CPC Chapter 15- Eye and Ocular Adnexa, Auditory Systems Review Questions

Question 1

Using the CPT® code book to look up Strabismus in the index. Strabismus surgery would be performed to correct which of the following eye disorders?
A. Removing a cloudy lens
B. Balancing the strength of extraocular muscles
C. Draining an orbital abscess
D. Reconstructing a damaged eyelid

Answer 1

B. Balancing the strength of extraocular muscles

Rationale: Strabismus in the CPT® Index takes you to code range 67311-67345. In the text, find the subheading entitled Extraocular Muscles. All of these codes involve the muscles moving the eyeball, and most of these codes address adjusting one or more ocular muscles to correct an imbalance in the muscles causing the eye to be pulled too much in one direction, causing disorders like crossed or wandering eyes.

Question 2

Which of the following has NO refractive properties?
A. Cornea
B. Lens
C. Vitreous
D. Iris

Answer 2

D. Iris

Rationale: The iris is the colorful muscle contracting and expanding in a measured fashion, controlling the amount of light permitted into the posterior segment of the eye. While the iris is involved in rationing light, it does not have any effect on the bending of light. As an opaque body, the iris has no refractive qualities.

Question 3

Code 69210 in the CPT® code book describes removal of impacted earwax from the external auditory canal. What type of conduction is interrupted by impacted earwax?
A. Bone conduction
B. Air conduction
C. Bone and air conduction
D. Neither bone nor air conduction

Answer 3

B. Air conduction

Rationale: The hearing of a patient is interrupted by impacted ear wax, called cerumen. The wax interrupts air conduction of sound as it travels through the ear canal across the tympanic membrane to the middle and inner ear. Bone conduction is not affected by ear wax buildup.

Question 4

The incus bone is between the malleus and the stapes. In which part of the ear is the incus located?
A. The external ear
B. The middle ear
C. The inner ear
D. The Eustachian tube

Answer 4

B. The middle ear

Rationale: The three ossicles (malleus, incus, and stapes) are found in the middle ear. When sound travels by air into the external auditory canal, it causes the tympanic membrane to vibrate. The sound is then transferred from the membrane to the tiny ossicles. From the stapes, the vibration is transferred to the oval window, which causes the round window to move and vibrate the endolymph of the cochlear duct. This causes the fine hairs in the organ of Corti to transmit impulses through the cochlear nerve to the brain.

Question 5

Which of the following statements is true regarding the vitreous humor?
A. It presses against the cornea so that the cornea keeps its shape
B. It signals the iris when to contract or expand
C. It produces tears that flow in the eyes and nose
D. It holds the retina firmly against the blood-rich choroid

Answer 5

D. It holds the retina firmly against the blood-rich choroid

Rationale: Vitreous humor is a gel-like substance in the posterior segment. In addition to its refractive qualities, the vitreous is responsible for holding the shape of the eyeball and keeping the retina pressed against the blood-rich choroid in the posterior segment.

Question 6

What is a blepharoplasty?
A. Excision of tumor of the tear duct
B. Corrective surgery for refraction error
C. Surgical repair of the eyelid
D. Suture repair of the sclera

Answer 6

C. Surgical repair of the eyelid

Rationale: Blephar/o is a root word identifying the eyelid, and plasty indicates a surgical repair.

Question 7

Keratoconus is a defect of which component of the eye?
A. Cornea
B. Lens
C. Choroid
D. Macula

Answer 7

A. Cornea

Rationale: Kerat/o is a root word identifying the cornea. In keratoconus, the cornea protrudes, causing a refraction error. Its cause is unknown, but it is thought to be hereditary.

Question 8

What occurs in myringotomy?
A. The external auditory canal is reconstructed
B. Myringa is removed from the inner ear
C. The tympanic membrane is excised
D. The tympaanic membrane is incised

Answer 8

D. The tympanic membrane is incised

Rationale: Myring/o is a root word identifying the tympanic membrane and -otomy is a suffix indicating an incision.

Question 9

A patient has a disorder of the ear causing extreme vertigo. Which part of the ear is diseased?
A. The inner ear
B. The middle ear
C. The external ear
D. None of the above

Answer 9

A. The inner ear

Rationale: The inner ear is responsible for balance in addition to conduction of sound. Vertigo, or extreme dizziness, is often a symptom of inner ear disorders including Mèniére’s disease and vestibular neuronitis.

Question 10

Based on what you have learned so far, which of the following statements is true?
A. All components of the eyes and ears occur bilaterally
B. Most procedures for the eyes or ears are performed by specialists
C. The eyes and ears are the two most important sense organs in the body
D. All of the above

Answer 10

D. All of the above

Rationale: All of the above are correct. The eye and ear both occur bilaterally, and their individual components occur bilaterally as well. Even within ophthalmology, you will find specialists in one area. For example, retinal specialists work with diseases/conditions of the retina, and an ophthalmologist may specialize in cataract surgery. The same is true for otorhinolaryngology: within the specialty, you will find subspecialists for hearing and vestibular disturbances. Because they are organs of communication, the eye and ear are considered to be the most important sense organs in the body. Physicians work very hard to safeguard and optimize their patients’ sight and hearing.

Question 11

The patient is a 40-year-old male with type 1 diabetes in good control. He is seen today for a follow up of his mild nonproliferative diabetic retinopathy in his left eye. Select the correct diagnosis code(s).
A. E10.3291, H35.022
B. E10.3292
C. H35.22
D. E11.3293

Answer 11

B. E10.3292

Rationale: In the ICD-10-CM Alphabetic Index look for Diabetes, diabetic/type 1/with/retinopathy/non-proliferative/mild and directs you to E10.329-. In the Tabular List, 7th character 2 is reported to indicate the left eye. This is a combination code that includes the diabetes and the complication of retinopathy. A separate code for retinopathy is not reported. Because macular edema is not indicated in the scenario, the default is without macular edema.

Question 12

Mrs. Johns brought in her 9-month-old baby today, complaining that he has been fussy and inconsolable. Indeed, James cried during the entire visit. Mrs. Johns believes her child has another case of otitis media as this is the exact behavior exhibited last time. However, the exam reveals no infection, no fever. Select the correct diagnosis code.
A. Z01.10
B. Z00.129
C. H66.90
D. R68.12

Answer 12

D. R68.12

Rationale: Look at the chief complaint — the reason for the visit — when considering the primary diagnosis. In the ICD-10-CM Alphabetic Index, look for Fussy baby directing you to code R68.12. In this case, the mother thought her son had a recurring ear infection because of the child’s excessive crying. D is the correct answer because it is the chief complaint and no other diagnosis was found. Codes Z00.129 and Z01.10 are inappropriate because these codes describe routine exams in asymptomatic populations. Code H66.90 is incorrect, as no definitive diagnosis is made.

Question 13

A patient had an acoustic neuroma removed. The pathology report comes back and the tumor is reported as a malignant tumor of the vestibulocochlear nerve (auditory vestibular nerve). What is the correct diagnosis code?
A. D49.89
B. D33.3
C. C72.40
D. C71.0

Answer 13

C. C72.40

Rationale: In the ICD-10-CM Alphabetic Index look for Neuroma/acoustic (nerve) D33.3. Although an acoustic neuroma is indexed to D33.3, the question indicates malignant which changes the way the diagnosis is reported. When you look up references to acoustic neuroma you will see that it is a benign tumor that usually grows slowly. A note at the beginning of the Table of Neoplasms discusses classifications in the columns of the table, and advises, “the guidance in the index can be overridden if one of the descriptors … is present.” Because the pathologist stated this particular acoustic neuroma is malignant, the word malignant overrides the Index entry. Look in the Table of Neoplasms for Neoplasm, neoplastic/auditory/nerve/Malignant Primary which directs you to C72.4-. Verify in the Tabular List and code C72.40 is reported because the laterality is not addressed. It’s very important to study and understand the information provided in the guidelines and notes within the code book. Be willing to look beyond the codes for the answers because the answers may be in the instructional notes and guidelines.

Question 14

While dressing for work, the patient caught her earring in her shirt, and the force of her arm’s motion ripped the earring free, tearing her earlobe. She is seen in the emergency department to have the left earlobe repaired and to receive a tetanus shot. What diagnosis codes are assigned?
A. S01.311A, Z23
B. S01.332A, Z23
C. S01.342A, Z23
D. S01.312A, Z23

Answer 14

D. S01.312A, Z23

Rationale: This is an open wound of the earlobe. In the ICD-10-CM Alphabetic Index look for Laceration/ear (canal) (external), which directs you to S01.31-. In the Tabular List, the code selection indicates a 6th character for laterality and 7th character to indicate the episode of care is required. Complete code S01.312A is for laceration of the left ear, initial encounter. The patient received a vaccination for tetanus, which is reported with Z23. Look in the Alphabetic Index for Vaccination/encounter for directs you to Z23.

Question 15

A child is exhibiting leukocoria in the left eye, and an MRI of the skull is ordered to rule out retinoblastoma. What diagnosis code is reported?
A. H44.532
B. C69.22
C. H17.12
D. H44.50

Answer 15

A. H44.532

Rationale: Look in the ICD-10-CM Alphabetic Index for Leukocoria and you are directed to see Disorder, globe, degenerated condition, leukocoria. Disorder/globe/degenerated condition/leukocoria directs you to H44.53-. In the Tabular List, 6th character 2 is reported to indicate the left eye. Leukocoria reports a symptom rather than an actual diagnosis. In leukocoria, an abnormal white reflection from the retina is visible through the pupil upon examination of the eye. It can be indicative of retinoblastoma, a congenital retinal cancer, but until this diagnosis is confirmed, the symptom of leukocoria is the appropriate diagnosis to report.

Question 16

Topical antibiotics were prescribed today for Jack Jones, who presented with pink eye in both eyes. His four children are all being treated for the same condition by their pediatrician. What is the correct diagnosis code?
A. H10.021
B. H10.023
C. H10.029
D. H10.519

Answer 16

B. H10.023

Rationale: Pink eye is a highly infectious form of mucopurulent conjunctivitis. This infection typically is accompanied by very bloodshot eyes and a heavy discharge. In the ICD-10-CM Alphabetic Index, look for Pink/eye - see Conjunctivitis, acute, mucopurulent. Look for Conjunctivitis/acute/mucopurulent H10.02-. In the Tabular List, the codes contain laterality and documentation indicates both eyes (bilateral) are affected.

Question 17

Mable reports her hearing is not what it used to be. Indeed, everything that was discussed today during her visit has been repeated loudly, and within very close range. The physician scheduled a hearing testing with Acme Audiology. What is the diagnosis code?
A. H90.8
B. R94.120
C. H91.09
D. H91.90

Answer 17

D. H91.90

Rationale: Without more specific information for the type of hearing loss, a nonspecific diagnosis is reported. In the ICD-10-CM Alphabetic Index, look for Loss/hearing (see also Deafness). Look for Deafness directing you to H91.9-. In the Tabular List, select code H91.90 Unspecified hearing loss, unspecified ear. No scientific study of the hearing loss was made, making R94.120 incorrect.

Question 18

The patient underwent an enucleation for retinal cancer and is here today with right orbital cellulitis, a foreign body response to the temporary implant placed following the surgery. The implant was removed, and the patient was admitted for observation and IV antibiotics. Select the correct diagnosis codes.
A. T85.79XA, H05.011, Z85.840
B. T86.8411, H05.011, Z80.8
C. H05.011, Z80.8
D. T86.8411, H05.011, Z85.840

Answer 18

A. T85.79XA, H05.011, Z85.840

Rationale: In the ICD-10-CM Alphabetic Index, look for Complication/eye/implant (prosthetic)/infection and inflammation directing you to T85.79-. In the Tabular List, code T85.79- requires a 7th character. Based on active treatment for the condition this would support A, initial encounter. Because T85.79 is a five-character code the placeholder X is needed to maintain the 7th character position. Subcategory code T85.7 states to “Use additional code to identify specified infections”. There is no documentation of the infective agent. Orbital cellulitis is indexed under Cellulitis/orbit, orbital H05.01-. In the Tabular List, the 6th character 1 is for the right side. The implant is the result of the patient’s previous cancer indicated with Z85.840. This is found under History/personal (of)/malignant neoplasm (of)/eye Z85.840. This is not a family history of cancer of the eye, Z80.8.

Question 19

The patient reports she turned her head quickly while pruning a dogwood tree in her yard and a branch entered her right ear. She states that when she performs a Valsalva maneuver (exhaling with the mouth and nose firmly closed), she can hear air course through her ear. On examination, there is no foreign body present. A small perforation of the right eardrum is noted, which should heal independent of treatment. Her ear will be re-evaluated in two weeks. Select the correct diagnosis codes.
A. H72.01, W60.XXXA, Y92.017, Y93.H2
B. S00.401A, H72.00
C. S09.21XA, W60.XXXA, Y92.017, Y93.H2
D. S09.21XA, W45.8XXA, Y92.017, Y92.157

Answer 19

C. S09.21XA, W60.XXXA, Y92.017, Y93.H2

Rationale: This is an acute injury and in ICD-10-CM injuries have different categories for open wounds, lacerations, bites, and are specific to with or without a foreign body. In the ICD-10-CM Alphabetic Index, look for Wound/puncture wound - see Puncture. Look for Puncture/ear/drum directing you to S09.2-. In the Tabular List subcategory S09.2- requires a 5th digit for laterality and a 7th character for the type of encounter. Because S90.21 is a five-character code, the place holder X is needed to maintain the 7th character position. The complete code is S09.21XA. Codes in the H72.0- subcategory are for perforations persisting after an illness or injury is resolved. Code S00.401- is for a superficial injury, but this isn’t superficial because it is in the middle ear. Do not confuse simple with superficial. External cause codes describe the circumstance of the injury. These codes are found in External Cause of Injuries Index. Look for Contact/with/plant thorns, spines, sharp leaves or other mechanisms W60. Category W60 requires a 7th character for type of encounter. Because this is a three-character code, the placeholder X is needed to maintain the 7th character position. The complete code is W60.XXXA. Next, in the External Cause of Injuries Index for look for Place of occurrence/yard, private/single family house Y92.017. In the same index look for Activity/gardening Y93.H2. Verify these codes in the Tabular List. These External cause codes help establish the cause of the injury for the payer.

Question 20

The patient has been compliant with his Xalatan eye drops, and his intraocular pressure (IOP) is now within normal limits at 20 mm Hg. The glaucoma seems to be in good control. He will continue the current regime and return for a follow-up exam in six months. What diagnosis code is reported?
A. H40.9
B. H40.10X0
C. Z86.69
D. H40.20X1

Answer 20

A. H40.9

Rationale: There is not a lot of information to work with and H40.9 Unspecified glaucoma is the appropriate choice. In the ICD-10-CM Alphabetic Index, look for Glaucoma and the default code is H40.9. In a medical office, you would have access to the entire patient record and to the physician to find out more about the type of glaucoma. The important thing to remember is the patient still has glaucoma, despite the normal (WNL is within normal limits) IOP (intraocular pressure). Code Z86.69 is inappropriate because it reports a history of a resolved condition.

Question 21

The patient is complaining of severe corneal pain and believes a wood chip entered his eye. He was working in his woodworking shop without goggles this morning. After placing two drops of proparacaine 0.5% in the right eye, I administered fluorescein and examined the cornea under ultraviolet light using a slit lamp. Seidel sign negative for penetrating injury. A small piece of wood was identified under a flap of lamellar cornea, and I was able to dislodge the wood and flush it from the eye. A single suture was placed to secure the flap.

What CPT® code is reported for this procedure?
A. 65270
B. 65275
C. 65280
D. 65285

Answer 21

B. 65275

Rationale: The presence of the foreign body has no bearing on code selection. In the CPT® Index, see Cornea/Repair/Wound/Nonperforating 65275. Note the code reads with or without removal of foreign body. The key to code choice is the site of the injury, which is the cornea and it was a nonperforating injury (lamellar means partial thickness of the cornea). The topical anesthetic is bundled into the procedure, although the physician could bill separately for any IV sedation used or if a therapeutic contact lens was applied.

Question 22

The 55-year-old patient presents with 1 cm lesion in his right ear canal posterior to the tragus. The lesion is red and raised, typical of basal cell carcinoma. After administration of lidocaine, I performed a shave biopsy. Electrocautery was required to control bleeding. The tissue sample was sent to pathology. What CPT® code is reported for this procedure?
A. 69100
B. 69105
C. 11301
D. 11102

Answer 22

B. 69105

Rationale: Although the area biopsied is skin, a code from the Auditory System chapter of CPT® is appropriate for this biopsy. CPT® tells us to report code 69100 for a biopsy of the external ear, and 69105 for a biopsy of the external auditory canal. In the CPT® Index, look for Biopsy/Auditory Canal, External. The tragus is the protective cartilage knob anterior to the ear canal. Code 69105 is the correct code for a biopsy, by any method of the external auditory canal.

Question 23

Today we excised bilateral recurrent pterygium under topical anesthetic. The conjunctival incisions were repaired simply. What CPT® code is reported for this procedure?
A. 65420-50
B. 65426-50
C. 68110-50
D. 68115-50

Answer 23

A. 65420-50

Rationale: In the CPT® Index, look for Pterygium/Excision 65420. A pterygium is an overgrowth of conjunctiva forming in the nasal aspect of the eye and growing outward towards the cornea. Excision of a pterygium is reported separately from other conjunctival disorders, with codes 65420 and 65426. Because this was a simple repair without a graft, 65420 is the correct code. Modifier 50 indicates a bilateral procedure was performed.

Question 24

The patient underwent a plastic repair of the external auditory canal for stenosis, a late effect of a burn. After excising the subepithelial stenotic tissue and a wedge of skin from the floor of the external auditory canal, a rubber tube was placed inside the external canal. The patient will return in two weeks to monitor his progress. What CPT® code is reported for this procedure?
A. 69433
B. 69799
C. 69310
D. 69140

Answer 24

C. 69310

Rationale: In the CPT® Index, look for Meatoplasty/External Auditory Canal 69310. The external opening of the ear is referred to as the meatus. A meatoplasty enlarges the opening. Another index option is to look for Auditory Canal/External/Reconstruction/for Stenosis 69310.

Question 25

The patient has hypertropia in her right eye with prior eye operations in this eye and today we are performing a recession of the superior oblique muscle to balance this muscle and eliminate strabismus. Adjustable sutures are applied. She is pseudophakic. What CPT® codes are reported for this procedure?
A. 67318, 67335-51
B. 67314, 67335, 67331
C. 67318, 67331, 67335
D. 67314, 67335, 67320

Answer 25

C. 67318, 67331, 67335

Rationale: In the CPT® Index, look for Strabismus/Repair/Superior Oblique Muscle 67318. Code 67318 is the only code listed describing a procedure on the superior oblique muscle. In addition to 67318, report add-on codes for adjustable sutures. In the index, see Strabismus/Repair/Adjustable Sutures 67335. This patient has a history of ophthalmic surgery. The medical history of ocular surgery makes the procedure riskier and more difficult. Look in the index for Strabismus/Repair/Previous Surgery, Not Involving Extraocular Muscles 67331. Modifier 51 is never applied to add-on codes.

Question 26

A patient with severe mixed hearing loss from chronic otitis media undergoes a round window implant with floating mass transducer. What CPT® code is reported for this procedure?
A. 69799
B. 69667
C. 69714
D. 69710

Answer 26

A. 69799

Rationale: In the CPT® Index, look for Ear/Unlisted Services and Procedures. The correct answer is A, for an unlisted procedure. Round window implants are a new technology not yet assigned CPT® a code. The word transducer should alert you to the hearing aid component of this procedure. There isn’t a new technology Category III code for this type of procedure, so an unlisted code is the best choice. The round window is the barrier between the middle and inner ear, but it is still considered middle ear.

Question 27

A patient has an oversized and embedded dacryolith in the lacrimal sac, and a dacryocystectomy is performed. What CPT® code(s) is/are reported for this procedure?
A. 68500
B. 68420
C. 68520
D. 68520, 68420-51

Answer 27

C. 68520

Rationale: In the CPT® Index, look for Dacryocystectomy referring you to 68520. The stone was embedded in the sac, which was removed. Only one code is used for removal of the stone and removal of the sac. The lacrimal gland is located near the eyebrow; the lacrimal sac is the upper dilated end of the lacrimal duct, aligned with the nostril.

Question 28

A patient underwent mastoidotomy for ossicular chain reconstruction with tympanic membrane repair, atticotomy, and partial ossicular replacement prosthesis. What CPT® code is reported for this procedure?
A. 69632
B. 69635
C. 69636
D. 69637

Answer 28

D. 69637

Rationale: In the CPT® Index, look for Mastoidotomy. Code 69637 represents a mastoidotomy (including atticotomy and tympanic membrane repair) with ossicular chain reconstruction and partial ossicular replacement prosthesis.

Question 29

What CPT® code is used to report surgery to remove an aqueous shunt from the patient’s extraocular posterior segment of the eye?
A. 65265
B. 65920
C. 67120
D. 67121

Answer 29

C. 67120

Rationale: An aqueous shunt is implanted material in the extraocular posterior segment of the eye. In the CPT® Index, look for Eye/Removal/Implant/Posterior Segment referring you to 67120-67121. It can also be found by looking for Removal/Implant/Eye.

Question 30

An ophthalmologist sees a patient for a yearly eye exam under his vision benefits and follow up for a cataract diagnosed at the last visit. The exam includes a history, external examination, ophthalmoscopy, biomicroscopy, and tonometry. The cataract of the left eye is stable and there are no new findings. The patient will return in one year. What CPT® code is reported for this procedure?
A. 92004
B. 92002
C. 92012
D. 92014

Answer 30

C. 92012

Rationale: In the CPT® Index, look for Ophthalmology, Diagnostic/Eye Exam/Established Patient referring you to 92012-92014. The cataract is stable and there were no other findings resulting in an intermediate exam. A comprehensive ophthalmological service always includes initiation of diagnostic and treatment programs.

Question 31

What is the transparent part of the eye?
A. Sclera
B. Choroid
C. Cornea
D. Retina

Answer 31

C. Cornea

Rationale: The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber.

Question 32

What ICD-10-CM code(s) is/are reported for bilateral cataracts?
A. H40.9, H260.233
B. H26.9-RT
C. H26.9
D. Q12.0

Answer 32

C. H26.9

Rationale: In the ICD-10-CM Alphabetic Index look for Cataract that refers to the default code H26.9. Modifiers are not appended to diagnosis codes. There is no documentation to support that the cataracts are congenital. Even though the cataract is in both eyes, it is only necessary to report the ICD-10-CM code once per ICD-10-CM guideline I.B.12.

Question 33

What is exophthalmos?
A. Excess sugar in the urine.
B. Protrusion of the eyeballs.
C. Enlargement of the thyroid gland.
D. A condition resulting from an excess of hormones from the adrenal cortex.

Answer 33

B. Protrusion of the eyeballs

Rationale: Exophthalmos is a protruding eyeball anteriorly out of the orbit (eye socket). When there is an increase in the volume of the tissue behind the eyes, the eyes will appear to bulge out of the face.

Question 34

What ICD-10-CM code is used to report acute actinic otitis externa of the left ear?
A. H60.62
B. H60.512
C. H66.90
D. H60.542

Answer 34

B. H60.512

Rationale: In the ICD-10-CM Alphabetic Index look for Otitis/externa/acute/actinic and you are directed to H60.51-. Verification in the Tabular List indicates a 5th character is reported for laterality. 5th character of 2 is for left ear.

Question 35

A surgeon performed a cataract extraction with an intraocular lens implant on the right eye of a Medicare patient. What modifier(s) would be reported?
A. RT
B. E1, E2
C. E2
D. 50

Answer 35

A. RT

Rationale: Modifiers RT and LT are used to identify procedures performed on paired organs such eyes, ears, breasts (excluding skin) or on sides of the body.

Question 36

What ICD-10-CM code is reported for an encounter for cataract screening?
A. Z13.9
B. Z13.5
C. H26.9
D. H26.8

Answer 36

B. Z13.5

Rationale: Look in the ICD-10-CM Alphabetic Index for Screening/cataract directing you to Z13.5. Verify in the Tabular List Z13.5 Encounter for screening for eye and ear disorders.

Question 37

To code for the operating microscope, what verbiage are you looking for in the medical record?
A. Loupes were donned for magnification.
B. Microdissection may be necessary.
C. “Due to the intricate dissection under magnification…”
D. The operating microscope was sterilely draped and brought into the surgical field.

Answer 37

D. The operating microscope was sterilely draped and brought into the surgical field

Rationale: A loupe is a single vision magnifying glass most often identified with jewelers or watchmakers. An operating microscope is a binocular microscope used to see and repair small intricate parts of the body, such as nerves and blood vessels. It is not an instrument that can be sterilized so it must be sterilely draped for use in the operating room

Question 38

What CPT® code is reported for removal of foreign body from the external auditory canal without general anesthesia?
A. 69200
B. 69205
C. 69210
D. 69220

Answer 38

A. 69200

Rationale: In the CPT® Index look for Auditory Canal/External/Removal/Foreign Body which directs you to code range 69200-69205. Verify the code in the numeric section. Code 69200 is the appropriate code for the removal of a foreign body from the external auditory canal without general anesthesia. Code 69205 is with anesthesia. Under direct visualization the foreign body is removed from the external auditory canal using delicate forceps, a cerumen spoon or suction. No anesthetic or local anesthetic is used.

Question 39

A patient has heavy skin and muscle (myogenic) that is drooping down and blocking his vision due to myogenic ptosis of the upper eyelid. The provider performed a bilateral upper blepharoplasty. What ICD-10-CM code(s) is (are) reported?
A. H02.423
B. H02.421, H02.422
C. H02.31, H02.34
D. H02.531, H02.534

Answer 39

A. H02.423

Rationale: Drooping (ptosis) of the upper eyelid is due to a muscle disorder (myogenic). In the ICD-10-CM Alphabetical Index look for Ptosis/eyelid which states to see Blepharoptosis. Look for Blepharoptosis/myogenic referring to H02.42-. Tabular List indicates 6th character is needed to indicate laterality. 6th character of 3 is for bilateral. Only one code is reported for both eyelids, not two separate codes.

Question 40

A patient with aphakia and anisometropia in the right eye undergoes surgery to implant a lens. An incision is made in the corneal-scleral juncture and a scleral tunnel is made. A partial vitrectomy is performed and the provider guides the intraocular implant into the eye pulling it into position by Prolene sutures. What CPT® code is reported?
A. 66985-RT
B. 66983-RT
C. 66984-RT
D. 66982-RT

Answer 40

A. 66985-RT

Rationale: Code 66985 is the correct code since the insertion of lens is for aphakia (not associated with cataract). In the CPT® Index look for Intraocular Lens/Insertion/Not Associated with Concurrent Cataract Removal.

Question 41

Michael has bilateral lazy eyes and undergoes strabismus surgery of the superior oblique muscle for both eyes. What CPT® code is reported?
A. 67318-50
B. 67345
C. 67311-50
D. 67318

Answer 41

A. 67318-50

Rationale: In the CPT® Index look for Strabismus/Repair/Superior Oblique Muscle it directs you to code 67318 and is confirmed by the code description in the numeric section. Modifier -50 is used to identify the procedure performed on both eyes.

Question 42

The patient was taken to the operating room. The provider everts the upper eyelid and places clamps across the everted undersurface of the upper lid. The tissue distal to the clamps is excised or resected. This tissue includes conjunctiva, tarsus, Muller’s muscle and the distal insertion of the levator aponeurosis. The remaining tissue is reattached and sutured. What CPT® code is reported?
A. 67906
B. 67901
C. 67903
D. 67908

Answer 42

D. 67908

Rationale: This is a repair of blepharoptosis. In the CPT® Index, look for Blepharoptosis/Repair directs the user to code range 67901-67909. The codes are selected based on the approach and technique. After verifying in the numeric section, code 67908 is the correct code.

Question 43

A patient is diagnosed with nuclear sclerotic cataract, right eye. She is taken to the operating room and a phacoemulsification with intraocular lens, right eye is performed. What CPT® code(s) is/are reported?
A. 66984-RT, V2632
B. 66982-RT
C. 66984-RT
D. 66984-RT, 66990

Answer 43

C. 66984-RT

Rationale: In the CPT® Index look for Phacoemulsification/Removal/Extracapsular Cataract and you are directed to 66982 and 66984. Verify these codes in the numeric section. Code 66982 is for a complex procedure. There is nothing in the note indicating this is a complex procedure. The correct code is 66984 which includes the insertion of the intraocular lens. Modifier RT is used to indicate it is performed on the right eye.

Question 44

An 89-year-old patient who has significant partial opacities in the lens of the left eye presents for phacoemulsification and lens implantation. What ICD-10-CM code is reported?
A. H26.112
B. H25.9
C. H26.9
D. H26.40

Answer 44

C. H26.9

Rationale: In the ICD-10-CM Alphabetical Index look for Opacity, opacities/lens which states see Cataract. Look in the Alphabetic Index for Cataract and the user is directed to the default code H26.9. Confirmation in the Tabular List confirms code selection.

Question 45

A 12-year-old male patient has an abscess located at the external auditory meatus. The ENT incises the abscess and packs it to absorb the drainage. What CPT® code is reported?
A. 69200
B. 69005
C. 69000
D. 69020

Answer 45

D. 69020

Rationale: The external auditory meatus is also referred to as the external auditory canal which starts from the opening of the ear to the eardrum. Look in the CPT® Index under Ear Canal referring to See Auditory Canal. Look up Auditory Canal/External/Abscess/Incision and Drainage which guides you to codes 69000, 69005 and 69020. Verify the correct code in the numeric section. 69020 is the correct code for an abscess of the auditory canal. The other codes refer only to the external ear.

Question 46

A provider uses cryotherapy for removal trichiasis of the right upper eyelid. What CPT® and ICD-10-CM codes are reported?
A. 67820-E3, H02.059
B. 67825-E3, H02.051
C. 67830-E3, H02.051
D. 67840-E3, B79

Answer 46

B. 67825-E3, H02.051

Rationale: In the CPT® Index, look for Trichiasis/Repair/Epilation, by Other than Forceps. Verify this code in the numeric section. Code 67825 describes the correction of trichiasis by other than forceps, for example cryotherapy. HCPCS Level II modifier E3 indicates upper right eyelid. In the ICD-10-CM Alphabetic Index look for Trichiasis (eyelid)/right/upper directs you to code H02.051 and is verified in the Tabular List as Trichiasis without entropion upper right eyelid.

Question 47

Repair of right eye retinal detachment with a giant tear is performed for an accidental injury sustained from a baseball to the eye at fastball practice. Vitrectomy, drainage of subretinal fluid, silicone oil tamponade, and endolaser photocoagulation are performed to correct the tear. What CPT® and ICD-10-CM codes are reported?
A. 67141, H33.8, W50.0XXA
B. 67113, H33.031, W21.03XA
C. 67108, H33.051, W50.0XXA
D. 67145, H33.001, T15.01XA

Answer 47

B. 67113, H33.031, W21.03XA

Rationale: In the CPT® Index look for Retina/Repair/Detachment/with Vitrectomy referring you to 67108, 67113. Code 67113 is used for the repair of a giant tear of the retina, with vitrectomy, and endolaser photocoagulation. In the ICD-10-CM Alphabetical Index look for Detachment/retina/with retinal/break/giant referring you to H33.03-. In the Tabular List a 6th character 1 is reported for the right eye. In the ICD-10-CM External Cause of Injuries Index look for Struck (accidentally) by/ball (hit) (thrown)/baseball referring you to W21.03-. In the Tabular List seven characters are reported to complete the code. The 6th character is a placeholder X and the 7th character A is used to identify the initial encounter. Surgical management represents an initial encounter.

Question 48

The provider creates an opening in the opaque posterior lens capsule of the patient’s right eye by cutting an inverted U shape in the tissue. The cut is made using a YAG laser. The tissue within the inverted U falls down, and out of the patient’s field of vision. The procedure is done to improve the vision of a patient with a secondary cataract. What CPT® code is reported?
A. 66999-50
B. 66830-50
C. 66821-RT
D. 66762-RT

Answer 48

C. 66821-RT

Rationale: In the CPT® Index look for Cataract/Incision/Laser. Documentation states that this is performed on a secondary cataract with a laser. The cataract is not removed from the eye, just from the line of vision. The cutting or incision through a part is a dissection. The procedure is described by code 66821. Modifier RT is used to indicate the procedure was performed on the right eye.

Question 49

Operative Report
PREOPERATIVE DIAGNOSIS: Prolapsed vitreous in anterior chamber with corneal edema
POSTOPERATIVE DIAGNOSIS: Same
OPERATION PERFORMED: Anterior vitrectomy

The patient is a 72-year-old woman who approximately 10 months ago underwent cataract surgery with a YAG laser capsulotomy, developed corneal edema and required a corneal transplant. The patient has done well. Over the last few weeks, she developed posterior vitreous detachment with vitreous prolapse to the opening in the posterior capsule with vitreous into the anterior chamber with corneal touch and adhesion to the graft host junction and early corneal edema. The patient is admitted for anterior vitrectomy.

PROCEDURE: The patient was prepped and draped in the usual manner after first undergoing retrobulbar anesthetic. A lid speculum was inserted. An incision was made at approximately the 10 o’clock meridian 3 mm in length, 2 mm posterior to the limbus, and grooved forward into clear cornea with a 3.2 mm anterior chamber. An anterior vitrectomy was carried out, placing a visco-elastic substance in the anterior chamber to maintain it. A Sinskey hook was used to sweep vitreous away from the corneal wound and this was removed with the disposable vitrectomy instrument. The patient’s pupil is noted to be round. There was no vitreous to the wound. The wound self-sealed without aqueous leak. Cautery was used to close the conjunctiva. Subconjunctival Decadron and Gentamicin was given. The patient tolerated the procedure well and was discharged to the recovery room in good condition. What CPT® code(s) is/are reported?
A. 67005
B. 65810
C. 67010
D. 67015, 67028, 65810, 67025

Answer 49

C. 67010

Rationale: In the CPT® Index look for Vitrectomy/Anterior Approach/Subtotal. This was a subtotal removal using a mechanical tool to sweep the vitreous away. Subtotal using a mechanical tool is reported with 67010.

Question 50

A patient presents to the emergency room with a severely damaged eye. The injury was sustained when the patient was a passenger in a multi-car accident on the public highway. The patient sustained a large open lacerated wound to the left eye. The posterior chamber was ruptured and significant vitreous and some intraocular tissue was lost. The eyeball was not repairable and was removed, en masse. A permanent implant was inserted but not attached to the extraocular muscles. The patient was released with an occlusive eye patch. What CPT® and ICD-10-CM codes are reported?
A. 65093-LT, S05.22XA, V43.92XA, Y92.411
B. 65101-LT, S05.22XD, V89.2XXD, Y92.488
C. 65091-LT, S05.22XS, V49.59XS, Y92.411
D. 65103-LT, S05.22XA, V49.59XA, Y92.411

Answer 50

D. 65103-LT, S05.22XA, V49.59XA, Y92.411

Rationale: Enucleation is the removal of the eye. At the time of surgery, an implant was inserted and extraocular muscles were not attached to it. In the CPT® Index look for Enucleation/Eye which gives codes 65101, 65103, 65105. Code 65103 best describes this procedure. The LT modifier is appended to indicate that this was the left eye. In the ICD-10-CM Alphabetical Index look for Laceration/eye (ball)/with prolapse or loss of intraocular tissue directing you to S05.2-. Tabular List indicates that seven characters are reported to complete the code. The 5th character 2 is reported to indicate left eye. X is used as placeholder for the 6th character position. The 7th character is A to report initial encounter for the patient receiving active treatment in the ED. Documentation does not provide sufficient details of the multi-car accident to specify whether the other cars were in motion and if a collision occurred with other objects/persons. Look in the ICD-10-CM External Cause of Injuries Index for Accident/transport/car occupant/passenger/collision (with)/motor vehicle NOS (traffic)/specified type NEC (traffic) V49.59-. The 6th character X is used as a placeholder and 7th character A for initial encounter in the ED. Look for Place of occurrence/highway (interstate) directing you to Y92.411.

Question 51

A provider extracts a tumor, using a frontal approach, from the lacrimal gland of a 14-year-old patient. What CPT® and ICD-10-CM codes are reported?
A. 68540, D49.89
B. 68500, C69.50
C. 68505, C69.51
D. 68520, D31.50

Answer 51

A. 68540, D49.89

Rationale: In the CPT® Index look for Lacrimal Gland/Tumor/Excision/Frontal Approach directs you to 68540. This code is used to describe the excision for a lacrimal gland tumor using the frontal approach. In ICD-10-CM Alphabetical Index look for Tumor directing you to see also Neoplasm, unspecified behavior, by site. Look in the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic/ lacrimal/gland and select the code from the Unspecified Behavior column. Verify code selection in the Tabular List.

Question 52

A 26-year-old female with a one-year history of a left tympanic membrane perforation has consented to have it repaired. A postauricular incision was made under general anesthesia. Dissection was carried down to the temporalis fascia and a 3 x 3 cm segment of fascia was harvested and satisfactorily desiccated. The tympanic membrane was excised. Using a high speed drill a canaloplasty was performed until the entire annulus could be seen. The ossicular chain was examined, it was found to be freely mobile. The previously harvested skin was trimmed and placed in the anterior canal angle with a slight overlapping over the temporalis fascia. Packing is placed in the ear canal, external incisions are closed, and dressings are applied. What CPT® code is reported?
A. 69632-LT
B. 69436-LT
C. 69631-LT
D. 69641-LT

Answer 52

C. 69631-LT

Question 53

A patient receives chemodenervation with Botulinum toxin injections to stop blepharospasms of the right eye. What CPT® and ICD-10-CM codes are reported?
A. 67345-RT, G24.5
B. 64650, R61
C. 64612-RT, G24.5
D. 64616-RT, R29.891

Answer 53

C. 64612-RT, G24.5

Rationale: In the CPT® Index look for Chemodenervation/Facial Muscle 64612, 64615. Code 64612 is used for chemodenervation of muscles that are innervated by the facial nerve for conditions such as blepharospasm. Modifier RT is appended to the CPT® code to indicate the procedure is performed on the right eye. Botulinum toxin is the substance most commonly used for chemodenervation of muscle tissue innervated by the facial nerve. In the ICD-10-CM Alphabetic Index look for Blepharospasm directs you to G24.5. Verification in the Tabular List confirms code selection.

Question 54

A patient with mixed conductive and sensorineural hearing loss in the right ear has tried multiple medical therapies without recovery of her hearing. Patient has consented to have an electromagnetic bone conduction hearing device implanted in the temporal bone. What CPT® and ICD-10-CM codes are reported?
A. 69930-RT, H90.0
B. 69714-RT, H90.8
C. 69710-RT, H90.71
D. 69710-RT, H90.11

Answer 54

C. 69710-RT, H90.71

Rationale: In the CPT® Index look for Hearing Aid/Implants/Bone Conduction/Implantation. You are referred to 69710. Review the code to verify accuracy. In the ICD-10-CM Alphabetical Index look for Loss (of)/hearing which states see also Deafness. Look for Deafness/mixed conductive and sensorineural/unilateral. You are referred to H90.7-. Review the code in the Tabular List to verify accuracy and 5th character 1 is for right ear.

Question 55

Preoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangioma
Postoperative Diagnosis: Left orbital cyst, hemangioma versus lymphangioma
Procedures Performed: Aspiration of left orbital cyst with injection of Kenalog
Anesthesia: General
Complications: None
Estimated Blood Loss: Minimal
Indications for Procedure: The patient presents with a small cyst of the superior medial left orbit felt to be suggestive for hemangioma versus lymphangioma. Risks, benefits, and alternatives of steroid injection to inactivate the cyst were reviewed. These risks included failure to work and significant visual loss. After discussion, they elected to proceed.
Description of Procedure: After informed operative consent was obtained, the patient was brought to the operating room and laid in the supine position. General anesthetic was administered per the anesthesiologist. A 25-gauge needle on a 5-cc syringe was placed within the mass and aspirated. Approximately 0.5 cc of blood was recovered, but the blood was of normal bright red color.
Kenalog 40 mg (1 cc) was then injected where the mass was aspirated without difficulty. Operative area was clean and dry. The patient was then awakened and taken to the recovery room. Pupil reactions were brisk and equal with 2 mm pupils noted in the recovery room. There were no operative complications. What CPT® and ICD-10-CM codes are reported?
A. 67500-LT, D18.09
B. 67405-LT, D18.1
C. 67515-LT, H05.812
D. 67415-LT, H05.812

Answer 55

D. 67415-LT, H05.812

Rationale: The provider aspirated a cyst that was in the left orbit. In the CPT® Index look for Aspiration/Orbital Contents referring you to code 67415. Code 67500 is reported when there is an injection of a therapeutic or local anesthetic behind the eyeball (retrobulbar). Diagnoses documented as versus are not definitive diagnosis codes and are not coded. The postoperative header indicates an orbital cyst. In the ICD-10-CM Alphabetical Index look for Cyst/orbit referring you to code H05.81-. Verify code in the Tabular List. A 6th character is required to indicate which eye; 2 is reported for the left eye.