CPC MOCK 6 (2)

Section -1
Number of question from each code range:
 Surgery, integumentary system (6 questions)
 Musculoskeletal system (6 questions)
 Respiratory system (6 questions)
 Digestive system (6 questions)
 Urinary system, male and female genital system (6 questions)
 Nervous system, eye and ocular adnexa, and auditory system (6
questions) 
Integumentary system
1. 12 - year-old female was chasing her friend when she fell through a sliding glass door
sustaining three lacerations. Left knee 5.5 cm laceration, involving deep subcutaneous
tissue and fascia, was repaired with layered closure using 1% lidocaine anesthetic. Right
knee: 7.2 cm laceration was repaired under local anesthetic with a single-layer closure.
Right hand: 2.5 c m laceration of the dermis was repaired with simple closure using Derma bond
tissue adhesive.
Assessment: Wounds of both knees and left hand requiring suture repair
Plan: Follow - up in 10 days for suture removal. Call office if any questions or complications. What
are the correct ICD- 10-CM and CPT procedure codes? Do not code anesthesia administration.
a. S81. 012A, S61.411A, W45.8XXA, Y92. 099, 12005
b. S81. 022A, S61.411A, 12002-Rt, 12032-51-LT, 17999-51-LT
c. S61.421A, 12032, 12002-LT,E/M code for Dermabond adhesive
d. S81. 012A, S61.411A, W45.8XXA, Y92.099, 12032-LT, 12004-51-RT

2. Operative Report
Postoperative Diagnosis: Full thickness burn wound to anterior left lower leg. Operation
Splitthickness graft, approximately 35 centimeters; preparation of the wound.
Procedure: Left lower leg was prepped and draped in the usual sterile fashion. The ulcer,
which measured approximately 8 x 4 to 4.5 cm, was debrided sharply with Goullian knife
until healthy bleeding was seen. The bleeding was controlled with epinephrine-soaked lap
pads. Split- thickness skin graft was harvested from the left lateral buttock area
approximately 4.5 to 5 cm x 8 cm a depth of 14/1000 of an inch. the graft was meshed to 1
to 1.5 fashion and placed over the prepared wound, stabilized with staples and then
Xeroform dressings and dry dressing, wrapped with Kerix and finally immobilized in a
posterior splint. The donor site was covered with Xeroform and fry dressings. What are the
correct procedure codes reported by the physician for this procedure performed in the
hospital outpatient surgical suite?
a. 15220-LT, 15221-51-LT, 15002-51-LT c. 14021-LT, 15002-51-LT
 b. 15100-Lt d. 15100-LT, 15002-51-LT

3. Stacey at 35-year-old female presents for biopsies of both breasts of total 6 lesions. The
biopsies were done using fine-needle aspiration without imaging guidance.
a. 19081-50 c. 10021-50, 10004x5
b. 19101-50 d. 10021x6-50

4. 30 year old female is having debridement performed on an infected ulcer with eschar on the right
foot. Usingsharp dissection, the ulcer and eschar infection was debrided all the way to down to the
bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the
metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of
the foot. It seems that the toes next to the ulcer may have some involvement and cultures were
taken. The area was dressed with sterile saline and dressings and the wrapped. What CPT code
should be reported?
a. 11000 c. 11044
b. 11011 d. 15004

5. A patient presents with a recurrent seborrheic keratosis of the left cheek. The area was
marked for a shave removal. The area was infiltrated with local anesthetic, prepped and
draped in a sterile fashion. The lesion measuring 1.8 cm was shaved using an 11- blade.
Meticulous hemostasis was achieved using light pressure. The specimen was sent for
permanent pathology. The Patient tolerated the procedure well.
What CPT ®code (s) is reported?
a. 11200 c. 11442
b. 11312 d. 11642

6. 46 year old female had a previous biopsy that indicated positive margins anteriorly on the
right side of her neck. A 0.5 cm margin was drawn out and a 15 blade scalpel was used for
full excision of an 8 cm lesion. Light undermining of all margins was performed along with
layered closure. The specimen was sent for permanent histopathologic examination. What
are the code (s) for this procedure?
a. 11426 c. 11626, 12044-51
b. 11626 d. 11426, 13132, 13133

Musculoskeletal system
7. 50-year -old male had surgery on his upper leg one day ago and presents with serous
drainage from the wound. He was taken back to the operating room for evaluation of the
hematoma. His wound was explored, and there was a hematoma at the base of the wound
 which was very carefully evacuated. The wound was irrigated with antibacterial solution.
What CPT and ICD-10- CM codes should be reported?
a. 10140-79, L76.02 c. 10140-76, T81. 9XXA
b. 27603-78, T81.4XXA d. 27301-78, L76.02

8. Fred, a 40 -year old carpenter at a local college. While working on a window frame from a
ladder, the weld on the rung of the metal ladder loosened and he fell backward 8 ft. He
landed on his left hip dislocating it. Under general anesthesia, the Allis maneuver is used to
repair the anterior dislocation of the left hip. The pelvis is stabilized and pressure applied to
the thigh to reduce the hip and bring it into proper alignment.
a. 27252-RT c. 27250-LT
b. 27253-LT d. 27252-LT

9. Don a 36-year-old male, fell 4 feet off scaffolding and hit his left heel on the bottom rung of
the support, fracturing his calcaneal bone in several locations. The surgeon manipulated the
bone pieces back into position and secured the fracture sites with percutaneous fixation.
a. 28456-LT c. 28405-LT
b. 28415-LT d. 28406-LT

10. Patient complains of chronic/acute arm and shoulder pain following bilateral carpal tunnel
surgery. Patient is followed by pain management for over a year. Physician finally diagnoses
patient with reflex dystrophy syndrome (RSD). Physician performs six trigger point injections
into four muscle groups. Code the procedure (s).
a. 20552 c. 20551 x 6
b. 20553 x 6 d. 20553

11. Tracy a 5- year -old female fell down stairs at a daycare. She hit her coccygeal bone and
fracturedIt. The doctor manually manipulated the bone into the proper alignment and told
Tracy’s mom to have her sit on a rubber ring to alleviate pain.
a. 27200 c. 27510
b. 27202 d. 28445

12. A patient presents with a healed fracture of the left ankle. The patient was placed on the OR
table in the supine position. After satisfactory induction of general anesthesia, the patient’s
left ankle was prepped and draped. A small incision was made in the previous incision. The
lower screws were removed. Another small incision was made just lateral about 1 cm long.
The upper screws were removed from the plate. Both wounds were thoroughly irrigated
with copious amounts of antibiotic containing saline. Skin was closed in a layered fashion
and sterile dressing applied. What CPT ® code (s) should be reported?
 a. 20680 c. 20670
b. 20680, 20680-59 d. 20680, 20670-59

Respiratory & Cardiovascular – system

13. The patient is seen at the clinic for chronic sinusitis. It is determined that an endoscopic
sinus surgery is scheduled for the next day. The patient arrives for same-day surgery, and
the physician performs and endoscopic total ethmoidectomy with an endoscopic maxillary
antrostomy with removal of maxillary tissue. Code the procedure(s) and diagnosis.
a. 31255, 31267-51, J32.9 c. 31254, 31256-51, J32.9
b. 31200, 31225-51, J32.9 d. 31255, 31267-51, J01.90

14. The patient is a fifty-eight-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 c. 32036-79
b. 32035-58 d. 32552-58

15. The patient comes in today to have an arteriovenous fistula created to facilitate dialysis. The
surgeon performs an upper arm basilic vein transposition based on the patient’s previous
arterial duplex scan.
Which is the appropriate code for this procedure?
a. 36825 c. 36818
b. 36830 d. 36819

16. Dr. Sacra performed a CABG surgery on Fred five months ago. Today, Dr. Sacra completed
another coronary artery bypass using three venous grafts with harvesting of a
femoropopliteal veinsegment. How would Dr. Sacra report her work for the current
surgery?
a. 33512, 33530-51, 35572-51 c. 33512, 33530, 35572
b. 33534, 35500-51, 33519 d. 33535, 33519, 33530-51, 35500

17. 72-year - old patient, a PICC line is inserted. Using Xylocaine local anesthesia, aseptic
technique and ultrasound guidance, a 21 gauge needle was used to aspirate the right
cephalic vein. When blood was obtained, 10.018 inch platinum tip guide wire was advanced
to the central venous circulation. A 6 French dual lumen PICC was introduced through 6
French peel-away sheath to theSVA RA junction and after removal of the sheath, the
catheter was attached to the skin with a STAT - LOCK device and flushed with 500 units of
 Heparin in each lumen. A sterile dressing was applied and the patient was discharged in
improved condition. Code the procedure (s).
a. 36565 c. 36561 76937-26
b. 36556, 76937-26 d. 36573

18. 50-year-old patient has a PICC line with a port placed for chemotherapy
infusion.Fluoroscopic guidance was used to gain access to check placement.
a. 35651, 77001 c. 36571, 76937
b. 36568, 77937 d. 36571, 77001

Digestive system

19. 45 - year - old patient with liver cancer is scheduled for a liver transplant. The patient’s
brother is a perfect match and will be donating a portion of his liver for a graft. Segments II
and III will be taken from the brother and then the backbench reconstruction of the graft
will be performed, both a venous and arterial anastomosis. The orthotopic
allotransplantation will then be performed on the patient. What CPT® code (s) is/are
reported?

a. 47140, 47146, 47147, 47135 c. 47140, 47147, 47146, 47136

b. 47141, 47146, 47135 d. 47141, 47146, 47136

20. Name of Procedure : Endoscopic retrograde cholangiopancreatogram with stent placement

and antral biopsy.
Indications: 50 - year-old male who underwent liver transplantation for end- stage liver
disease secondary to chronic hepatits C and hepatocellular carcinoma in 01/ 2007. The
patient has cholestatic liver enzymes, requiring 1RCP before placement of 7 - Frency 12
cm stent and to evaluate the biliary system.
Description of procedure: The patient was taken to the fluoroscopy suite in the GI lab
where he was found to be alert and oriented x 3. After discussing risks and benefits of the
procedure, informed consent was obtained. Patient was kept in the semi prone position.
After adequate conscious sedation, and Olympus side viewing therapeutic scope was
inserted through the mouth all the way to the second portion of the duodenum. Then, the
common bile duct was cannulated and the cholangiogram was obtained. After the
fluoroscopy evaluation of the cholangiogram a 12 cm stent was deployed for biliary
drainage. A biopsy from the antrum was obtained. The patient tolerated the procedure
well. There were no immediate complications.
a. 43276, 43261-51 c. 43266, 43239-51
 b. 43274, 43261-51 d. 43212, 43202-51

21. Patient diagnosed with GERD presents to the same day surgery department for an upper GI
endoscopy. The procedure is done in order to treat the GERD by delivering thermal energy
to the muscle of the gastric cardia and lower esophageal sphincter. Anesthesia was
administered and as the physician begins the procedure, the patient’s blood pressure drops
to a dangerously low level. The physician decides not to finish the procedure due to the risk
it may cause the patient. What are the codes for this procedure and diagnosis?
a. 43257-53, K22.6, I95.89 c. 43257-74, K21.9, I95.81
b. 43499, K21.9, I95.9 d. 43257-52, K21.9, I95.81, Z53.09

22. What code would you use if the physician performs a pyloroplasty and vagotomy in the
samesurgical session?
a. 43865 c. 43635
b. 50400 d. 43640

23. Katherine had a hernioplasty to repair a recurrent ventral incarcerated hernia with
implantation of mesh for closure. The surgeon completed debridement for necrotizing soft
tissue due to infection. How would you report this procedure?
a. 49566, 11005-51, 49568 c. 49565
b. 49565, 11005-51, 49568 d. 49525, 11006, 49568-51

24. This 10-year-old girl presents for a tonsillectomy because of chronic tonsillitis and possible
adenoidectomy. On inspection the adenoids were found not to be inflamed. Only the
tonsillectomy was done. Code the tonsillectomy only.
a. 42825, J35.01 c. 42826, 42835-51, J35.03
b. 42820, J35.3 d. 42830, 42825-51, J35.3

Urinary system, Male and Female genital system

25. 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 hysteroscopy 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 c. 58661, 58558
b. 58661, 58563-51 d. 58662, 58563-51

26. Patient presents with cervical cancer, it has spread and metastasized throughout the pelvic
area. She receives a total abdominal hysterectomy with bilateral salpingoophorectomy,
cystectomy and creation of an ileal conduit and partial colectomy. What is/ are the CPT®
code(s) reported for this service?
a. 58150, 51590, 44140 c. 58150, 51590, 44140, 58720
b. 58152, 44141 d. 58240

27. 35-year-old male patient presented to an urologist because he was having continuous yeast
infections and irritation on his penis. The physician recommended he have a circumcision.
The physician performed the circumcision using a clamp with regional block. Code this
procedure.
a. 54150 c. 54161
b. 54160 d. 54150-52

28. Newborn male is scheduled for a circumcision. He is sterilely prepped and draped; and
penile nerve block is performed. The circumcision is performed by a ring device. Hemostasis
is achieved. Vaseline Gauze dressing applied. Patient tolerated the procedure well. How
would this encounter be coded?
a. 54160 c. 54161, 64450
b. 54150 d. 54150, 64450

29. The patient presents with a recurrent infection of the Bartholin’s gland which has previously
been treated with antibiotics and I & D. At this visit her gynecologist in clsesthe cyst,
draining thematerial in it and tacks the edges of the cyst open creating an open pouch
to prevent recurrence. How is this procedure coded?
a. 56405 c. 56440
b. 56420 d. 56740

30. 5 - year - old male with a history of prematurity was found to have penile curvature,
congenital hypospadias. He presents for surgical management for straightening the
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 the 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 c. 54360
b. 54340 d. 54440

Nervous system, Eye and Ocular adnexa, and auditory system

31. What CPT code(s) should be reported for removal of foreign body from the external
auditory canal w/o general anesthesia?
a.69205 c. 69200
b. 69220 d. 69210

32. 63-year -old woman presented to the eye clinic as a new patient with symptoms of flashing
lights and floaters in the right eye for two days. The ophthalmologist does a general
evaluation of the complete visual system, including dilating her eyes and checking her with
an indirect ophthalmoscope, revealing peripheral retinal tear. The physician explains to the
patient that there is a high likelihood of retinal detachment. The patient agrees to have the
procedure. The physician lasers the retinal tear and tells the patient to come back in 24
hours for follow- up. Code this visit.
a. 67210, 92004-25 c. 67220, 92004-25
b. 67145, 92004-25 d. 67141, 92004-26

33. An extra capsular 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 code should be used for this procedure?
a. 66985 c. 66982
b. 66984 d. 66983

34. Patient had recently experienced muscle atrophy and noticed she did not have pain when
she cut herself on a piece of glass. The provider decides to obtain a biopsy of the spinal cord
under fluoroscopic guidance. The biopsy results come back as syringomyelia. What CPT and
CID-10-CM codes are reported?
a. 62270, G12.9, R20.0 c. 62269, G12.9, R20.0
b. 62270, G95.0 d. 62269, G95.0
35. Mrs. Den slipped on the ice last winter and fractured several lumbar vertebrae. Since then
she has required pain management therapy at her local hospital with an anesthesiologist.
He injects five percent Marcaine mixed with the steroid Decadron (16mg) into the nerve
located in the facet joints at levels L3-L4 and L4-L5 on both sides at each level, What CPT ®
code(s) are reported for this procedure ?
a. 64483 x 2 c. 64493– 50, 64494-RT, 64494-LT
b. 64483 - 50, 64484 –RT, 64484-LT d. 64479 - 50, 64480-RT, 64480-LT

36. PROCEDURE : Bilateral lumbar medial branch block under ultrasound guidance for the L3,
L4, medial branches injecting the L4-L5, L5-S1 facets for diagnostic and therapeutic
purposes.
PROCEDURE : The patient was placed in the prone position and automated blood pressure
cuff and pulse oximeter applied. The skin entry points for approaching the anatomic target
points of the bilateral segmental medial branches or dorsal ramus ofL3, L4, L5 were
identified with a 22.5 degree from an ultrasound view and marked. Following through
Chloraprep preparation of the skin and draping and 1% lidocaine infiltration of the skin
entry points and subcutaneous tissues,a 22 gauge 6” spinal needle was placed under ultra-
sound guidance for the L4-L5 and L5-S1 facet joints. At each joint 1 Ml consisting of 0.5%
bupivacaine and Depo-Medrol was injected. A total of 80 mg Depo-Medrol was given in
both sides. Which CPT® codes should be used?
a. 0216T-50, 0217T-50, 0218T-50, 76042-26 c. 64493-50, 64494-50, 76942-26
b. 64493-50, 64494-50, 64495-50 d. 0216T-50, 0217T-50

Section -2
Number of questions from each code range:
 Evaluation and Management (6 questions)
 Anesthesia (4 questions)
 Radiology (6 questions)
 Laboratory and Pathology (6 questions)
 Medicine (6 questions)

Evaluation and Management

37. The attending physician requests a confirmatory consultation from an interventional
radiologist for a second opinion about a 60-year-old male with abnormal areas within the
liver. the recommendation for a CT guide biopsy is requested, which the attending has
recommended be performed. During the comprehensive history, the patient reported right
upper quadrant pain. His liver enzymes were elevated. Previous CT study revealed multiple
low attenuation with in the liver (infection not tumor). The laboratory studies were
 creatinine,0.9; hemoglobin, 9.5; PT and TT, 13.0/31.5 with an INR of 1.2. The comprehensive
physical examination showed that the lungs were clear to auscultation and the heart had
regular rate and rhythm. The mental status was oriented times three. Temperature,
0
intermittent lowgrade fever, up to 101 Fahrenheit, usually occurs at night. The CT-guided
biopsy was considered appropriate for this patient. The medical decision making was of high
complexity.
a. 99223 c .99255
b. 99245 d.99221

38. Patient comes in today at four months of age for a checkup. She is growing and developing
well. Her mother is concerned because she seems to cry lot when lying down but when she
is picked up she is fine. She is on breast milk but her mother has returned to work and is
using a breast pump, but hasn’t seemed to produce enough milk.
PHYSICAL EXAM : Weight 12 libs 11 oz, Height 25 in., OFC 41.5 cm HEENT: Eye: Red reflex
normal.Right eardrum is minimally pink, left eardrum is normal, Nose: slight mucous Throat
with slight thrush on the inside of the cheeks and on the tongue. LUNGS: clear. HEART: W/o
MURMUR. ABDOMEN: soft. Hip exam normal. ASSESSMENT Four month old well check Cold
Mild thrush Diaper rash PLAN: Okay to advance to baby foods Okay to supplement with
Similac Nystain suspension for the thrush and creams for the diaper rash if it recurs Mother
will bring child back after the cold symptoms resolve for her DPT, HIB and polio/ What E/M
code (s) are reported ?
a. 99212 c. 99391, 99212-25
b. 99391 d. 99213

39. A cardiology consultation is requested for a 69- year-old inpatient for recent onset of
dyspnea on exertion and chest pain. The comprehensive history reveals that the patient
cannot walk there blocks without exhibiting retrosternal squeezing sensation with shortness
of breath. She relate that she had the first episode 3 months ago, which she attributed to
indigestion. Her medical history is negative for stroke, tuberculosis, cancer, or rheumatic
fever but includes seborrheic keratosisand benign positional vertigo. She has no known
allergies. A comprehensive physicalexamination reveals pleasant, elderly female in no
apparent distress. She has a blood pressure of 150/7- with a heart rate of 76. Weight is 131
pounds, and she is 5 foot 4 inches. Head and neck reveal JBP less than 5 cm. Normal carotid
volume and upstroke without bruit. Chest examination shows clear to auscultation with no
rales, crackles, crepitation, or wheezing. Cardiovascular examination reveals a normal PMI
with- out RV lift. Normal S1 and S2 with an S3 without murmur are noted. The medical
decision making complexity is high based on the various diagnosis options.
a. 99223 c. 99255
b. 99254 d. 99245
40. A 56-year -old established male patient presents to his family physician for a checkup at the
local outpatient clinic. The physician conducts a detailed history and physical examination,
and the checkup takes 45 minutes.
a. 99214 c. 99386
b. 99403 d. 99396

41. Jane has a family history of skin melanoma. Her primary care doctor asked for a consult with
Dr. John. During Jane’s first visit with her new dermatologist, Dr. John, he documented a
comprehensive history, comprehensive examination, and medical decision-making of
moderate complexity. Dr. John also performed a whole body integumentary photography
for monitoring of Jane’s skin Dr. John sent a report back to her PCP and told Jane should in
one year or before then if anything should change on her skin.
What code(s) would you use to report Dr. John’s services?
a. 99244-25, 96904 c. 96904
b. 99213 d. 99204, 96904

42. 60 year -old male present for a complete physical. There are no new complaints since my
previous examination of June 9 of last year. The patient spends 6 hours a week golfing and
reports a brisk and active retirement. He does not smoke and has only an occasional glass of
wine. He sleeps well but has been having nocturnal times three. On physical examination,
the patient is a well- developed, wellnourished male. The physician continues and provides
a complete examination of the patient lasting 45 minutes.
a. 99396 c. 99403
b. 99386 d. 99450

Anesthesia
43. General anesthesia is administered to a 9 month old undergoing a tracheostomy. Code the
anesthesia service.
a. 00320, 99100 c. 00326
b. 00320 d. 00326, 99100

44. Using your CPT® Index, look up anesthesia for a cholecystectomy. No indication of the
approach is mentioned. What CPT ® code (s) is for the anesthesia?
a. 00790 c. 00840
b. 00797 d.00842

45. Code anesthesia service provided for an anterior cervical discectomy with decompression of
asingle interspace of the spinal cord and nerve roots and including Osteophytectomy.
a. 00620 c. 00630
 b. 00640 d. 00600

46. A 40 - year-old female in good physical health is having a laparoscopic tubal ligation. The
anesthesiologist begins to prepare the patient for surgery at 08.30. Surgery begins at 0900
and ends at 1000. The anesthesiologist releases the patient to recovery nurse at 1015. What
is the total anesthesia time and anesthesia code?
a. 1 hr. 30 minutes, 00840 c. 1 hr. 00840
b. 1 hr. 45 minutes, 00851 d. 1 hr. 15 minutes, 00851

Radiology
47. 76-year-old female had a ground level when she tripped over her dog earlier this evening
her apartment. The emergency Department took x-ray of the wrist in oblique and lateral
views which revealed a displaced distal radius fracture, grade I open right wrist. What radio-
logical service and ICD-10 codes should be reported?
a. 73100-26, S52.50IB, W18.49XA, Y92.099 c. 73115-26, S52.501A, W18.49XA, Y92.099
b. 73110-26, S52,501B, W19.49XA, Y92.099 d. 73100-26, S52.601B, W19.40XA, Y92.099

48. Code an endoscopic catheterization of the biliary ductal system for the professional
radiology component only.
a. 74330-26 c. 74328-26
b. 43271, 74320 d. 74300-26

49. The physician orders a heart CT without contrast. The tests will evaluate the amount of
coronary calcium.
What is the correct code?
a. 75571 c. 75574
b. 75572 d. 75557

50. A patient in her 2nd trimester with a triplet pregnancy is seen for an obstetrical ultrasound
only including fetal heartbeats and position of fetuses. What CPT codes is/are reported for
the ultrasound?
a. 76805, 76810, 76810 c. 76815 x 3
b.76811, 76812, 76812 d. 76815

51. 65-year -old female has a 2.5 cm by 2.0 cm non-small cell lung cancer in her right upper lobe
of her lung.
The tumor is inoperable due to severe respiratory conditions. She will be receiving
stereotactic body radiation therapy under image guidance. Beams arranged in 8 fields will
deliver 25 GY per fraction for 4 fraction. What CPT and ICD-10-CM code are reported?
 a. 77435-26, C34.11, Z51.0 c. 77373-26, Z51.0, C34.11
b. 77371-26 ,C34.91 d. 77431-26, Z51.0, C34.91

52. 52-year-old male has a 32 cm metastasized lung cancer in his left upper lobe. The tumor
cannot be removed by surgery due to the patient having severe respiratory conditions. He
will be receiving stereotactic body radiation therapy management under image guidance.
There is a delivery of 25 Gy for four fractions under direct supervision of the radiation
oncologist. The patient’s treatment set up is assessed to manage the execution of the
treatment to make any adjustments needed for accuracy and safety. The oncologist reviews
and approves all the images used to locate the tumor and images of fields arranged to
deliver the dose. What CPT and ICD-10-CM codes should be reported?
a. 77373, Z51.0, C34.91 c. 77435, C78.02, Z51.0
b. 77435, Z51.0, C78.02 d. 77402, C34.91, Z51.0
Laboratory and Pathology
53. This patient presented to the laboratory yesterday for a creatine measurement. The result
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, R79.89 c. 82550, R79.81
b. 82550, R79.89 d. 82540, R79.89

54. The 67 -year - old female suffers from Chronic liver disease and needs a hepatic function
panel performed every six months. Tests include total bilirubin (82247), direct bilirubin
(82248), total protein (84155), alanine, aminotransferases) ALT and SGPT (84460), s e p a r a
t e aminotransferases (ALST and SGPT) (84450) and what other lab tests?
a. 82040, 84075 c. 82040, 82247
b. 80061, 83718 d. 84295, 84450

55. A pathologist performs a comprehensive consultation and report after reviewing a patient’s
records, specimen and official findings from other sources. What is the correct code?
a. 88325 c. 80502
b. 99244 d. 88329

56. The patient presents with burning urination and frequency. The physician performs a UA
dipstick, which shows elevated WBC. He orders a urine culture with identification for each
isolate to determine which antibiotic to give to the patient for the infection. What are the
appropriate lab codes?
a. 81000, 81007 c. 81001, 87086
b. 81002, 87088 d. 87086, 87088
57. Patient presents with right upper quadrant pain, nausea, and other symptoms of liver
disease as well as complaints of decreased urination. Her physician orders and albumin;
bilirubin, both total and direct; alkaline phosphatase; total protein; alanine amino
trasferase; aspartate aminotransferase, and creatinine. What CPT ® code (s) / are reported?
a. 82040, 82247, 82248, 84075, 84155, 84460, 84450, 82565
b.80076, 82565
c. 80076
d. 80076-22

58. The patient presented to the laboratory at the clinic for the following blood tests ordered by
her physician: albumin (serum), bilirubin (total), and BUN (quantitative)
a. 82044, 82248, 84520 c. 82040, 82247, 84520
b. 82040, 82252, 84525 d. 82044, 82247, 84540

Medicine

59. An elderly man comes in for his flu (split virus, IM) and pneumonia (23-valent, IM) vaccines.
Codeonly the immunization administration and diagnoses for the vaccines.
a. 90658, 90632, Z23 c. 90471 x 2, 90658, 90632, Z23
b. 90471, 90658, 90472, 90732, Z23 d. 90471, 90472, Z23

60. Mary who has food allergies, came to her physician for her weekly allergen immune therapy
that consists of two injections prepared and provided by the physician. The correct code is:
a. 95125 c. 95131
b. 95117 d. 95146

61. OPERATIVE REPORT

PROCEDURE PERFORMED: Primary stenting of 70% proximal posterior descending
artery stenosis.
INDICATIONS: Atherosclerotic heart disease
Description of procedure : Stents inserted via percutaneous transcatheter placement. A 2.5 x
13 mm pixel stent was deployed.
COMPLICATIONS: None
RESULTS: Successful primary stenting of 70% proximal posterior descending artery stenosis
with no residual stenosis at the end of the procedure.
a. 902920-RC, 92928, I25.10 c. 92928- RC, I25.10
b. 92920-RC, I25.9 d. 92933-RC, I25.10
 62. The patient, a 55-year-old male, this was a follow up for POAG. The patient had IOPof 22
OD and 24 OS, The Optometrist added Timolol Maleate to the patient’s Xalatan
prescription. The OD performed a Comprehensive Eye Exam, which included Extra
Ocular Motility (EOM) Confrontation Fields and a Dilated Fundus Exam, No ROS was
taken. The provider performed a refraction exam and GDX of the retina of both eyes.
a. 99215, 92132 c. 92014, 92134, 92015
b. 92004, 92250, 92105 d. 92014, 92134

63. Dr. Green is a neuroradiologist who has taken Barry, a 42-year-old male, with a diagnosis of
carotid stenosis, to the operating room to perform a thrombaoendarteroctomy, unilateral.
During the surgery, the patient is monitored by eletroencephalogram (EEG). Code the
monitoring only

a. 95957 c. 95817
b. 95816 d. 95955

64. Patient that has multiple sclerosis has been seeing a therapist for four visits. today’s visit the
therapist will be performing a comprehensive - re-evaluation to determine the extent of
progress in parameters and if the patient is reaching his goals for common impairments
associated with this neurologic condition, which includes performing activities of daily
living, movement, muscle strength and reasoning abilities for independent living. What CPT
AND ICD-10-CM codes should be reported?
a. 97168, Z51.89, G35 c. 97172, Z51.89, G35
b. 97164, Z51.89, G35 d. 97167, Z51.81, G35

Section -3
Number of questions from each topic:
 Medical Terminology (4 questions)
 Anatomy: 4 questions
 ICD - 10-CM (5 questions)
 HCPCS Level II (3 questions)
 Coding Concepts & Guidelines (7 questions)
 Compliance & Regulatory :3 questions

Medical Terminology
65. What is a root word for vagina?
a. Uter /o c. Hyster/o
b. Colp /o d. Metri/o
66. In the medical term myopathy the term - pathy means disease. What is diseased?
a. Mind c. Eye
b. Muscle d. Nervous System

67. If a surgeon cuts into a patient’s stomach he has performed a

a. Gastrectomy c. Gastrostomy
b. Gastrotomy d. Gastrorrhaphy

68. A surgeon performs and “escharotomy.” The procedure is best described as :

a. Removal of scar tissue resulting from ulcer burns or other injuries
b. Removal of basal cell carcinoma
c. Debridement of a pressure.
d. Removal of a fingernail
Anatomy
69. Which of the following anatomical sites have septum?
a. Nose, heart c. Sternum, coccyx
b. Kidney, lung d. Orbit, ovary

70. What does IOL stand for?

a. Interoptic laser c. Interdimensional ocular lengths
b. Intraocular lens d. Iridescence over lamina

71. What are the four lobes of the brain?

a. Frontal, Parietal, Temporal, Occipital c. Frontal, Cerebral, Cerebellum, Pons
b. Sulci, Cerebellum, Pons, Medulla d. Frontal, Cerebrum, Temporal,
Occipital

72. What condition has predominant symptoms of rapid, involuntary eye movement?
a. Astigmatism c. Diplopia
b. Nystagmus d. Hyperopia

ICD-10-CM

73. A patient with esophageal cancer is being treated for neoplasm related pain. What is/are
the appropriate ICD-10-CM code (s)?
a. R10.13 b. G89.3, C15.9
c. C15.9, G89.3 d. G89.3
74. Patient presents with pain in the joint of the left great toe. The joint is painful and swollen
with erythema. X-ray are taken and the patient is diagnosed with Hallux Rigidus. What is the
appropriate ICD-10-CM code?
a. M20.10 c. M20.22
b. M20.20 d. M79.672

75.A late effect is the effect after the acute phase of an illness or injury has terminated.
a. Residual c. Positive
b. Current d. Short-term

76. The patient is being seen today due to her fears of flying. She has a flight planned for a work
trip.
What is the appropriate CID-10-CM code?
a. F40.241 c. F40.9
b. F40.228 d. F40.243

77. 8- year-old female presents for wellness exam. She is without complaints. Exam reveals a
curvature of the spine and she is diagnosed with congenital scoliosis of the lumbar spine.
What is /are the appropriate ICD-10-CM code (s)?
a. Z00.121, Q67.5 b. Z00.129, Q67.5
c. Z00.121, M41.26 d. Z00.01, Q67.5

HCPCS Level II

78. A 78-year-old patient, with known arrhythmia, presented to an outpatient clinic for the
insertion of a cardiac event recorder. What is the proper HCPCS Level II code for this device?
a. C1767 c. C1777
b. C1764 d. E0616

79. 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 c.E0585, E0550
b. E0570, E0560 d.E0570, E0555
80. 67-year-old newly diagnosed with IDDM type I is being seen in the office today for dietetic
training was for an hour and covered special diet instructions, blood glucose monitoring,
and instruction on how to administer daily insulin injections. Which HCPCS Level II code (s)
will be reported for this session?
a. G0108 x 2 c. A9275, A4211
b. G0109 x 2 d. S9214

Coding Concepts & Guidelines

81. The symbol TRIANGLE before a code in the CPT manuals means?
a. The code is except from bundling requirements
b. The code has been revised in some way this year.
c. The code is exempt from unbundling requirements.
d. The code can be used as an add-on code, never reported alone or first.

82. When using the CPT index to locate procedure, which of the following are considered
primaryclasses for main entries?
a. Procedure or service; organ or other anatomic site; condition; synonyms, eponyms,
and abbreviations
b. Abbreviations; signs and symptoms, anatomic site; and code assignment
c. Conventions; code ranges; modifying terms.
d. Procedure or service; modifiers; clinical examples; and definitions

83. In order to use the critical care codes, which of the following statements is TRUE?
a. Critical care services can be provided in an internist’s office
b. Critical care services provided for more than 15 minutes but less than 30 minutes
should be billed with 99291 and modifier 52.
c. Time spent reviewing laboratory test results or discussing the critically ill patient’s
care with other medical staff in the unit or at the nursing station on the floor cannot
be included in the determination of critical care time.
d. Critical care services can only be billed if the patient is in a licensed emergency room
or intensive care type unit (i.e., cardiac, surgical respiratory).

84. A patient suffered a burn that involved the epidermis, dermis, and subcutaneous layers with
some muscle
involvement. What degree of burn would describe this injury?
a. Fist-degree, superficial with blisters
b. Second- degree, partial thickness with muscle
 c. Third -degree, full thickness
d. None of the above

85. What is episiotomy and why would a patient need to have this procedure?
a. Surgical suturing of the rectum caused extensive tissue damage following a bowel
repair.
b. Surgical incision of the vulva to facilitate delivery of a baby
c. Surgical puncture of the cervix to remove fluid
d. Surgical creation of an opening into the small intestine to provide relief of excessive
gastritis

86. Patient develops severe sepsis during a hospital encounter that was not present on
admission, how is this coded?
a. Systematic infection and appropriate code from R65.2 is assigned as secondary
diagnosis
b. System infection and appropriate code from R65.2 is assigned as a primary diagnosis.
c. Systematic infection is coded with A41.9 with code R65.21
d. A41.2 following by R65.2 as secondary diagnosis

87. Which answer describes a malignant neoplasm that stays encapsulated and has not
metastased?
a. Primary malignant c. In situ
b. Secondary malignant d. Unspecified

Practice Management

88. Which option below is NOT a covered entity under HIPAA?

a. Medicare c. BCBS
b. Medicaid d. Worker’s Compensation

89. Healthcare providers are responsible for developing and policies and procedures regarding
privacy in their practices.
a. Patient hotlines c. Fees
b. Work around procedures d. Notices of Privacy Practices

90. Which of the following statement regarding advanced beneficiary notices (ABN) is TRUE?
a. ABN must specify only the CPT ® code that Medicare is expected to deny.
 b. Generic ABN which states that a Medicare denial of payment is possible or the
internist is unaware whether Medicare will deny payment or not is acceptable.
c. An ABN must be completed before delivery of items or services are provided.
d. An ABN must be obtained from a patient even in a medical emergency when the
servicesto be provided are not covered.

Case studies
91. Operative Report
PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration.
POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration
OPERATION PERFORMED: Debridement and split thickness auto grafting of left foot
ANESTHESIA: General endotracheal.
INDICATIONS FOR PROCEDURE: This patient with multiple complications from Type II
diabetes has developed ulcerations which were debrided and homografted last week. The
homograft is taking quite nicely; the wounds appear to be fairly clean; he is ready for
autografting.
DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the
operating room and placed in the supine position on the operating table. Anesthetic
monitoring was instituted, internal anesthesia was induced. The left lower extremity is
prepped and draped in a sterile fashion. Staples were removed and the homograft was
debrided from the surface of the wounds. One wound appeared to have healed; the
remaining two appeared to be relatively clean. We debrided this sharply with good bleeding
in all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked
sponges. With good hemostasis a donor site was then obtained on the left anterior thigh,
measuring less than 100 cm. The wound were then grafted with a split-thickness autograft
that was harvested with a patch of Brown dermatome set at 12,000 of an inch thick.
This was meshed 1:5:1. The donor site was infiltrated with bupivacaine and dressed. The
skin graft was then applied over the wound, measured approximately 60 cm2 in dimension
of the left foot. This was secured into place with skin staples and was then dressed with
Acticoat 18’s Kerix incorporating a catheter, and gel pad. The patient tolerated the
procedure well. The right foot was redressed with skin lubricant sterile gauze and Ace wrap.
Anesthesia was reversed. Thepatient was brought back to the ICU in satisfactory condition.
What CPT and ICD -10-CM codes are reported?

a. 15220-58, 15004-58, L97.529, E11.621

b. 15120-58, 15004-58, E11.621, L97.529
c. 15950-78, 15004-78, E11.9, L97.409
d. 11044-78, 15120-78, 15004-78, E11.621, L97.529

92. PREOPERATIVE DIAGNOSIS: Right scaphoid fracture.

 TYPE OF PROCCEDURE: Open reduction and internal fixation of right scaphoid fracture.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room,
anesthesiahaving been administered. The right upper extremity was prepped and draped in
a sterile manner. The limb was elevated, exsanguinated and a pneumatic arm tourniquet
was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin
flaps were elevated. Cutaneous nerve branches were identified and very gently retracted.
The interval between thesecond and third dorsal compartment tendon were identified and
entered. The respective tendons were retracted and lateral capsulotomy incision was made,
and the fracture was visualized. There did not appear to be any type of significant defect at
the fracture site. A 0.045 Kirschner wire was then used as a guide wire, extending from the
proximal pole of the scaphoid distal ward. The guide wire was positioned appropriately and
then measured. A 25 mm Acutrak drill bit was drilled to 25 mm. A 22.5 mm screw was
selected and inserted and rigid internal fixation was accomplished in this fashion. This was
visualized under the OEC imaging device in multiple projections. The wound was irrigated
and closed in layers. Sterile dressings were then applied. The patient tolerated the
procedure well and left the operating room in stable condition. What code should be used
for this procedure?
a. 25628 – RT c. 25645-RT
b. 25624-RT d. 25651-RT

93. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Atherosclerotic heart disease.
POSTOPERATIVE DIAGNOSIS: Atherosclerotic heart disease.
OPERATIVE PROCEDURE: Coronary bypass graft x 2 with a single graft from the aorta to the
distal left anterior descending and from the aorta to the distal right coronary artery.
PROCEDURE: The patient was brought to the operating room and placed in a supine
position under general intubation anesthesia, the anterior chest and legs were prepped and
draped inthe usual manner. A segment of greater saphenous vein was harvested from the
left thigh,utilizing the endoscopic vein harvesting technique, and prepared for grafting. The
sternum was opened in the usual fashion, and the left internal mammary artery was taken
down and prepared for grafting. The flow through the internal mammary artery was very
poor. The patient did have a 25- mm difference in arterial pressure between the right and
left arms, the right arm being higher. The left internal mammary artery was therefore not
used. The pericardium wasincised sharply and a pericardial well created. The patient was
systemically heparinized and placedon bicaval to aortic cardiopulmonary bypass with the
sump in the main pulmonary artery for cardiac decompression. The patient was cooled to
26, and on fibrillation an aortic cross-clamp was applied and potassium-rich cold crystalline
cardiopegic solution was administered through the aortic root with satisfactory cardiac
arrest. Subsequent doses were given were given down the vein grafts as the anastomoses
were completed and via the coronary sinus in a retrograde fashion. Attention was directed
to the anastomoses were completed and via the coronary sinus in a retrograde fashion.
 Attention was directed to the right coronary artery. The end of the greater saphenous vein
was then anastomosed there to with 7-0 continuous Prolene distally. The remaining graft
material was then grafted to the left anterior descending at the junction of the middle and
distal third. The aortic cross clamp was removed after 149 minutes ofspontaneous cardio
version. The usual maneuvers to remove air from the left heart were then carried out using
transesophageal echocardiographic technique. After all the air was removed and the
patient had returned to a satisfactory temperature, he was weaned from cardiopulmonary
bypass after 213 minutes utilizing 5 g per kilogram per minute of dopamine. The chest was
closed in the usual fashion. A sterile compression dressing was applied, and patient
returned to the surgical intensive care unit in satisfactory condition.
a. 33511, 33517, I70.90 c. 33534, 33508, I25.10
b. 33511, 33508, I25.10 d. 33511, 33517, I25.10

94. PREOPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula

POST OPERATIVE DIAGNOSIS: Diverticulitis, perforated diverticula
PROCEDURE: Hartman procedure which is sigmoid resection with Hartman 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 Rocephin IV piggy- back 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 the 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 the mobilized using blunt dissection. The proximal
rectum just distal to the inflammatory mass was divided using a GIA stapler with 3.5mm
staples. The mesentery of the sigmoid colon was then taken down and tied using two 0
Vicylties. 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 was
removed with 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 10mm 10French 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
intraabdominal 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 pal- pated the colostomy; it was completely patient with
no obstructions. Dressings were applied.
Colostomy bag was applied. Which CPT code should be used?
a. 44140 c. 44160
b. 44143 d. 44208

95. 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, dorsolithotomy
position, after which the perineum and vagina were prepped, the bladder straight
catheterize, and the patient draped. After bimanual exam was performed a weighted
speculum. An endocervical curettage was then the anterior lip of the cervix was grasped
with a single toothed tenaculum. Endocervical curettage was then done with a Kevorkian
curette. 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 10mm 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 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 had essentially been removed. The
patient tolerated the procedure well and returned to the recovery room in stable condition
(Pathology confirmed benign endometrial polyps). Pathology confirmed benign endometrial
stable condition (Pathology confirmed benign endometrial polyps).
Pathology confirmed benign endometrial polyps.
a. 58558, 57460-51, N92.0, N84.0 c. 58558, 57558-51, N92.0, N84.0
b. 58558, N92.0, N84.0 d. 58558, N92.1, D49.5

96. 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 May field pins. We then proceeded with a
craniotomy. An inverted Ushaped incision was made over the posteior 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 Gel foam 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 c. 61150, G06.0
b. 61154, D496.6 d. 61150, D49.6

97. 22 -year-old driver lost control of her car and crashed into a light pole on the highway. She
arrived to the hospital by ambulance in an unconscious state. She had CT scans without
contrast of the brain and chest. She had X-rays of AP and PA views of her left ribs and AP
and PA views of her right ribs with a posterior- anterior view of the chest. The CT scan of the
brain showed a fracture of the skull base with no hemorrhage of the brain. The CT of the
lung showed no puncture of the lungs. The X-ray showed fractures in her second, third, and
fifth ribs. What CPT and ICD- 10-CM codes should be reported.
a. 79450-26 71250-26, 71101-26, S02.91XA, S22.43XA, V86.09XA, Y92.410
b. 70460-26, 71260-26, 71110-26, S02.10XA, S22.43XB, V86.09XA, Y92.410
c. 70450-26, 71250-26, 71111-26, 71010-26, S02.10XA, S22.49XA, V86.09XA, Y92.410
d. 70450-26, 71250-26, 71111-26, S02.10XA, S22.49XA, V86.09XA, Y92.410

98. Report the global service.

CLINICAL HISTORY: Mass, left atrium.
SPECIMEN RECEIVED: Left atrium.
GROSS DESCRIPTION: The specimen is labeled with patient’s name and “left atrial myxoma”
andconsists of a4 x 4 x 2 cm ovoid mass with a partially calcified hemorrhagic white-
tan tissue.
INTRAOPERATIVE FROZEN SECTION DIAGNOSIS: Myxoma
MICROSCOPIC DESCRIPTION: Sections show a well-circumscribed mass consisting of
fibromyxoid tissue showing numerous vascular channels. Areas of superficial ulceration and
chronic inflammatory infiltrate are noted. Areas of calcification are also present.
DIAGNOSIS: Myxoma, benign, left atrium.
a. 88305, D49.89 c. 88307, 88331-26, D15.1
b. 88305, 88331, D15.1 d. 88305, D15.1

99. 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 day’ 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-ray, and routine laboratory workup. The
physician considers the multiple diagnoses of pericarditis following infection, unstable
angina, dissecting aneurysm, pulmonary infraction, or esophageal disease indicating a high
level of medical decision making complexity.
a. 99236, R07.2, R06.8
b. 99223, I30.0, R07.2, R06.82
c. 99245, I30.0, I20.0, I72.9. I26.99, K22.9
d. 99223, I30.0, I20.0, I72.9, I26.99, K22.9

100. CLINICAL SUMMARY: The patient is a 55-year-old female with known coronary disease
and previous left anterior descending and diagonal artery intervention, with recent
recurrent chest pain. Cardiac catheterizations demonstrated continued patency of the
stented segment, but diffuse borderline changes in the distal/proximal portion of the right
coronary artery.
PROCEDURE: With informed consent obtained, the patient was prepped and draped in the
usual sterile fashion. With the right groin area infiltrated with 2% Xylocaine and the patient
given 2 mg of versed and 50 mcg of study was exchanged for a 6 -French sheath and pain
control, the 6-French catheter sheath from the diagnostic study was exchanged for a 6-
French sheath and a 6-French JR4 catheter with side holes utilized. The patient initially
received 3000 units of IV heparin, and then IVUS interrogation was carried out using an
Atlantis Boston scientific probe. After it had been deter- mined that there was significant
stenosis in the distal/proximal segment of the right coronary artery in a primary stenting
procedure with inflation pressure up to 12 atmospheres applied. Final angiographic
documentation was carried out, and then the guiding catheter pulled, the sheath upgraded
to a 7-French system, because of some diffuse oozing around the 6- French-sized sheath,
and the patient is now being transferred to telemetry for post- coronary intervention
observation and care.
RESULTS: The initial guiding picture of the right coronary artery demonstrates the right
coronary artery to be dominant in distribution, with luminal irregularities in its proximal and
mid third with up to 50% stenosis in the distal/proximal segment per angiographic criteria,
although some additional increased radiolucency observed in that segment. IVUS
interrogation confirms severe,concentric plaque formation in this distal/proximal portion
of the right coronary artery with over 80% area stenosis demonstrated. The mid, distal
lesions are not significant, with less than 40% stenosis per IVUS evaluation. Following the
coronary intervention with stent
placement, there is marked increase in the distal/proximal right coronary artery size, with
no evidence for intimal disruption, no intraluminal filling defect, and TIMI III flow preserved.
CONCLUSION: Successful coronary intervention with drug-eluting Taxus stent placement to
the distal/proximal right coronary artery.
a. 92928-RC, 92978-RC c. 92928-RC, 92978-51-RC
b. 92933-RC, 92978-RC d. 92941-RC, 92978-51-RC