tolerated the procedure well and returned to the recovery room in stable
condition.Pathology confirmed benign endometrial polyps.
A.58558, 57460-51, N92.0, N84.0 B.58558, N92.0, N84.0
C.58558, 57558-51, N92.0, N84.0 D.58558, N92.0, N84.2

28. This patient is 35 years old at 36 weeks' gestation. She presented in spontaneous labor. Because of her
prior cesarean section, she is taken to the operating room to have a repeat lower-segment transverse
cesarean section performed. The patient also desires sterilization, and so a bilateral tubal ligation will
also be performed. A single liveborn infant was the outcome of the delivery.
A.59510, 58600-51, Z30.2 B.59620, 58615-51, Z37.0
C.59514, 58605-51, Z37.0, D.59514, 58611, Z37.0, Z30.2

29. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Possible recurrent transitional cell carcinoma of the bladder.
POSTOPERATIVE DIAGNOSIS: No evidence of recurrence. PROCEDURE PERFORMED: Cystoscopy with
multiple bladder biopsies.
PROCEDURE NOTE: The patient was given a general mask anesthetic, prepped, and draped in the
lithotomy position. The 21-French cystoscope was passed into the bladder.There was a hyperemic area
on the posterior wall of the bladder, and a biopsy was taken.Random biopsies of the bladder were also
performed. This area was fulgurated. A total of 7 sq cm of bladder was fulgurated. A catheter was left at
the end of the procedure. The patient tolerated the procedure well and was transferred to the recovery
room in good condition. The pathology report indicated no evidence of recurrence.
A.52224, Z85.51 B.51020, 52204, Z80.52
C.52234, Z85.51 D.52224 X 4, D41.4

30. This 41-year -old female presented with a right labial lesion. A biopsy was taken, and the results were
reported as VIN-III, cannot rule out invasion. The decision was therefore made to proceed with wide local
excision of the right vulva.
PROCEDURE: The patient was taken to the operating room, and general anesthesia was administered. The
patient was then prepped and draped in the usual manner in lithotomy position, and the bladder was
emptied with a straight catheter.The vulva was then inspected. On the right labium minora at
approximately the 11 o'clock position, there was a multifocal lesion. A marking pen was then used to
mark out an elliptical incision, leaving a 1-cm border on all sides. The skin ellipse was then excised using a
knife. Bleeders were cauterized with electrocautery. A running locked suture of 2-0 Vicryl was then
placed in the deeper tissue. The skin was finally reapproximated with 4- 0 Vicryl in an interrupted
fashion. Good hemostasis was thereby achieved. The patient tolerated this procedure well. There were no
complications.
A.56605, C51.9 B.56625, D07.1
C.56620, D07.1 D.11620, C51.9

31. Left frontal ventricular puncture for implanting catheter, layered repair of 8-cm scalp laceration, and
repair of multiple facial and eyelid lacerations with an approximate total length of 12 cm.
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 MOCK TEST 3

A.61020, 12015-51 B.61107, 12034-51, 12015-51

C.61215, 12015-51 D.61107, 12034-51

32. Marginal laceration involving the left lower eyelid and laceration of the left upper eyelid involving the
tarsus. Both required full-thickness repair. Also there were multiple stellate lacerations above the left eye,
totaling 24.2 cm and requiring full-thickness layered repair.
A.67935-E2, 12017 B.67930-E2, 13152-51, 13153
C.67935-E2, 67935-E1-51, 12056-51 D.67935-E2, 12017-51

33. OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Fever.

PROCEDURE PERFORMED: Lumbar puncture.
DESCRIPTION OF PROCEDURE: The patient was placed in the lateral decubitus position with the left side
up. The legs and hips were flexed into the fetal position the lumbosacral area was sterilely prepped. It was
then numbed with 1% Xylocaine. I then placed a 22-gauge spinal needle on the first pass into the
intrathecal space between the L4 and L5 spinous processes. The fluid was minimally xanthochromic. I
sent the fluid for cell count for differential, protein, glucose, Gram stain, and culture. The patient tolerated
the procedure well without apparent complication. The needle was removed at the end of the procedure.
The area was cleansed, and a Band-Aid was placed.
A.62272, R68.12 B.62268, R50.9
C.62272, R60.9, R50.9 D.62270, R50.9

34. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Herniated disk L4-5 on the left.
PROCEDURE PERFORMED: Laminotomy, foraminotomy, removal of herniated disk L4-5 on the left.
PROCEDURE: Under general anesthesia, the patient was placed in the prone position and the back was
prepped and draped in the usual manner. An incision was made in the skin extending through
subcutaneous tissue. Lumbodorsal fascia was divided. The erector spinae muscles were bluntly dissected
from the lamina of L4-5 on the left. The interspace was localized. I then performed a generous
laminotomy and foraminotomy here, and retracted on the nerve root. It was obvious there was a
herniated disk. I removed it, entered the space, and removed degenerating material, satisfied that I
Had decompressed the root well. There were free fragments lying around beneath the nerve root. We
removed all of these. I was able to pass a hockey stick down the foramen across the midline, satisfied I
had taken out the large fragments from the interspace at L4-5, and decompressed it well. I irrigated the
wound well, put a Hemovac drain in the wound, and then closed the wound in layers using doubleknotted
0 chromic on the lumbodorsal fascia with Vicryl, 2-0 plain in the subcutaneous tissue and surgical staples
on the skin. A dressing was applied. The patient was discharged to the recovery room.
A.63030-LT, M51.26 B.63012-LT, M51.27
C.63047-LT, M51.27 D.63047-LT, 63048-LT, M51.26

35. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Brain tumor versus abscess. PROCEDURE: Craniotomy.
DESCRIPTION OF PROCEDURE: Under general anesthesia, the patient's head was prepped and draped in
the usual manner. It was placed in Mayfield pins. We then proceeded with a craniotomy. An inverted U-
shaped incision was made over the posterior right occipital area. The flap was turned down. Three burr
holes were made.
Having done this, I then localized the tumor through the burr holes and dura. We then made an incision in
the dura in an inverted U-shaped fashion. The cortex looked a little swollen but normal. We then used the
localizer to locate the cavity. I separated the gyrus and got right into the cavity and saw pus, which was
removed. Cultures were taken and sent for pathology report, which came back later describing the
presence of clusters of gram-positive cocci, confirming that this was an abscess. We cleaned out the
abscessed cavity using irrigation and suction. The bed of the abscessed cavity was cauterized. Then a
small piece of Gelfoam was used for hemostasis. Satisfied that it was dry, I closed the dura. I
approximated the scalp. A dressing was applied. The patient was discharged to the recovery room.
A.61154, G06.0 B.61154, D49.6
C.61320, G06.0 D.61150, D49.6

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 MOCK TEST 3

36. This patient came in with an obstructed ventriculoperitoneal shunt. The procedure performed was to
be a revision of shunt. After inspecting the shunt system, the entire cerebrospinal fluid shunt system was
removed and a similar replacement shunt system was placed.
A.62180 B.62258 C.62256 D.62190

37. This 69-year -old female is in for a magnetic resonance examination of the brain because of new
seizure activity. After imaging without contrast, contrast was administered and further sequences were
performed. Examination results indicated no apparent neoplasm or vascular malformation.
A.70543-26, R56.00 B.70543-26, R56.9
C.70553-26, R56.9 D.70553, G40.909

38. This patient undergoes a gallbladder sonogram due to epigastric pain. The report indicates that the
visualized portions of the liver are normal. No free fluid noted within Morison's pouch. The gallbladder is
identified and is empty. No evidence of wall thickening or surrounding fluid is seen. There is no ductal
dilatation. The common hepatic duct and common bile duct measure 0.4 and 0.8 cm, respectively. The
common bile duct measurement is at the upper limits of normal.
A.76700-26, R10.13 B.76705-26, R10.13
C.76775-26, R10.33 D.76705, R10.13

39. A patient presents to the physician with stiffness and numbness in the neck, shoulders, and arms. The
physician orders MRI of the cervical spine, without and with control, to rule out cervical spinal stenoids.
Code the MRI.
A. 72020 B. 72127 C. 72141, 72142 D. 72156

40. EXAMINATION OF: Abdomen and pelvis.

CLINICAL SYMPTOMS: Ascites.
CT OF ABDOMEN AND PELVIS: Technique: CT of the abdomen and pelvis was performed without oral or
IV contrast material per physician request. No previous CT scans for comparison. FINDINGS: No ascites.
Moderate-sized pleural effusion on the right.
A.74177-26, R18.8 B.74176-26, J91.8
C.74178, J91.8 D.74176, R18.8

41. EXAMINATION OF: Brain.

CLINICAL FINDING: Headache.
COMPUTED TOMOGRAPHY OF THE BRAIN was performed without contrast material. FINDINGS: There is
blood within the third ventricle. The lateral ventricles show mild dilatation with small amounts of blood.
IMPRESSION: Acute subarachnoid hemorrhage.
A.70460-26, R51 B.70250, R51
C.70450-26, I60.9 D. 70450-26, R51

42. This 68-year-old male is seen in Radiation Oncology Department for prostate cancer. The oncologist
performs a complex clinical treatment planning, dosimetry calculation, complex isodose plan; treatment
devices include blocks, special shields, wedges, and treatment management. The patient had 5 days of
radiation treatments for
2 weeks, a total of 10 days of treatment.
A.77263, 77300, 77307, 77334, C61 B.77300, 77307, 77334, 77427 X 2, C61
C.77263, 77300, 77307, 77334, 77427 X 2, C61 D.77263, 77427 X 2, C61

43. CLINICAL HISTORY: Boil, left groin.

SPECIMEN RECEIVED: Necrotic fascia left groin and leg (anterior and posterior).
GROSS DESCRIPTION: The specimen is labeled with the patient's name and "fascia left groin and leg" and
consists of multiple segments of skin and soft tissue measuring up to 30 cm in greatest dimension. The
skin is unremarkable, with the soft tissue being hemorrhagic and friable and foul smelling.
MICROSCOPIC DESCRIPTION: Sections of skin and soft tissue show coagulative necrosis with neutrophilic
exudates.DIAGNOSIS: Skin and soft tissue, left groin and leg, anterior and posterior showing coagulative
necrosis and acute inflammation.
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A.88304 B.88305-26 C.88304-26 D.88305

44. This patient is in for a kidney biopsy (50200) because a mass was identified by ultrasound. The
specimen is sent to pathology for gross and microscopic examination. Report the technical and
professional components for this service. The results were inconclusive.
A.88305-26, N28.9 B.88307-26, N28.82
C.88307, N28.9 D.88305, N28.9

45. This 34-year-old established female patient is in for her yearly physical and lab. The physician orders
a comprehensive metabolic panel, hemogram automated and
Manual differential WBC count (CBC), and a thyroid stimulating hormone. Code the lab only.
A.99395, 80050 B.80050-52 C.80069, 80050 D.80050

46. This patient presented to the laboratory yesterday for a creatine measurement. The results came back
at higher than normal levels; therefore, the patient was asked to return to the laboratory today for a
repeat creatine test before the nephrologist is consulted. Report the second day of test only.
A.82540 X 2 B.82550 C.82552 D.82540

47. Code a pregnancy test, urine.

A.84702 B.84703 C.81025 D.84702 X 2

48. A patient with deep vein thrombosis requires heparin to maintain therapeutic anticoagulation levels.
He has regular PTTs drawn to monitor his level of anticoagulation. What code describes this testing?
A.85730 B. 85520 C. 80299 D. None of these

49. INDICATION: Hypertension with newly diagnosed acute myocardial infarction. PROCEDURE
PERFORMED: Insertion of Swan-Ganz catheter.
DESCRIPTION OF PROCEDURE: The right internal jugular and subclavian area was prepped with
antiseptic solution. Sterile drapes were applied. Under usual sterile precautions, the right internal jugular
vein was cannulated. A 9-French introducer was inserted, and a 7-French Swan-Ganz catheter was
inserted without difficulty. Right atrial pressures were 2 to 3, right ventricular pressures 24/0, and
pulmonary artery 26/9 with a wedge pressure of 5. This is a Trendelenburg position. The patient
tolerated the procedure well.
A.93505, 93503-51, I10 B.93505, I10
C.93503, 93563, I10, I21.3 D.93503, I10, I21.3

50. DIAGNOSIS: Atrial flutter.

PROCEDURE PERFORMED: Electrical cardioversion.
DESCRIPTION OF PROCEDURE: The patient was sedated with Versed and morphine. She was given a total
of 5 mg of Versed. She was cardioverted with 50 joules into sinus tachycardia. The patient was given a 20-
mg Cardizem IV push. Her heart rate went down to the 110s, and she was definitely in sinus tachycardia.
CONCLUSION: Successful electrical cardioversion of atrial flutter into sinus tachycardia.
A.92961, I49.1 B.92960, I48.92
C.92960, 92973, I48.92 D.92960, I48.92

51. What code would be used to code the technical aspect of an evaluation of swallowing by video
recording using a flexible fiberoptic endoscope?
A. 92611 B.92612 C.92610 D.92613

52. Which code would be used to report an EEG (electroencephalogram) provided during carotid
surgery?
A.95816 B.95819 C.95822 D.95955

53. How would you report a screening hearing test?

A.92551 B.92555 C.92553 D.92620

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54. The patient presented for a spontaneous nystagmus test that included gaze, fixation, and recording
and used vertical electrodes:
A.92541 B.92547 C.92541, 92544, 92547 D.92541, 92547

55. This is the first portion of the small intestine:

A. jejunum B. ileum C. duodenum D. cecum

56. This is a part of the inner ear:

A. vestibule B. malleus C. incus D. stapes

57. This is the area behind the cornea:

A. anterior chamber B. choroid layer C. ciliary body D. fundus

58. Thisis the collarbone:

A. patella B. tibia C. scapula D. clavicle

59. The act of turning upward, such as the hand turned palm upward:
A. supination B. adduction C. pronation D. circumduction

60. Anesthesia service for a pneumocentesis for lung aspiration, 32420.

A.00522 B.00500 C.00520 D.00524

61. Patient is a 26-year-old female presented to the labor room for vaginal delivery.
After 12 hours of labor vaginal delivery is not completed and OB/GYN decides to go for cesarean delivery
and anesthesia was administered.
A.01960 B.01961 C.01960, 01961 D.01963

62. Anesthesia for craniotomy for evacuation of intracranial hematoma on 74-year-old patient.
A.00215, 99100 B.00211, 99100 C.00210 D.00211

63. An complex therapeutic radiology simulation-aided field setting procedure (CPT codes 77280-77290)
is for the:
A. Simulation of a single treatment area of interest.
B. Simulation of three separate treatment areas.
C. Simulation of two treatment areas.
D. Simulation of five separate treatment areas

64. What is the correct code for place of service birthing center?
A.26 B.25 C.17 D.12

65. HIPAA was established with which goal?

A. To allow standardization in claims processing and submission
B. To provide incentives to payers
C. To provide incentives to providers
D. To identify submission of paper claims

66. Which of the following are included in Medicare part A?

A. Hospital inpatient services
B. Hospital outpatient services
C. Prescription drugs
D. Both outpatient and inpatient services.

67. Which modifier indicates discontinued procedure?

A.52 B.53 C.26 D.51

68. Bill, a retired U.S. Air Force pilot, was on observation status 12 hours to assess the outcome of a fall
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from the back of a pickup truck into a gravel pit. The physician discharged Bill from observation that same
day after determining that no further monitoring of his condition was necessary. The physician provided
a comprehensive history and examination and indicated that the medical decision making was of a low
complexity.
A.99214, Z04.9, W18.30XA B.99234, Z04.3, W17.89XA
C.99213, Z04.3, W18.30A D.99234, 99213, Z04.3, W17.89XA

69. Dr. Martin admits a 65-year- old patient to the hospital with acute pericarditis following a severe viral
infection. The patient has complained of retrosternal, sharp, intermittent pain of 2 days' duration that is
reduced by sitting up and leaning forward, accompanied by tachypnea. The physician completes a
comprehensive history and physical examination. The physician ordered an electrocardiogram, x-rays,
and routine laboratory workup. The physician considers the multiple diagnoses of pericarditis following
infection, unstable angina, dissecting aneurysm, pulmonary infarction, or esophageal disease, indicating a
high level of medical decision making complexity.
A.99236, R07.2, R06.82 B.99223, 420.91, I30.0, I72.9, I26.99, K22.9
C.99245, 420.91, I30.0, I72.9, I29.99, K22.9 D.99223, R07.2, R06.82

70. A gynecologist admits an established patient, a 35-year-old female with dysfunctional uterine
bleeding (DUB), after seeing her in the clinic that day. During the course of the comprehensive history, the
physician notes that the patient has a history of infrequent periods of heavy flow. She has had irregular
heavy periods and intermittent spotting for 4 years. The patient has been on a 3-month course of oral
contraceptives (OCP). The family history is positive for endometrial cancer, with mother, two aunts, and
two sisters who had endometrial cancer. The patient has a personal history of cervical and endometrial
polyp removal 3 years prior to admission. As a part of the comprehensive physical examination, the
physician notes the patient has a large amount of blood in the vault and an enlarged uterus. The
prolonged hemorrhaging has resulted in a very thin and friable endometrial lining. The physician orders
the patient to be started on intravenous Premarin and orders a full laboratory workup. The medical
ecision making is of moderate complexity.
A.99215, 99222, Z89.42, Z80.49 B.99222, N92.0
C.99215, 99222, N89.8 D.99222, N91.5

71. Dr. Black admits a patient with an 8-day history of a low-grade fever, tachycardia, tachypnea, and
basal consolidation of the lung and limited pleural effusion on the left side. An extensive past, family, and
social history is taken as part of a comprehensive history. Bowel sounds are feeble. The pulse is rapid and
thready. The comprehensive examination further indicates a jaundiced appearance with distention of the
abdomen. There is a bluish discoloration of the flanks. The physician orders laboratory tests and
radiographic studies, including an abdominal sonogram as he considers the extensive diagnostic options
and the medical decision making complexity is high for this patient.
A.99233, R50.9, R00.0, R06.82, J18.1, J91.8, R19.15
B.99233, R50.9, I47.1, R06.82, J16.4, J91.8
C.99223, R50.9, R00.0, R06.82, J18.1
D.99223, R50.9, R00.0, R06.82, J18.1, J91.8, R19.15

72. Dr. Stephanopolis makes subsequent hospital visits to Salanda Ortez, who has been in the hospital for
primary viral pneumonia. She was experiencing severe dyspnea, rales, fever, muscle aches, and chest
pain. The chest radiography showed patchy bilateral infiltrates and basilar streaking. Sputum
microbiology was positive for a secondary bacterial pneumonia. The physician conducted an interval
history focused on the patient's current problems and continued to do a problem-focused physical
examination. The medical decision making was straightforward, and the patient was given
Intravenous antibiotic to address the bacterial pneumonia.
A.99231, R06.00, R09.89, R50.9, 729.1, M79.1, R89.9
B.99231, J15.9, J12.9
C.99221, R06.00, R09.89, R50.9, 729.1, M79.1, R89.9
D.99234, J15.9

73. A 57-year-old male was sent by his family physician to an urologist for an office consultation. The
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patient has had bright red blood in his urine sporadically for the past 3 weeks. The urologist obtains a
detailed history from the patient and continues with a detailed physical examination. The urologist
recommends a cystoscopy to be scheduled for the following week and discusses the procedure and risks
with the patient. The medical decision making is of moderate complexity. Report only the office service.
A.99243-57 B.99244-57, 52000 C.99253 D.99221

74. A patient is issued a 22-inch seat cushion for his wheelchair.

A.E0995 B.E0950 C.E0190 D.E2601

75. A patient with chronic lumbar pain previously purchased a TENS and now needs replacement
batteries.
A.E1592 B.A5082 C.A4772 D.A4630

76. A patient with chronic obstructive pulmonary disease is issued a medically necessary nebulizer with a
compressor and humidifier for extensive use with oxygen delivery.
A.E0570, E0550 B.E0555, E0571 C.E0580, E0550 D.E0575, E0550

77. Type 1 diabetic patient is brought to the ER by ambulance in a coma. Patient is pale, rapid heartbeat,
and their face is covered in sweat. Physician finds the insulin pump not delivering insulin and after
reviewing the lab's diagnosis the patient with diabetic ketoacidosis with diabetic coma.
A.T85.614A, T38.3X1A, E10.641 B.T85.614A, T38.3X6A, E10.11
C.E10.11, T85.614A, T38.3X6A D.T85.614A, T38.3X6A, E11.641

78. 40 year-old Tim’s diet has him morbidly obese with a BMI of 47.6.
A.E66.1 B.E66.2, Z68.42 C. E66.01, Z68.42 D.Z68.42, E66.01

79. Patient presents with pain associated with his primary lung cancer of the left upper lobe.
A.C34.12, G89.29 B.G89.3 C.G89.3, C34.12 D.G89.3, C34.11

80. A patient presents to the nephrology clinic suffering from malignant hypertensive heart and Stage V
chronic kidney disease, without heart failure, due to hypertension.
A. I13.11, I10 B. I13.11 C. I13.11, N18.5 D.N18.5, I10

81. A patient is treated for three pressure ulcers: bilateral buttock ulcers, stage 3 on the right and stage 2
on the left; and a stage 4 on the sacral area.
A.L89.44, L89.303, L89.312 B.L89.154, L89.300, L89.014
C.L89.154, L89.313, L89.322 D.L89.153, L89.313, L89.322

82. A 79-year-old with osteoporosis with a new pathological fracture of the right femur.
A.M81.0, M84.451A B.M80.051A, M84.451A
C.M80.051A D.M80.052A

83. Chronic kidney disease in a Type 1 diabetic patient, which is moderate.

A.I12.9, N18.3 B.I12.0, N18.3 C.E10.22, N18.3 D.E11.22, N18.3

84. Full term, uncomplicated delivery of a single live birth.

A.O80, Z37.0, Z3A.00 B.Z37.1, Z3A.00
C.Z37.2, Z3A.00 D.Z37.3, Z3A.00

85. Specific coding guidelines in the CPT manual are located in the:
A. index. B. introduction.
C. beginning of each section. D. Appendix A.

86. Which punctuation mark between codes in the index of the CPT manual indicates a range of codes is
available?
A. period B. comma C. semicolon D. hyphen
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87. The term that indicates this is the type of code for which the full code description can be known only if
the common part of the code (the description preceding the semicolon) of a preceding entry is
referenced:
A. stand-alone B. indented C. independent D. add-on

88. Specific coding guidelines in the CPT manual are located in the:
A. index. B. introduction.
C. beginning of each section. D. Appendix A.

89. Anesthesia service includes the following care:

A. Preoperative, intraoperative B. Preoperative, intraoperative, postoperative
C. Intraoperative, postoperative D. Preoperative, postoperative

90. When you see the symbol “ ₵ “next to a code in the CPT manual, you know that:
A. the code is a new code. B. new or revised text
C. the code is a modifier -51 exempt code. D. FDA approval pending.

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