CPC Chapter 9- Respiratory Review Questions

Question 1

Where does the exchange of oxygen and carbon dioxide take place within the lungs?
A. Bronchioles
B. Larynx
C. Alveoli
D. Windpipe

Answer 1

c. Alveoli

Rationale: The alveoli or air sacs are where the exchange of oxygen from the lungs and carbon dioxide from the capillaries of the circulatory system takes place. High partial pressure of oxygen in the alveoli diffuses into the low partial pressure of oxygen in the capillaries and high partial pressure of carbon dioxide in the capillaries diffuses to the low partial pressure of carbon dioxide in the alveoli.

Question 2

What protects the trachea from food or liquids entering?
A. Larynx
B. Glottis
C. Voice Box
D. Epiglottis

Answer 2

D. Epiglottis

Rationale: The epiglottis is the lid that covers the larynx during swallowing to prevent food or liquid from entering the trachea, which can lead to choking.

Question 3

How many lobes are in both lungs combined?
A. 6
B. 3
C. 2
D. 5

Answer 3

D. 5

Rationale: There are five lobes total, three in the right and two in the left.

Question 4

What is the major muscle used during respiration?
A. Intercostal muscles of the ribs
B. Diaphragm
C. Abdominal muscles
D. Chest wall or pectoral muscles

Answer 4

B. Diaphragm

Rationale: The diaphragm separates the thoracic cavity from the abdominal cavity and is the primary muscle used during respiration. The diaphragm contracts during inspiration and relaxes during exhalation.

Question 5

What is also referred to as the “windpipe?”
A. Bronchus
B. Larynx
C. Trachea
D. Glottis

Answer 5

C. Trachea

Rationale: The trachea carries air from the mouth and throat down to the lungs and is often referred to as the windpipe.

Question 6

Which of the following is not one of the four organs of the lymph system?
A. Spleen
B. Thymus Gland
C. Tonsils
D. Bone Marrow

Answer 6

D. Bone Marrow

Rationale: Bone marrow is not an organ of the lymphatic system; rather, it is included in the hemic system.

Question 7

What is the term for removal of part of the lymph system?
A. Lymphoma
B. Lymphadenectomy
C. Lymphadenitis
D. Lymphedema

Answer 7

B. Lymphadenectomy

Rationale: The suffix “ectomy” means removal, so lymphadenectomy is the correct answer.

Question 8

Where is the mediastinum located?
A. Left upper abdominal quadrant
B. Muscle that separates the abdominal and thoracic cavities
C. In between the two lungs
D. Below the diaphragm

Answer 8

C. In between the two lungs

Rationale: The mediastinum is the part of the thoracic cavity between the lungs that contains the heart, aorta, esophagus, trachea, and thymus gland, as well as blood vessels and nerves. The Diaphragm is the muscle separating the thoracic and abdominal cavities and plays a significant role in respiration.

Question 9

What portion of the thoracic cavity lies between the lungs and contains the heart?
A. Mediastinum
B. Diaphragm
C. Lymphatic channels
D. Bone marrow

Answer 9

A. Mediastinum

Rationale: The mediastinum contains the heart and great vessels and lies between the lungs in the thoracic cavity.

Question 10

What is another name for the larynx?
A. Windpipe
B. Trachea
C. Voice box
D. Epiglottis

Answer 10

C. Voice box

Rationale: The larynx is responsible for speech and is known as the voice box.

Question 11

What is the ICD-10-CM code selection for a patient with COPD presenting with an acute bronchitis?
A. J44.0
B. J21.8
C. J44.9
D. J44.0, J20.9

Answer 11

D. J44.0, J20.9

Rationale: Acute bronchitis with COPD should be coded as COPD with a lower respiratory tract infection. An instructional note states to code also for the infection. In this case - we know bronchitis is the infection, but the infectious agent is not specified. Look in the ICD-10-CM Alphabetic Index for Disease/pulmonary/chronic obstructive with lower respiratory ­infection referring you to J44.0. Look for Bronchitis/acute or subacute referring you to J20.9.

Question 12

What is the ICD-10-CM code for a patient who presents with enlarged tonsils and adenoids for the fourth time in a year?
A. J35.03
B. J35.9
C. J35.3
D. J03.90

Answer 12

C. J35.3

Rationale: Repetitive enlargement of the tonsils and adenoids in a year is a chronic condition. Look in the ICD-10-CM Alphabetic Index for Enlargement, enlarged (see also Hypertrophy)/adenoids/with tonsils.

Question 13

What is the ICD-10-CM code selection for a patient with whooping cough who presents with pneumonia?
A. J12.9
B. A37.01
C. A37.91
D. J18.9

Answer 13

C. A37.91

Rationale: This condition is coded with a combination code. A combination code is a single code used to describe a diagnosis with an associated secondary process (manifestation) or a diagnosis with an associated complication. A secondary code is not required. In the ICD-10-CM Alphabetic Index locate Pneumonia/In (due to)/whooping cough.

Question 14

What is the ICD-10-CM code for a child with an acute exacerbation of hay fever asthma?
A. J45.22
B. J45.901
C. J45.32
D. J45.902

Answer 14

B. J45.901

Rationale: Look in the ICD-10-CM Alphabetic Index for Asthma/with/Hay Fever which points to see Asthma, allergic extrinsic. Locate Asthma/allergic extrinsic/with/exacerbation (acute) referring you to J45.901. In ICD-10-CM asthma codes are specific to severity - mild, moderate, severe as well as intermittent or persistent. In this case the indexing leads to an unspecified code.

Question 15

A 20-year-old male presents to the emergency department (ED) with chest pain and shortness of breath. Chest X-ray reveals a pneumothorax. The patient gives a history of no recent trauma; patient smokes two packs of cigarettes a day. The ED physician documents a diagnosis of spontaneous tension pneumothorax. What is the ICD-10-CM code selection?
A. S27.0XXA
B. S27.0XXA, Z77.22
C. J93.0
D. J93.0, F17.210

Answer 15

D. J93.0, F17.210

Rationale: Spontaneous tension pneumothorax is reported with J93.0. Look in the ICD-10-CM Alphabetic Index for Pneumothorax NOS/tension (spontaneous). Nicotine dependence is reported as it could be significant to the patient’s condition. Look in the ICD-10-CM Alphabetic Index for Dependence/drug/nicotine/cigarettes.

Question 16

What is the ICD-10-CM code for primary malignant thymoma?
A. C37
B. C73
C. D15.0
D. D09.8

Answer 16

A. C37

Rationale: Primary malignancy of the thymus is coded with C37. Look in the ICD-10-CM Alphabetic Index for Thymoma/malignant.

Question 17

What is the ICD-10-CM code for acquired lymphedema?
A. I88.1
B. I89.0
C. Q82.0
D. I88.8

Answer 17

B. I89.0

Rationale: Acquired lymphedema typically occurs after major surgery or cancer treatment such as radiation therapy. It is more common than congenital lymphedema. Look in the ICD-10-CM Alphabetic Index for Lymphedema (acquired) (see also Elephantiasis). Locate Elephantiasis (nonfilarial) referring you to I89.0.

Question 18

A 4-month-old infant presents to the physician with cold-like symptoms, coughing, and wheezing. The infant is diagnosed with bronchiolitis due to RSV. How is this condition coded?
A. J21.0
B. J21.8
C. J21.0, B97.4
D. R05.9, B97.4

Answer 18

A. J21.0

Rationale: RSV is a common cause for bronchiolitis. Look in the ICD-10-CM Alphabetic Index for Bronchiolitis/due to/respiratory syncytial virus. Code J21.0 is a combination code used to describe a diagnosis with an associated secondary process (manifestation) or a diagnosis with an associated complication. A secondary code is not required.

Question 19

A patient presents to the physician with persistent stuffiness and facial pain. The physician documents a diagnosis of nasal polyps. What ICD-10-CM code is reported?
A. J33.0
B. J33.8
C. J33.1
D. J33.9

Answer 19

D. J33.9

Rationale: Look in the ICD-10-CM Alphabetic Index for Polyp, polypus/nasal, J33.9. This is the correct code for an unspecified nasal polyp.

Question 20

A patient with right arm and shoulder pain, and a droopy eyelid is referred to a pulmonologist after the discovery of an abnormality in the right upper lobe on a recent chest X-ray. The pulmonologist orders a CT scan and determines the patient has a Pancoast tumor. What ICD-10-CM code is used to report this?
A. C34.10
B. C34.12
C. 34.11
D. 34.91

Answer 20

C. C34.11

Rationale: A Pancoast tumor is typically a fast growing, non-small cell tumor in the upper part of the lung. Look in the ICD-10-CM Alphabetic Index for Pancoast’s syndrome or tumor, C34.1-. A 5th character is needed to identify laterality. C34.11 identifies a malignant neoplasm of the upper lobe of the right lung.

Question 21

Patient is a mouth-breather. He is diagnosed with inflamed inferior turbinates and a superficial ablation is performed. What CPT® code is reported?
A. 30802
B. 30140
C. 30801
D. 30802-52

Answer 21

C. 30801

Rationale: Code 30801 is superficial ablation of the turbinates, as compared to 30802, which is intramural ablation of the turbinates. Code 30140 is a submucous resection of the inferior turbinate, not an ablation. In the CPT® Index, look for Ablation/Turbinate Mucosa which directs you to 30801-30802.

Question 22

Which code(s) describe(s) bilateral endoscopic nasal procedure to diagnose breathing problems?
A. 31231-50
B. 31230-RT, 31230-LT
C. 31233
D. 31231

Answer 22

D. 31231

Rationale: Code 31231 is a diagnostic nasal endoscopy, unilateral or bilateral. No modifier is necessary. In the CPT® Index, look for Nasal Sinuses/Endoscopy/Diagnostic which directs you to 31231–31235.

Question 23

An indirect endoscopic procedure of the larynx means the larynx is viewed:
A. Directly with a scope
B. With mirrors
C. Through an open incision
D. Through an open mouth

Answer 23

B. With mirrors

Rationale: Indirect endoscope of the larynx is performed by viewing the larynx with the use of mirrors. A direct laryngoscopy is the use of an endoscope to look directly at the larynx.

Question 24

Can bronchoscopy codes be coded together by a physician, and if yes, how? Are multiple procedures reported with modifier 51?
A. No.
B. Yes:Report multiple procedures with modifier 51 (if required by the payer).
C. Yes: Report distinct procedures with modifier 59.
D. Yes: Report multiple bronchoscopy codes together because no modifier is required.

Answer 24

B. Yes: Report multiple procedures with modifier 51 (if required by the payer).

Rationale: Yes, bronchoscopy codes are billed as multiple procedures with a modifier 51. List the highest RVU valued code first and then all other codes with a modifier 51.

Question 25

A thoracotomy procedure was performed for repair of hemorrhage and lung tear. What CPT® code is reported?
A. 32100
B. 32110
C. 32120
D. 32151

Answer 25

B. 32110

Rationale: Thoracotomy main code is 32100; control of the hemorrhage and lung tear would be code 32110. In the CPT® Index, look for Thoracotomy/Hemorrhage.

Question 26

Which CPT® code describes a pneumonectomy?
A. 32442
B. 32440
C. 32440-50
D. 32445

Answer 26

B. 32440

Rationale: A pneumonectomy is removal of a lung. In the CPT® Index, look for Pneumonectomy 32440–32445. Read the code descriptors to select the correct code.

Question 27

Can a diagnostic thoracoscopy be billed with video-assisted thoracoscopic surgery (VATS) under certain circumstances?
A. No: A diagnostic thoracoscopy is always included in the surgical VATS.
B. No: A surgical VATS is always included in the diagnostic VATS.
C. Yes: Anytime a diagnostic VATS and surgical VATS are performed together.
D. Yes: When a diagnostic biopsy is performed and submitted for pathologic evaluation, resulting in a surgical VATS.

Answer 27

A. No: A diagnostic thoracoscopy is always included in the surgical VATS.

Rationale: Diagnostic thoracoscopy is bundled into surgical VATS and cannot be billed separately during the same surgical session, per CPT® instruction.

Question 28

Which CPT® code(s) describes VATS therapeutic wedge resection of the left upper lobe followed by left upper lobectomy?
A. 32480
B. 32505, 32480
C. 32663, 32666
D. 32663

Answer 28

D. 32663

Rationale: CPT® subsection guidelines for Lungs and Pleura indicate therapeutic wedge resection is bundled into the lobectomy when it is the same lobe. The wedge resection can only be coded separately if it was performed on a different lobe or contralateral lung.

Question 29

A patient has a mass in her left axilla that is a suspected recurrence of lymphoma. She has a left axillary node excisional biopsy. The lymph node biopsied is under the pectoralis minor. What CPT® code is reported?
A. 38500
B. 38562
C. 38745
D. 38525

Answer 29

D. 38525

Rationale: The patient has an excisional biopsy of the left axillary node. Because the lymph node biopsied is under the pectoralis minor muscle, it is considered a deep lymph node. Look in the CPT® Index for Biopsy/Lymph Nodes/Open and you are directed to 38500, 38510–38530. 38525 is for biopsy of the deep axillary nodes.

Question 30

A patient with adenocarcinoma of the larynx has developed cervical adenopathy and is undergoing an excisional biopsy of the right cervical node. An incision is made above the clavicle and dissection taken down into the muscle. Blunt dissection was used to work the way down to the node, which was firm and white. The entire node was taken, and the wound was closed. What CPT® code is reported?
A. 38500
B. 38510
C. 38520
D. 38542

Answer 30

B. 38510

Rationale: The patient had a deep cervical node excisional biopsy. It is considered deep because the node was below the muscle. Look in the CPT® Index for Biopsy/Lymph Nodes/Open and you are directed to 38500, 38510-38530. There is no mention of excision of the scalene fat pad. 38510 is for a biopsy of the deep cervical node(s).

Question 31

What is the largest single mass of lymphatic tissue?
A. Thymus
B. Peyer’s Patches
C. Spleen
D. Tonsils

Answer 31

C. Spleen

Rationale: The spleen is the largest single mass of lymphatic tissue.

Question 32

What ICD-10-CM code is reported for spontaneous pneumothorax?
A. S27.0XXA
B. J93.83
C. J95.811
D. S27.2XXA

Answer 32

B. J93.83

Rationale: In the ICD-10-CM Alphabetic Index look for Pneumothorax/spontaneous NOS referring you to code J93.83. Verify code selection in the Tabular List.

Question 33

What is the name of the structure made of bone and cartilage separating the nostrils?
A. Nasal turbinates
B. Nasal septum
C. Nasal membrane
D. Nasal septal

Answer 33

B. Nasal septum

Rationale: A septum is a partition. The nasal septum separates the nostrils.

Question 34

What CPT® code is reported for a frontal sinusotomy, nonobliterative, with osteoplastic flap, brow incision?
A. 31080
B. 31086
C. 31084
D. 31087

Answer 34

B. 31086

Rationale: In the CPT® Index look for Sinusotomy/Frontal Sinus/Nonobliterative directing you to code range 31086, 31087. Code selection is based on whether it is a brow incision or coronal incision; 31086 is the correct code.

Question 35

What CPT® code is reported for a major thoracotomy for post-op hemorrhage following an endoscopic upper lobectomy?
A. 32120
B. 32310
C. 32110
D. 32100

Answer 35

A. 32120

Rationale: In the CPT® Index, look for Thoracotomy/for Post-op Complications referring you to 32120. Since post-op hemorrhage is considered a complication and occurred following an operation/surgery, code 32120 is the correct code to report.

Question 36

Where in the respiratory system is the carina located?
A. Left bronchus
B. Inferior turbinate
C. Tracheal bifurcation
D. Sphenoid sinus

Answer 36

C. Tracheal bifurcation

Rationale: The carina is located at the tracheal bifurcation. The tracheal bifurcation is the opening of the bronchi as it splits into left and right sides.

Question 37

Which option is TRUE regarding reporting codes for cytomegaloviral pneumonitis in ICD-10-CM?
A. Only the pneumonia is reported, it is not necessary to report the underlying diseases.
B. Pneumonia is reported first; the underlying disease is reported second.
C. The underlying disease is reported first; pneumonia is reported second.
D. One code is used to report both the pneumonia and the cytomegaloviral disease.

Answer 37

D. One code is used to report both the pneumonia and the cytomegaloviral disease.

Rationale: ICD-10-CM Tabular List does not have the instructional note to code first underlying disease that is seen for codes listed in ICD-10-CM for category code B25. Both conditions are reported with one code in ICD-10-CM.

Question 38

The provider performs a diagnostic thoracoscopy followed by the thoracoscopic excision of a pericardial cyst. What CPT® code(s) is/are reported?
A. 32601, 32662-51
B. 32658
C. 32661
D. 32601, 32661-51

Answer 38

C. 32661

Rationale: Endoscopy guidelines state that surgical thoracoscopy always includes a diagnostic thoracoscopy and, therefore, is not coded separately. In the CPT® Index look for Thoracoscopy/Surgical/with Excision Pericardial Cyst, Tumor and/or Mass referring to 32661.

Question 39

A patient is seen in the endoscopy suite for a diagnostic maxillary sinusotomy. During the sinusotomy, the provider observes some diseased tissue which needs to be removed. The provider decides to perform a maxillary antrostomy with tissue removal. Bleeding is controlled. The patient tolerated the procedure well. What CPT® code(s) is/are reported?
A. 31231, 31267
B. 31254, 31256
C. 31256
D. 31267

Answer 39

D. 31267

Rationale: According to the CPT® guidelines for coding of endoscopies, a surgical sinus endoscopy includes a sinusotomy and diagnostic endoscopy. In the CPT® Index look for Sinus/Sinuses/ Maxillary/Antrostomy and you are directed to code range 31256-31267. We see code 31267 represents a surgical maxillary antrostomy with maxillary tissue removal.

Question 40

Which statement is TRUE regarding coding COPD with asthma in ICD-10-CM?
A. COPD with bronchitis is reported for COPD with asthma.
B. Only the COPD is reported.
C. Only the asthma is reported.
D. The type of asthma is reported along with the COPD.

Answer 40

D. The type of asthma is reported along with the COPD.

Rationale: For COPD with asthma, ICD-10-CM Tabular List provides instructional notes to code also type of asthma, if applicable (J45.-) and use additional code for certain type of external causes listed in the Tabular List.

Question 41

A patient presents with wheezing and shortness of breath. After evaluating the patient, the provider determines the patient is suffering from an exacerbation of his asthma. The provider orders nebulizer treatments to be administered in his office. According to the ICD-10-CM guidelines for coding signs and symptoms, what is/are the correct ICD-10-CM code(s)?
A. J45.901
B. R06.2, R06.02
C. J45.902, R06.2, R06.02
D. J45.902

Answer 41

A. J45.901

Rationale: Because the type of asthma is not indicated, the correct code is J45.901. In the ICD-10-CM Alphabetic Index look for Asthma, asthmatic/with/exacerbation (acute) directing you to J45.901. The Tabular List verifies this code choice. Wheezing and shortness of breath are signs and symptoms of an exacerbation of asthma and not reported separately. According to the Official ICD-10-CM guideline I.B.4 or I.C.18.b., do not report signs and symptoms when a definitive diagnosis has been established.

Question 42

A patient with AML (Acute Myelogenous Leukemia) has just learned his sister is an HLA (Human Leukocyte Antigen) match for him. Stem cells taken from the donor (the patient’s sister) will be transplanted into the patient to help with his treatment. What CPT® code is used to report the harvesting of the stem cells from the donor (his sister)?
A. 38205
B. 38206
C. 38207
D. 38204

Answer 42

A. 38205

Rationale: In the CPT® Index look for Stem Cell/Harvesting referring you to 38205, 38206. Code selection is based on whether it is allogenic (from a donor) or autologous (from the patient). This is allogenic making 38205 the correct code choice.

Question 43

Provide the correct ICD-10-CM code(s) for acute RSV bronchiolitis.
A. J20.9
B. J21.0
C. J21.8, B97.4
D. J21.8

Answer 43

B. J21.0

Rationale: RSV is the acronym for respiratory syncytial virus. In the ICD- 10-CM Alphabetic Index look for Bronchiolitis. Acute is a nonessential modifier. Bronchiolitis (acute) (infective) (subacute)/due to/respiratory syncytial virus referring you to J21.0. Verification in the Tabular List confirms code selection.

Question 44

A 43-year-old female is seen in the emergency room with severe epistaxis. She said this is a common occurrence for her during the cold dry months of winter and this is why she is here for the third time this week. Extensive posterior cautery and packing is again required to control the hemorrhage.
What CPT® code is reported for the procedure? (Note: Do not code the E/M)
A. 30905
B. 30906
C. 30905-22
D. 30903

Answer 44

B. 30906

Rationale: Epistaxis is the term for nasal hemorrhage. In the CPT® Index look for Packing/ Nasal Hemorrhage and you are directed to code range 30901-30906. Code selection is determined by whether the procedure is posterior or anterior. This is posterior and is subsequent making the correct code 30906.

Question 45

What anatomical cavity or compartment contains all of the thoracic viscera except the lungs?
A. Peritoneum
B. Thoracic
C. Mediastinum
D. Mesentery

Answer 45

C. Mediastinum

Rationale: The mediastinum extends from the sternum to the vertebral column and contains all the thoracic viscera, except the lungs.

Question 46

The pulmonologist in a multispecialty group refers a patient to the otolaryngologist because he thinks that the shortness of breath that the patient is experiencing may be due to sinusitis and laryngopharyngeal reflux (LPR). The otolaryngologist decides to perform a rigid bilateral nasal endoscopy to get a better look at what is going on in the sinuses and a flexible laryngoscopy to determine if (LPR) is contributing to the problems because he could not get adequate visualization on manual exam. First the bilateral nasal endoscopy is performed and the otolaryngologist diagnosis chronic pansinusitis. Next a flexible fiberoptic laryngoscope is introduced nasally and the larynx and trachea are inspected. The diagnosis is chronic laryngitis/tracheitis and LPR. He prescribes Singulair and Nexium and proposes endoscopic surgery will be considered in the future if the current treatment does not fully take care of the problems experienced by the patient. What CPT® and ICD-10-CM codes are reported for the procedure?
A. 31576, 31231-51, J32.4, J02.9, J41.8
B. 31575, 31231-59, J32.4, J37.1
C. 31576, 31237-50-59, J32.4, J37.0, J41.8
D. 31575, 31231-50-59, J32.4, J37.1

Answer 46

B. 31575, 31231-59, J32.4, J37.1

Rationale: The nasal endoscopy and laryngoscopy can both be performed via the nasal cavity. In the CPT ®Index look for Laryngoscopy/Fiberoptic/Diagnostic directing you to code 31575. Next in the CPT® Index look for Endoscopy/Nose/Diagnostic referring you to 31231, 31233, 31235. The correct code is 31231 because there is no mention of entering the maxillary or sphenoid sinuses. Modifier 50 is not needed because 31231 describes a unilateral or bilateral procedure. Code 31231 is listed as a separate procedure; therefore, modifier 59 is appended. These procedures are indeed separate because a nasal endoscope was used and then the provider used a flexible laryngoscope.

The otolaryngologist has diagnosed chronic pansinusitis. In the ICD-10-CM Alphabetic Index look for Pansinusitis (chronic) directing you to J32.4. Also diagnosed is chronic laryngotracheitis. In the Alphabetic Index look for Laryngotracheitis/chronic directing you to J37.1. Code J37.1 encompasses the LPR and the chronic laryngitis and tracheitis.

Question 47

A 14-year-old boy presents at the Emergency Department experiencing an uncontrolled epistaxis. Through the nares, the ED provider packs his entire nose via an anterior approach with extensive packing of medicated gauze. In approximately 15 minutes the nosebleed stops. What CPT® and ICD-10-CM codes are reported?
A. 30901, I78.0
B. 30905, R04.0
C. 30901-50, R04.0
D. 30903-50, R04.0

Answer 47

D. 30903-50, R04.0

Rationale: Epistaxis is the term for nasal hemorrhage. In the CPT® Index look for Packing/Nasal Hemorrhage which directs you to code range 30901-30906. 30903 represents anterior packing for an uncontrolled or extensive nasal hemorrhage. Modifier 50 indicates this was done in both nares (bilaterally).

In the ICD-10-CM Alphabetic Index look for Epistaxis referring you to code R04.0. Verification in the Tabular List confirms code selection.

Question 48

A 65-year-old patient is complaining of difficulty breathing. Patient is scheduled for a diagnostic VATS (Video-assisted thoracoscopic surgery). Under general anesthesia he was placed in left lateral decubitus position and a thoracoscope was inserted through a port site. The VATS exploration immediately revealed a mass of the right upper lobe. A biopsy was performed and sent to pathology. Results from pathology revealed small cell carcinoma. The decision was made to perform VATS and remove the upper lobe of the right lung. What CPT® code(s) is (are) reported?
A. 32480
B. 32671, 32609-51
C. 32663, 32607-51
D. 32663

Answer 48

D. 32663

Rationale: The patient started out with a diagnostic VATS but became a surgical VATS when the up-per lobe of the right lung was removed. According to CPT® guidelines a surgical thoracoscopy always includes diagnostic thoracoscopy. You will not report 32607 or 32609 which are diagnostic VATS codes. The removal of the upper lobe was performed by VATS. Code 32480 is not correct because that is if the patient had an open surgery to remove the upper lobe.

Question 49

How are multiple moderate lacerations of the spleen, initial encounter coded in ICD-10-CM?
A. S36.031A
B. S36.030A
C. S36.032A
D. S36.039A

Answer 49

C. S36.032A

Rationale: Look in the ICD-10-CM Alphabetic Index for Laceration/spleen/moderate referring you to S36.031. However, in the Tabular List code S36.032 has inclusion terms that includes multiple moderate lacerations of spleen. Code S36.032 requires a 7th character of A, D, or S.

Question 50

A patient presents to the emergency department (ED) with a sucking chest wound. The ED provider on duty performs an immediate tube thoracostomy in order to restore normal breathing to the patient before rushing him to surgery for another provider to address other injuries. What CPT® code is reported by the ED provider?
A. It is not coded, as it will be bundled with any procedures performed during surgery.
B. 31500
C. 31603
D. 32551

Answer 50

D. 32551

Rationale: In the CPT® Index look for Thoracostomy/Tube referring you code 32551. The ED provider would not be performing the surgery for other injuries so we would not bundle the tube insertion into any of those procedures.

Question 51

A surgeon performs a high thoracotomy with resection of a single lung segment on a 57-year-old who is currently a heavy cigarette smoker who had presented with a six-month history of right shoulder pain that radiates to the chest. An apical lung biopsy had confirmed lung cancer. What CPT® and ICD-10-CM codes are reported?
A. 32503, C34.10, F17.210
B. 21602, 32551-51, M25.511, R07.9, F17.210
C. 32100, M25.511, R07.9, F17.210
D. 32484, C34.10, F17.210

Answer 51

D. 32484, C34.10, F17.210

Rationale: A segment of the lung is removed. In the CPT® Index look for Removal/Lung/Single Segment referring you to code 32484.
We have a confirmed diagnosis of apical lung cancer, a cancer in an upper lobe, which is code C34.10 (no indication of right or left lung). The term apical means the tip of a pyramidal or rounded structure, so apical lung cancer means the tumor/cancer is located at the top or upper lobe of the lung. We find this by looking in the Table of Neoplasms for Neoplasm, neoplastic/lung/upper lobe and select from the Primary Malignant column referring you to code C34.1-. Verification in the Tabular List indicates the code requires five characters. There is no indication which side of the lung has cancer, report code C34.10 for unspecified lung. There is also an instructional note under category C34 to use additional code for tobacco use. Code F17.210 is reported to indicate the patient is a smoker. Look for Dependence/drug NEC/nicotine/cigarettes referring you to code F17.210. Verification in the Tabular List confirms code selection.

Question 52

A 25-year-old male presents with a deviated nasal septum. The patient undergoes a nasal septum repair and submucous resection. Cartilage from the bony septum was detached and the nasoseptum was realigned and removed in a piecemeal fashion. Thereafter, 4-0 chronic was used to approximate mucous membranes. Next, submucous resection of the turbinates was handled in the usual fashion by removing the anterior third of the bony turbinate and lateral mucosa followed by bipolar cauterization. What CPT® codes are reported?
A. 30450, 30999-51
B. 30620, 30999-51
C. 30520, 30140-51
D. 30420, 30140-51

Answer 52

C. 30520, 30140-51

Rationale: Septum repair is a septoplasty. In the CPT® Index Septoplasty or Resection/Nasal Septum Submucous refers you to see Nasal Septum, Submucous Resection directing you to 30520. Under the code, there is a parenthetical statement to use 30140 for submucous resection of the turbinates. Modifier 51 is used to indicate multiple procedures.

Question 53

A 20-year-old female who returned from spring break in Mexico six days ago, presents to the ED with a high fever for three days, a sore throat, general aches and a miserable cough. The ED provider suspects flu and orders a rapid flu test. What ICD-10-CM code(s) is reported?
A. J11.1, R50.9, J02.9, R05.9
B. J11.1
C. R50.9, J02.9, R52, R05.9
D. J09.X9

Answer 53

C. R50.9, J02.9, R52, R05.9

Rationale: According to the ICD-10-CM guideline I.B.4 or I.C.18.a, signs and symptoms are reported when a related definitive diagnosis has not been established. The flu was suspected but not established therefore we code the patient’s presenting symptoms. In the ICD-1-CM Alphabetic Index look for Fever directing you to R50.9. She also has a sore throat, look for Pharyngitis directing you to code J02.9. For the general aches look for Pain(s) directing you to R52. Look for Cough directing you to R05.9. Verify codes in the Tabular List.

Question 54

A patient with chronic pneumothoraces presents for chemopleurodesis. Under local anesthesia a small incision is made between the ribs. A catheter is inserted into the pleural space between the parietal and pleural viscera. Subsequently, 5g of sterile asbestos free talc was introduced into the pleural space via the catheter. What CPT® and ICD-10-CM codes are reported?
A. 32650, J95.811
B. 32601, 32560, J95.811
C. 32650, 32560, J93.11
D. 32560, J93.81

Answer 54

D. 32560, J93.81

Rationale: Chemopleurodesis is represented by codes 32560-32562. In the CPT® Index look for Pleurodesis/Instillation of Agent. Code 32560 is appropriate for the described actions taken to instill the talc used to treat recurrent pneumothorax.

Look in the ICD-10-CM Alphabetic Index for Pneumothorax NOS/chronic which directs you to code J93.81. Verification in the Tabular List confirms code selection.

Question 55

A patient with a diagnosis of chronic sphenoidal sinusitis undergoes a bilateral sinusotomy. While the provider examines the diseased sphenoid sinus, she takes a biopsy of the sphenoidal masses and removes the mucosa with several polyps. Transseptal sutures are placed and the intraoral incision is closed in a single layer. The nose is packed and external nasal dressings are placed. What CPT® and ICD-10-CM codes are reported?
A. 31051-50, J32.3, J33.8
B. 31090, 30115-50-51, J32.9
C. 31288-50, J32.9
D. 31237-50, J32.3

Answer 55

A. 31051-50, J32.3, J33.8

Rationale: In the CPT® Index look for Sinusotomy/Sphenoid Sinus directing you to codes 31050, 31051. 31051 is appropriate for the reporting of biopsies taken in the sphenoids as well as removal of mucosa and polyps. The procedure was an open procedure; it was not performed endoscopically. Modifier 50 is appended to indicate the procedure was performed bilaterally.

Look in the ICD-10-CM Alphabetic Index for Sinusitis/sphenoidal directing you to code J32.3 (this is for chronic) and Polyp, polypus/sinus (sphenoidal) is J33.8. Verification in the Tabular List confirms code selection.

Question 56

A patient with laryngeal spasms undergoes therapeutic injection of the vocal cords. Topical anesthesia is administered to the oral cavity, pharynx and larynx. Using an operating microscope, a direct laryngoscope is inserted into the patient’s mouth. The interior larynx is examined, and the surgeon injects the vocal cords at two sites with glycerin. What CPT® and ICD-10-CM codes are reported?
A. 31571, J38.5
B. 31571, 69990, J38.5
C. 31570, 69990, J38.5
D. 31535, J38.5

Answer 56

A. 31571, J38.5

Rationale: In the CPT® Index look for Laryngoscopy/Direct directing you to 31515-31571. 31571 is appropriate for the injection into the vocal cords using an operating microscope. There is a parenthetical instruction note that states, “Do not report code 69990 in addition to code 31571”.

In the ICD-10-CM Alphabetic Index look for Spasm(s), spastic, spasticity/larynx, laryngeal referring you to code J38.5. Verify code selection in the Tabular List.

Question 57

A 55-year-old female smoker presents with cough, hemoptysis, slurred speech and weight loss. Chest X-ray done today demonstrates a large, unresectable right upper lobe mass, and brain scan is suspicious for metastasis. Under fluoroscopic guidance in an outpatient facility, a percutaneous needle biopsy of the right lung lesion is performed for histopathology and tumor markers. A diagnosis of small cell carcinoma is made and chemoradiotherapy is planned. What CPT® and ICD-10-CM codes are reported?
A. 32408-RT, C34.11, F17.200
B. 32408-RT, 77002-26, C34.11, F17.200
C. 32607-RT, 77002-26, R22.2, F17.210
D. 32098-RT, 77002-26, C34.10, R07.9, R04.89, R47.81, R63.4, F17.210

Answer 57

A. 32408-RT, C34.11, F17.200

Rationale: In the CPT® Index look for Needle biopsy/lung referring you to 32408. An instructional note states not to report 32408 in conjunction with 76942, 77002, 77012, 77021. The imaging guidance is included in the code. RT modifier is to indicate the right lung was where the biopsy was performed.
We have a diagnosis of small cell carcinoma of the right lung which is code C34.11. In the ICD-10-CM Alphabetic Index look for Carcinoma which states see also Neoplasm, malignant, by site. Look in the Table of Neoplasms for Neoplasm, neoplastic/lung/upper lobe and select from the Malignant Primary column directing you to C34.1-. Verification in the Tabular List requires a 5th character to indicate laterality. Report C34.11 to indicate the right lung. The signs and symptoms are not coded because we do have a definitive diagnosis (ICD-10-CM guideline I.B.4 or I.C.18.a). Brain metastasis is suspected but not confirmed so it would not be reported. The chemotherapy is planned but not performed so it would not be reported either. The patient is a smoker. There is an instructional note under category code C34 to use an additional code to identify tobacco dependence. In the Alphabetic Index look for Smoker, referring you to see Dependence, drug, nicotine. Look in the Index for Dependence (on) (syndrome) / drug NEC / nicotine, which refers you to code F17.200.

Question 58

A patient presents to the emergency department (ED) with a sucking chest wound. The ED provider on duty performs an immediate tube thoracostomy in order to restore normal breathing to the patient before rushing him to surgery for another provider to address other injuries. What CPT® code is reported by the ED provider?
A. 32551
B. It is not coded, as it will be bundled with any procedures performed during surgery.
C. 31500
D. 31603

Answer 58

A. 32551

Rationale: In the CPT® Index look for Thoracostomy/Tube referring you code 32551. The ED provider would not be performing the surgery for other injuries so we would not bundle the tube insertion into any of those procedures.

Question 59

A returning 2-year-old child is seen in the pediatrician’s office with stridor and a bark like cough. The pediatrician examines the child quickly and determines the child has stridulous croup. The child is given a nebulizer breathing treatment in the office to improve PO2 levels. Medication used is breathable Epinephrine. What CPT® and ICD-10-CM codes are reported?
A. 94644, R06.1, R05.9
B. 94640, J38.5
C. 94644, J04.2
D. 94642, J38.5, R05.9, R06.1

Answer 59

B. 94640, J38.5

Rationale: To code the nebulizer treatment look in the CPT® index for Inhalation Treatment/for Airway Obstruction Pressurized or Nonpressurized directing you to code 94640. This code accurately represents a nebulizer treatment.

A definitive diagnosis of stridulous croup is given and the signs and symptoms the child presented with is not coded (ICD-10-CM guideline I.B.4 or I.C.18.b). In the ICD-10-CM Alphabetic Index look for Croup/stridulous directing you to J38.5. Verification in the Tabular List confirms code selection.

Question 60

The surgeon makes an incision in the neck through the cricothyroid membrane for an emergency tracheostomy for a patient who arrives in the emergency room with tracheal crushing injuries suffered in a car accident in which the patient was riding as the passenger. What CPT® and ICD-10-CM codes are reported?
A. 31605, S17.0XXA, V49.9XXA
B. 31603, S11.10XA, V49.9XXA
C. 31612, S21.309A, V86.19XA
D. 31600, S21.309A, V86.19XA

Answer 60

A. 31605, S17.0XXA, X49.9XXA

Rationale: The correct CPT® code for an emergency cricothyroid tracheostomy is code 31605. Look in the CPT® Index for Tracheostomy/Emergency which directs you to 31603-31605.

Look in the ICD-10-CM Alphabetic Index for Crush/trachea referring you to S17.0-. Verification in the Tabular List indicates to complete the code with seven characters. The placeholder X is required for the 5th and 6th characters and a 7th character A for initial encounter are assigned. The documentation tells us this was a motor vehicle accident and the patient was the passenger in the vehicle. Look in the External Cause of Injuries Index for Accident/transport/car occupant refers you to V49.9-. In the Tabular List it indicates seven characters the placeholder X is required for the 5th and 6th characters and a 7th character A for initial encounter are assigned.

Question 61

A patient with partial bilateral vocal cords paralysis requires removal of the arytenoids cartilage to improve breathing. The laryngoscope with operating microscope is inserted. Adequate visualization is established and the arytenoid cartilage is exposed by excision of the mucosa overlying it. What diagnosis and procedure codes are reported for this procedure?
A. 31560, 69990, J38.02
B. 31561, 69990, J38.02
C. 31560, J38.00
D. 31561, J38.02

Answer 61

D. 31561, J38.02

Rationale: In the CPT® Index look for Laryngoscopy/Operative/Arytenoidectomy, referring you to codes 31560, 31561. 31561 is appropriate for a direct operative laryngoscopy with arytenoidectomy using an operating microscope. There is a parenthetical note under code 31561 that states, “Do not report code 69990 in addition to code 31561”.

In the ICD-10-CM Alphabetic Index look for Paralysis/vocal cords/bilateral directing you to code J38.02 which is confirmed in the Tabular List.

Question 62

A 27-year-old girl has been on the lung transplant list for months and today she will be receiving a LT and RT lung from an individual involved in an MVA. This person was DOA at the hospital and is an organ donor. The donor pneumonectomy was performed by physician A, the backbench work by physician B and the transplant of both lungs into the prepped and waiting patient by physician C. What is the correct coding for the removal (physician A), preparation (physician B) and insertion (physician C) of the lungs?
A. 32850, 32856, 32853
B. 32850, 32855, 32851
C. 32850, 32855 x 2, 32850-50
D. 32850, 32856, 32851 x 2

Answer 62

A. 32850, 32856, 32853

Rationale: DOA means the individual is dead on arrival thus the lungs will be harvested from a cadaver donor. In the CPT® Index look for Donor Procedures/Lung Excision, the removal of the lungs by physician A will be reported with 32850 representing plural cadaver donor pneumonectomies (lung removals). In the CPT® Index look for Transplantation/Lung/Double, without Cardiopulmonary Bypass, the insertion of the lungs is reported with 32853 by physician C. In the CPT® Index look for Transplantation/Lung/Allograft Preparation directing you to 32855, 32856, 33933. The backbench preparation of both lungs (bilateral) by physician reported with 32856 by physician B. Because different physicians separately report each procedure, modifier 51 is not required.

Question 63

A 40-year-old patient was complaining of continued shortness of breath. A biopsy was performed on a mass located on his left lung and sent to pathology. Results from pathology revealed that she has lung cancer. Patient is scheduled today to remove the cancer. A VATS is performed in removing a wedge section of the lung. The What CPT® code is reported?
A. 32666
B. 32663
C. 32607
D. 32661

Answer 63

A. 32666

In the CPT® Index look for VATS referring you to see Thoracoscopy. Look for Thoracoscopy/Surgical/with Therapeutic Wedge Resection referring you to 32666 and 32667. This is a therapeutic procedure because the patient is having the cancer removed. Code 32607 is reported when the physician is performing a wedge resection for a diagnostic biopsy to find out if the mass is cancerous.

Question 64

A patient’s nose was hit with a baseball during a high school baseball game. At that time reconstruction was performed with local grafts. Patient returns now as an adult, discontent with the bony prominence along the bony pyramid and flat look of the tip of the nose. He underwent major repair with osteotomies and nasal tip work. What CPT® code is reported?
A. 30462
B. 30450
C. 30410
D. 30435

Answer 64

B. 30450

Rationale: The procedure performed now is a secondary rhinoplasty due to unfavorable results from the initial rhinoplasty. In the CPT® Index look for Rhinoplasty/Secondary directing you to code range 30430-30450. Code selection is based on the reason for the repair and the extensiveness of the repair. 30450 reports a major secondary revision including osteotomies and nasal tip work.

Question 65

A surgeon performed a transthoracic median sternotomy for exploration of the space around the lung sacs and for drainage of fluid, caused by pneumonia. What is/are the appropriate code(s) for this scenario?
A. 39010
B. 39401
C. 39000, 32554-51
D. 39220, 32554-51

Answer 65

B. 39010

Rationale: In the CPT® Index look for Mediastinum/Exploration which directs us to codes 39000-39010, 60505. Code selection is made based on the approach used. In this case, it is a transthoracic approach making 39010 the correct code. Drainage of fluid is already included in the code and is not separately reportable.

Question 66

A patient is seen in the OR for removal of a hepatic adenoma which has invaded the diaphragm. The resection of the diaphragm portion of the mass was repaired with primary sutures. What CPT® code is reported for the diaphragmatic mass resection?
A. 39561
B. 39560
C. 39540
D. 39545

Answer 66

B. 39560

Rationale: In the CPT® Index look for Resection/Diaphragm, referring you to 39560 and 39561. Code selection depends on the type of repair. The repair is with primary sutures which is considered a simple repair making 39560 the correct code choice.

Question 67

What ICD-10-CM code is reported for COPD with acute bronchitis?
A. J44.1
B. J44.9, J22
C. J40
D. J44.0, J20.9

Answer 67

D. J44.0, J20.9

Rationale: COPD stands for Chronic Obstructive Pulmonary Disease. In the ICD-10-CM Alphabetic Index, look for Disease/lung/obstructive (chronic)/with/acute bronchitis referring you to J44.0. Verification in the Tabular List confirms code selection and gives additional instruction to code also to identify the infection. The infection is reported with a code from category code J20 Acute Bronchitis. Because there is no indication of the infectious agent for the acute bronchitis, an unspecified code is used. Bronchitis/acute or subacute refers you to J20.9. There is also an Excludes2 note that lists category code J44.-, which indicates that a code from that category can be coded with J20.9.

Question 68

A 20-year-old patient is seen for 5 transbronchial lung biopsies of 2 separate lobes. One biopsy is taken in one lobe and 4 biopsies in another lobe. What CPT® code(s) is/are reported?
A. 31628, 31632
B. 31628, 31632 X4
C. 31628
D. 31629, 31632

Answer 68

A. 31628, 31632

Rationale: Transbronchial biopsies are performed via a bronchoscopy. In the CPT® Index look for Bronchoscopy/Biopsy and we are directed to codes 31625-31629, 31632, 31633. Code 31628 represents a transbronchial biopsy of one lobe. A parenthetical statement under this code indicates to use code 31632 for any additional transbronchial biopsies on additional lobes. Code 31632 is reported once even when multiple biopsies are taken in a lobe.

Question 69

Most nasal passages have how many turbinates present on the lateral wall of each nasal cavity?
A. 3
B. 2
C. 6
D. 5

Answer 69

A. 3

Rationale: There are three turbinates on each side of the nose: superior, middle and inferior. These turbinates may become swollen and require surgery to restore airflow.

Question 70

What CPT® code is reported for an emergency endotracheal intubation to save the patient’s life?
A. 31502
B. 31600
C. 31603
D. 31500

Answer 70

D. 31500

Rationale: In the CPT® Index, look for Intubation/Endotracheal Tube referring you to code 31500, which is for an emergency endotracheal intubation.

Question 71

What ICD-10-CM code is reported for a patient that has RSV (respiratory syncytial virus) pneumonia?
A. J21.0
B. B97.4
C. J18.9
D. J12.1

Answer 71

D. J12.1

Rationale: RSV stands for respiratory syncytial virus. In the ICD-10-CM Alphabetic Index look for Pneumonia/respiratory syncytial virus which referring you to code J12.1. Verify code selection in the Tabular List.