CPC Final Flashcards by elissa hanson

The OIG releases a ____ outlining its priorities for the fiscal year ahead and beyond.

A. Work Plan
B. Self-referral law
C. CIA yearly review
D. Compliance Plan

A. Work Plan

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Which of the following is NOT an example of an Advanced Alternative Payment Model (AAPM)?

A. Comprehensive Primary Care Plus
B. Bundled Payments for Home Care Services
C. Comprehensive End-Stage Renal Disease Care
D. Bundled Payments for Care Improvement Advanced

B. Bundled Payments for Home Care Services

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What will the scope of a compliance program depend on?

A. The number of insurance carriers the provider is contracted with.
B. The size and resources of the provider’s practice.
C. The specific guidelines set forth in the OIG compliance plan.
D. How many patients are seen in the office on a daily basis.

B. The size and resources of the provider’s practice.

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The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer?

A. Part B
B. Part C
C. Part D
D. Part D

A. Part B

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What form is used to submit a provider’s charge to the insurance carrier?

A. ABN
B. UB-04
C. Provider reimbursement form
D. CMS-1500

D. CMS-1500

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What are chemicals which relay, amplify and modulate signals between a neuron and another cell?

A. Interneurons
B. Neurotransmitters
C. Hormones
D. Myelin

B. Neurotransmitters

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What is the great toe called?

A. Calcaneus
B. Talus
C. Metatarsal
D. Hallux

D. Hallux

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The corpus luteum secretes progesterone. What is an effect of this secretion?

A. Enlargement and development of the organs of the female reproductive system
B. Closure of the epiphyseal discs in long bones
C. Thickens the endometrium for implantation and is necessary to sustain pregnancy
D. Deposition of fat beneath the skin

C. Thickens the endometrium for implantation and is necessary to sustain pregnancy

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Melasma is defined as:

A. A dark vertical line appearing on the abdomen
B. Lines where the skin has been stretched
C. A discharge of mucus and blood
D. Brownish pigmentation appearing on the face

D. Brownish pigmentation appearing on the face

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The meaning of heteropsia (or anisometropia) is:

A. Blindness in half the visual field
B. Unequal vision in the two eyes
C. Blindness in both eyes
D. Double vision

B. Unequal vision in the two eyes

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What is an example of an eponym?

A. Xanthoma
B. Paget’s disease
C. Salpingo-oophoritis
D. Neuropathy

B. Paget’s disease

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NEED TO FIX

When coding for an ambulatory surgical procedure, how is the diagnosis determined?

A. Z codes are always reported for ambulatory surgery.
B. Code the preoperative diagnosis and postoperative diagnosis if the diagnoses are different.
C. Code the preoperative diagnosis because it is the most definitive.
D. Code the postoperative diagnosis because it is the most definitive.

B. Code the preoperative diagnosis and postoperative diagnosis if the diagnoses are different.

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What is the ICD-10-CM code for strep throat?

A. B97.89
B. A49.1
C. J02.8
D. J02.0

D. J02.0

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A 50-year-old female presents to her provider with symptoms of insomnia and upset stomach. The provider suspects she is premenopausal. She is diagnosed with impending menopause. What diagnosis code(s) should be reported?

A. N95.9, G47.00, K30
B. E28.319
C. N95.9
D. G47.00, K30

D. G47.00, K30

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What diagnosis codes should be reported for spastic cerebral palsy due to previous illness of meningitis?

A. G09, G80.1
B. G80.1, G43.909, G03.9
C. G03.9, G80.1
D. G80.1, G09

D. G80.1, G09

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When a patient has a blood test for HIV that is inconclusive, what ICD-10-CM code is assigned?

A. R75
B. Z11.4
C. Z21
D. B20

A. R75

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A patient presents to the ED with weakness on the left side and aphasia. Tests are ordered and the patient is admitted with a cerebrovascular accident (CVA). What ICD-10-CM code(s) is/are reported?

A. I67.89
B. I63.50
C. R53.1, R47.01
D. I63.9

D. I63.9

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The patient has a significant visual impairment (category 2) due to astigmatism in the left eye. It is corrected with glasses. The right eye has normal vision. What ICD-10-CM code(s) is/are reported?

A. H52.212
B. H54.7, H52.202
C. H52.202, H54.52A2
D. H54.7

C. H52.202, H54.52A2

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A patient with chronic back and neck pain developed a drug dependency on oxycodone (opioid). After being taken off the drug, he was seen in the clinic for withdrawal symptoms. What ICD-10-CM codes are reported?

A. F11.23, T40.2X5S
B. F11.24, T40.2X5D
C. F11.10, F11.23, T40.2X5A
D. F11.23, T40.2X5A

D. F11.23, T40.2X5A

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A patient is admitted after being found unresponsive at home. The patient had right-sided hemiplegia and aphasia from a previous CVA. The provider documents a current cerebral infarction due to occlusion of the right middle cerebral artery as the final diagnosis and the patient is transferred for rehabilitation. What ICD-10-CM code(s) is/are reported?

A. I65.319
B. I67.89, I69.954, R47.01
C. I67.89, I69.959, I69.920
D. I63.511, I69.351, I69.320

D. I63.511, I69.351, I69.320

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According to the ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A), codes in this range have sequencing priority over what codes?

A. All codes including Z33.1
B. Chapter 15 codes do not have sequencing priority over other codes.
C. Codes from Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99).
D. Codes from all other chapters.

D. Codes from all other chapters.

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A child has a splinter under the right middle fingernail. What ICD-10-CM code is reported?

A. S60.452A
B. S61.242A
C. S61.227A
D. S61.222A

A. S60.452A

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A patient has benign prostatic hyperplasia with urinary retention. What ICD-10-CM code(s) is/are reported?

A. N40.0
B. N40.1, R33.8
C. Q55.4
D. N40.3, R33.8

B. N40.1, R33.8

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A baby boy is born by cesarean section in the hospital. ABO incompatibility was documented, but the Coomb’s test was negative, ruling out the ABO incompatibility, so no treatment was given. What ICD-10-CM codes are reported for the newborn’s record?

A. P01.8, Z38.01
B. O36.1190, Z38.01, Z03.79
C. Z38.01, Z05.89
D. Z38.01, P55.1

C. Z38.01, Z05.89

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At 39 weeks gestation, a 26-year-old woman is admitted for precipitous labor and vaginally delivers a healthy baby girl. What ICD-10-CM codes are reported on the maternal record? A. O62.3, Z37.0, Z3A.39 B. O62.3, O80, Z37.0, Z3A.39 C. O80, 062.3, Z38.00, Z3A.39 D. O80, Z38.00, Z3A.39

A. O62.3, Z37.0, Z3A.39

What is the correct CPT® coding for a cystourethroscopy with brush biopsy of the renal pelvis? A. 52007 B. 52005, 52007 C. 52000, 52007 D. 52005

A. 52007

What is the correct CPT® code to report a microscopic urinalysis? A. 81000 B. 81001 C. 81003 D. 81015

D. 81015

The Global Surgical Package applies to services performed in what setting? A. Hospitals B. Ambulatory Surgical Centers C. Physician’s offices D. All of the above

D. All of the above

What is the correct code for the administration of one vaccine given intramuscularly for a child under eight years of age when the physician counsels the parents? A. 90473 B. 90460 C. 90471 D. 90461

B. 90460

A patient is seen in the physician’s office for a 2,400,000 U injection of Bicillin L-A. What code represents this drug and the units given? A. J0558 x 24 B. J2510 x 4 C. J2540 x 4 D. J0561 x 24

D. J0561 X 24

What is the correct diagnosis code to report treatment of a melanoma in-situ of the left upper arm? A. C44.609 B. D03.62 C. C43.62 D. D04.62

B. D03.62

# NEED TO FIX The patient has a suspicious lesion of the left jaw line. Clinical diagnosis of this lesion is unknown, but due to the appearance, malignancy is a realistic concern. The lesion was excised into the subcutaneous fat measuring 0.8 cm and margins of 0.1 cm on each side. Hemostasis was achieved using light pressure. The wound was closed in layers using 5.0 Monocryl and 6.0 Prolene. Pathology revealed a nevus with clear margins. What CPT® and ICD-10-CM codes are reported? A. 12051, 11641-51, D22.39 B. 13131, 11441-51, C44.309 C. 13131, 11441-51, D49.2 D. 12051, 11441-51, D22.39

D. 12051, 11441-51, D22.39

A patient is diagnosed with actinic keratosis of the chest and arms. She presents to her physician’s office for destruction of these lesions. Using cryosurgery, the physician destroys 4 lesions on the right arm, 4 lesions on the left forearm and 4 lesions on the chest. What CPT® and ICD-10-CM codes are reported? A. 17000, 17003 x 11, L57.0 B. 17003 x 19, D48.5 C. 17000, 17003, 17004, L57.0 D. 17000, 17003, D49.2

A. 17000, 17003 x 11, L57.0

# NEED TO FIX Patient is an 81-year-old male with a biopsy-proven basal cell carcinoma of the posterior neck just near his hairline; additionally, the patient had two other areas of concern on his cheek. Informed consent was obtained and the areas were prepped and draped in the usual sterile fashion. Attention was first directed to the basal cell carcinoma of the neck. I excised the lesion measuring 2.6 cm as drawn down to the subcutaneous fat. With extensive undermining of the wound I closed it in layers using 4.0 Monocryl, 5.0 Prolene and 6.0 Prolene; the wound measured 4.5 cm. Attention was then directed to the other two suspicious lesions on his cheek. After administering local anesthesia, I proceeded to take a 3 mm punch biopsy of each lesion and was able to close with 5.0 Prolene. The patient tolerated the procedures well. Pathology later showed the basal cell carcinoma was completely removed and the biopsies indicated actinic keratosis. What CPT® codes should be reported? A. 12042, 11623-51, 11104-59, 11105 B. 13132, 11623-51, 11104-59, 11105 C. 13131, 11622-51, 11104-59, 11104-59 D. 13132, 11623-51, 11440-51, 11440-51

B. 13132, 11623-51, 11104-59, 11105

# NEED TO FIX A localization wire placement in the lower outer aspect of the right breast was performed by a radiologist the day prior to this procedure. During this operative session, the surgeon created an incision through the wire track and the wire track was followed down to its entrance into breast tissue. A nodule of breast tissue was noted immediately adjacent to the wire. This entire area was excised by sharp dissection, sent to pathology and returned as a benign lesion. Bleeders were cauterized and subcutaneous tissue was closed with 3-0 Vicryl. Skin edges were approximated with 4-0 subcuticular sutures and adhesive strips were applied. The patient left the operating room in satisfactory condition. What is/are the correct code(s) for the surgeon’s service? A. 19125-RT B. 19125-RT, 19285 C. 19120-RT D. 11400-RT

B. 19125-RT, 19285

The acronym BKA means: A. The acronym BKA means: B. bilateral knee amputation C. bilateral knee arthritis D. bursitis knee & arthritis

A. below knee amputation

An 85-year-old has developed a lump in her right groin. An incision over the lesion was made and tissue was dissected through the skin and subcutaneous tissue going deep through the femoral fascia. Sharp dissection of the mass was performed, freeing it from surrounding structures. The 3 cm mass was isolated and excised. The incision was closed, the area was cleaned and dried, and a dressing applied. What CPT® code is reported? A. 27049 B. 27087 C. 27047 D. 27048

D. 27048

A 6-year-old male suffered a fracture after falling off the monkey bars at school. He fell on an outstretched hand and suffered a transcondylar fracture of the left humerus. After prep and drape, a manipulation was done to achieve anatomic reduction. Once the joint was adequately reduced, pins were placed through the skin distally and proximally into the bone to maintain excellent fixation and anatomic reduction. The pins were bent, trimmed and covered with a sterile dressing and a posterior splint was placed on the patient’s arm. What CPT® code is reported? A. 24546-LT B. 24538-LT C. 24530-LT D. 24516-LT

B. 24538-LT

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 about 1 cm long 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- saline solution. Skin was closed in a layered fashion and sterile dressing applied. What CPT® code(s) should be reported? A. 20680-LT, 20680-59-LT B. 20680-LT, 20670-59-LT C. 20670-LT D. 20680-LT

D. 20680-LT

# NEED TO FIX This 36-year-old female presents with an avulsed anterior cruciate ligament off the femoral condyle with a complete white on white horizontal cleavage tear of the posterior horn of the medial meniscus, causing instability. A general endotracheal anesthesia was performed, and the patient was placed supine on the operating table. The right lower extremity was prepped with Betadine and draped free. Standard arthroscopic portals were created, and the knee was systematically examined and probed. The posterior horn of the medial meniscus was noted to be buckled and frayed. This area was carefully probed and found to be irreparable. It was decided that our best option was to proceed with a limited partial meniscectomy, with the goal being to leave as much viable meniscal tissue as possible. Therefore, a medial infrapatellar portal was developed with a longitudinal stab wound. A series of straight-angled and curved basket punches was used to perform a saucerization of the damaged portion of the meniscus, leaving the intact portion of the medial meniscus in place. Debris was meticulously removed with the 4.0 meniscal cutter. Approximately 50% of the medial meniscus remained. Next, our attention was turned to the ACL repair. Through a 5 cm longitudinal anterior incision, a central one-third tendon bone was harvested. A 10 mm graft was taken and bone plug sculpted. Anterolateral notchplasty was done with a curette and polished with the burr. All debris was removed and instruments were used to ensure proper isometry. The graft was tightened in extension about 2.5 mm and actually lengthened in flexion, and this was considered acceptable. Endoscopic guides were used to create the tibial and femoral tunnels, and the edges were rasped smooth. Using a percutaneous guide pin, the graft was placed retrograde to the knee and secured proximally with an 8 x 25 mm interference screw. The knee was put through range of motion, and with the leg in 30 degrees of flexion with the posterior drawer applied to the proximal tibia; an 8 x 20 mm interference screw was used to secure the bone plug distally. The graft was tight, isometric and without adverse features. The wound was copiously irrigated with Kantrex1. Cancellous bone fragments from bone plugs were used to graft the donor site defect in the patella. The paratenon was closed over this to house the graft with a running #1 Vicryl. The edge of the distal bone plug was beveled with the rongeur. The subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. Steri-Strips, sterile dressing, cryo cuff and hinged knee brace were applied. The patient was awakened and taken to the recovery room in satisfactory condition. What CPT® codes are reported? A. 29889-RT, 29880-51-RT B. 29888 -RT, 29882-51-RT C. 29888-RT, 29880-51-RT D. 29888-RT, 29881-51-RT

D. 29888-RT, 29881-51-RT

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

A. 32120

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. 39540 B. 39545 C. 39560 D. 39561

C. 39560

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. 30435 B. 30462 C. 30450 D. 30410

C. 30450

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. 32484, C34.10, F17.210 B. 32100, M25.511, R07.9, F17.210 C. 32503, C34.10, F17.210 D. 21602, 32551-51, M25.511, R07.9, F17.210

A. 32484, C34.10, F17.210

# NEED TO FIX 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. 32098-RT, 77002-26, C34.10, R07.9, R04.89, R47.81, R63.4, F17.210 C. 32607-RT, 77002-26, R22.2, F17.210 D. 32408-RT, 77002-26, C34.11, F17.200

What part of the cardiovascular system is responsible for the one-way flow of blood through the chambers of the heart? A. Bundle of His B. Atria C. Septum D. Heart valves

In the cath lab, from a right femoral artery access, the following procedures are performed: Catheter placed in the left renal, accessory renal superior to the left renal and one main right renal artery. Radiologic supervision and imaging are performed in all locations. What CPT® code(s) is/are reported? A. 36245, 36245-59, 36245-59, 36252-26 B. 36252 C. 36252, 36251 D. 36245-LT, 36245-59-LT, 36245-59-RT, 75774-26

Select the ICD-10-CM diagnosis codes used for pseudoaneurysm, cardiac tamponade and left ventricular failure. A. I34.89, I31.9, I50.9 B. I25.3, I31.9, I50.9 C. I71.9, I31.9, I50.9 D. I71.9, I31.9, I50.9

D. I71.9, I31.9, I50.9

The skin over the left groin was prepped and draped in a sterile fashion and anesthetized with 1% Xylocaine. Through a right femoral artery access, a 5 French pigtail catheter was placed in the abdominal aorta and a run-off was performed following injection of 80cc of contrast. Oblique DSA images of the iliac circulation were performed following two injections, each 15cc. Findings: Abdominal aorta: no signs of renal artery stenosis. There is mild atheromatous change involving the lower abdominal aorta. There are two eccentric plaques arising from the distal aorta just above the iliac bifurcation. There are high-grade stenoses involving both proximal iliacs, the right far more pronounced than the left. The right superficial femoral, profunda femoral, popliteal arteries are normal. The trifurcation vessels are unremarkable. On the left, there is an eccentric plaque in the common femoral artery just below the catheter entrance site. This creates approximately 40-50% stenosis at this site. The remainder of the proximal femoral artery is normal. The trifurcation vessels and popliteal artery are normal. What CPT® codes are reported? A. 36215, 75630-26-50 B. 36200, 75625-26 C. 36200, 75630-26 D. 36200, 75625-26, 75716-26

C. 36200, 75630-26

Where is the vermilion border located? A. Stomach lining B. Underneath the tongue C. In the esophagus D. Upper and lower lips

D. Upper and lower lips

What CPT® and ICD-10-CM codes are reported for diagnosis of a recurrent unilateral reducible femoral hernia repair? A. 49555, K41.21 B. 49550, K41.91 C. 49555, K41.91 D. 49505, K41.31

C. 49555, K41.91

A patient is seen in the gastroenterologist’s clinic for a diagnostic colonoscopy. When performing the service, the physician notes suspicious looking polyps and removes three using a snare technique to send to pathology for further testing. What CPT® coding is reported? A. 45385 B. 45378, 45385-51 C. 45378, 45380-51 D. 45380

A. 45385

# NEED TO FIX A patient suffering from cirrhosis of the liver from alcohol abuse presents with a history of coffee ground emesis (bleeding). The surgeon diagnoses the patient with esophageal gastric varices. Two days later, in the hospital GI lab, the surgeon ligates the varices with bands via an UGI endoscopy. What CPT® and ICD-10-CM codes are reported? A. 43244, K74.60, I85.01, F10.20 B. 43235, I83.008, F10.20, K70.30 C. 43400, I85.11, F10.10, K74.60 D. 43205, K70.30, I85.11, F10.10

A. 43244, K74.60, I85.01, F10.20

Transurethral resection of a medium-size (3.0 cm) bladder tumor was performed in an outpatient setting. What CPT® code is reported for this service? A. 52234 B. 52240 C. 52224 D. 52235

D. 52235

In ICD-10-CM when both CKD and ESRD are reported what code(s) is/are reported? A. N18.6, N18.5 B. N18.5, N18.6 C. N18.5 D. N18.6

D. N18.6

The patient has a 3.6 cm tumor in the lower pole of the right kidney. A percutaneous right renal cryosurgical ablation is performed. What CPT® code is reported for this service? A. 50593-RT B. 50541-RT C. 50542-RT D. 50250-RT

A. 50593-RT

The patient presents to the office for cystometrogram (CMG). Complex CMG with voiding pressure studies is done. Intraabdominal voiding pressure studies and complex uroflowmetry are also performed. What CPT® code(s) is/are reported for this service? A. 51728, 51797, 51741-51 B. 51726 C. 51728-26, 51797-26, 51741-51-26 D. 51726, 51728-51, 51797

A. 51728, 51797, 51741-51

# NEED TO FIX If a woman is hospitalized with severe pre-eclampsia in the 30th week of her pregnancy what is the diagnosis code for her daily visits? A. O14.10, Z3A.00 B. O14.13 C. O14.03, Z3A.30 D. O14.13, Z3A.30

C. O14.03, Z3A.30

Vulvar cancer in situ can also be documented as: A. Adenocarcinoma of the vulva B. VIN III C. VIN II D. VIN 1

B. VIN III

A 23-year-old woman presents with sudden LLQ (left lower quadrant) pain which does not resolve. The decision is made to perform exploratory laparoscopy revealing a cyst on the left ovary. The cyst is removed along with a partial oophorectomy. What is/are the CPT® code(s) reported for this procedure? A. 58661 B. 49320, 58925-51 C. 58661, 49320-51 D. 58925

A. 58661

A pregnant patient presents to labor and delivery with the baby in a breech presentation. During the delivery the doctor attempts to turn the baby (version of the breech presentation) while it is still in the uterus. The baby turns but then immediately resumes his previous breech position. Can this service (the version of the breech) be billed? If so, what is the code? A. Yes, because the doctor did the work, even though the outcome was unsuccessful. Report this procedure with code 59412 B. Yes, only billing it with postpartum care 59515 C. No, this procedure is included in the obstetrical global package D. No, because the doctor was unable to successfully turn the baby.

A. Yes, because the doctor did the work, even though the outcome was unsuccessful. Report this procedure with code 59412

Looking in the CPT® manual the Nervous System is divided into what subheadings? A. Skull, Spine, Peripheral Nervous System, Central Nervous System B. Brain, Central Nervous System, Autonomic Nervous System C. Central Nervous System and Peripheral Nervous System D. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System.

D. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System.

The provider removes the thymus gland in a 27-year-old female with myasthenia gravis. Using a transcervical approach the blood supply to the thymus is divided and the thymus is dissected free from the pericardium and the thymus is removed. What CPT® code is reported for this procedure? A. 60540 B. 60520 C. 60521 D. 60522

B. 60520

What is the ICD-10-CM code for a cavernous hemangioma in intracranial structures? A. D18.00 B. D18.02 C. Q82.5 D. D18.03

B. D18.02

A patient with a malignant neoplasm of the spinal meninges is receiving a programmable pump implantation for chemotherapy. The patient is placed in the prone position where the provider made a midline incision overlying the area of the spinal cord. The reservoir was placed in the subcutaneous tissues and attached to the previously placed catheter. Layered sutures were used to close the incision. The patient tolerated the procedure well and was released in good condition. What CPT® and ICD-10-CM codes are reported for this procedure? A. 62362, C70.1 B. 62350, C70.0 C. 62367, C70.1 D. 62360, C70.0

A. 62362, C70.1

What ICD-10-CM code is reported for suppurative otitis media in the right ear? A. H66.43 B. H66.40 C. H66.41 D. H66.42

C. H66.41

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. 67903 B. 67908 C. 67906 D. 67901

B. 67908

The provider makes an incision in the patient's left tympanic membrane in order to inflate eustachian tubes and aspirate fluid in a patient with acute eustachian salpingitis. The procedure is completed without anesthesia. What CPT® and ICD-10-CM codes are reported? A. 69421, H68.022 B. 69421, H68.012 C. 69420, H68.012 D. 69420, H68.022

C. 69420, H68.012

A 53-year-old woman with scarring of the right cornea has significant corneal thinning with a high risk of perforation and underwent reconstruction of the ocular surface. The eye is incised and an operating microscope is used with sponges and forceps to debride necrotic corneal epithelium. Preserved human amniotic membrane is first removed from the storage medium and transplanted by trimming the membrane to fit the thinning area of the cornea then sutured. This process was repeated three times until the area of thinning is flush with surrounding normal thickness cornea. All of the knots are buried and a bandage contact lens is placed with topical antibiotic steroid ointment. What CPT® code is reported? A. 65435 B. 65781 C. 65710 D. 65780

D. 65780

What is the anesthesia code for a mediastinoscopy utilizing OLV (one lung ventilation)? A. 00541 B. 00529 C. 00528 D. 00540

B. 00529

A 77-year-old patient was scheduled for a left total hip replacement due to degenerative joint disease (DJD) and the anesthesiologist documented the DJD as primary. The pre-anesthesia assessment indicates the patient had surgery in 2015 for gastroesophageal reflux disease (GERD). What ICD-10-CM coding is reported? A. M16.12 B. M16.9, K21.9 C. M16.7 D. K21.9

A. M16.12

What time is used to report the start of anesthesia time? A. During the pre-anesthesia assessment B. When the anesthesiologist begins to prepare the patient for anesthesia C. Surgery start time D. Entering the operating room

B. When the anesthesiologist begins to prepare the patient for anesthesia

A preanesthesia assessment was performed and signed at 10:21 am. Anesthesia start time is reported as 12:26 pm, and the surgery began at 12:37 pm. The surgery finished at 15:12 pm and the patient was turned over to PACU at 15:26 pm, which was reported as the ending anesthesia time. What is the anesthesia time reported? A. 12:26 pm to 15:26 pm (180 minutes) B. 10:21 am to 15:12 pm (291 minutes) C. 12:26 pm to 15:12 pm (166 minutes) D. 12:37 pm to 15:26 pm (169 minutes)

A. 12:26 pm to 15:26 pm (180 minutes)

A 5-year-old patient is experiencing atrial fibrillation with rapid ventricular rate. The anesthesia department is called to insert a nontunneled central venous (CV) catheter. What CPT® coding is reported? A. 36557 B. 00400 C. 36556 D. 36555

C. 36556

What ICD-10-CM code is reported for a routine chest X-ray? A. R07.1 B. Z00.01 C. Z01.89 D. R07.9

C. Z01.89

A patient needing scoliosis measurements is coming in to have standing anteroposterior and lateral views of his entire thoracic and lumbar spine. What CPT® code(s) is/are reported for radiology? A. 72040, 72070, 72100 B. 72083 C. 72084 D. 72082

D. 72082

What ICD-10-CM code is reported for a routine screening mammogram? A. Z12.31 B. Z12.39 C. C50.919 D. C50.929

A. Z12.31

A patient was admitted to observation status after losing control and crashing his motorcycle into the guardrail on the highway. A CT scan of the brain without contrast and the chest is performed. It revealed a fracture of the skull base with no hemorrhage in the brain. There was no puncture of the lungs. Three views of the right and left sides of the ribcage reveal fractures of the left third and fifth rib. What CPT® and ICD-10-CM codes are reported? A. 70450-26, 71275-26, 71101-26, S02.19XA, S22.41XA, V27.09XA, Y92.413 B. 70450-26, 71250-26, 71101-26, S02.109B, S22.43XB, V27.29XA, Y92.411 C. 70450-26, 71250-26, 71110-26, S02.109A, S22.42XA, V27.49XA, Y92.411 D. 70460-26, 71260-26, 71101-26, S02.0XXA, S22.43XA, V27.99XA, Y92.412

C. 70450-26, 71250-26, 71110-26, S02.109A, S22.42XA, V27.49XA, Y92.411

What modifier identifies the professional component of a service? A. PC B. 91 C. TC D. 26

D. 26

A lab test reveals an excessive level of alcohol in the blood. What ICD-10-CM code is reported? A. R78.0 B. R78.89 C. R78.4 D. R78.9

A. R78.0

A patient has a cholecystectomy and a soft tissue lipoma removed during the same operative session. Both specimens were sent to pathology in separate containers are examined by the pathologist. What CPT® code(s) are reported? A. 88305, 88304 B. 88304, 88302 C. 88304 x 2 D. 88305 x 2

C. 88304 X 2

A patient arrives at to the ED. It appears the patient has been suffering from periods of disorientation, persistent stomachache, fatigue, over the past several months but the persistent patch of dark skin that appeared on the patient’s chest has prompted his visit. The treating ED physician orders a stimulation panel for adrenocorticotropic hormone (ACTH) consisting of two cortisol injections, 60 minutes apart. Blood tests reveal ACTH levels are at 300 nmol/L and diagnoses the patient with adrenal insufficiency. What CPT® codes are reported for the lab services? A. 82533 x 2, 83498 x 2 B. 80400 C. 80408 D. 82533 X 2

B. 80400

Fred is fishing at the local area lake while on vacation. He gets lightheaded and dizzy and goes to the local hospital Emergency Department. He’s evaluated by the ED provider. This is the first time he has been to this hospital. What subsection is used to report the ED visit? A. Emergency Department Services B. Office or Other Outpatient Consultations C. Initial Hospital Care D. Office or Other Outpatient Services; New Patient

A. Emergency Department Services

Dr. Howitzer sees Mrs. Jones in Clinic Eight for sudden loss of consciousness while watching the Olympic Torch go by. He is a new provider to the neurology department. Dr. Drake Rinaldi, a prominent member of the neurology faculty at the university saw Mrs. Jones last month. Dr. Howitzer performs a medically appropriate history and exam. Medical decision making is of high complexity. The final diagnosis given is transient loss of consciousness. The patient makes a follow-up appointment to see Dr. Rinaldi in one week. What is the appropriate diagnosis and E/M code for this visit? A. 99215, R55 B. 99214, R40.1 C. 99202, R40.1 D. 99203, R55

A. 99215, R55

The total time documented for an established patient office visit is 29 minutes. What E/M code is reported? A. 99215 B. 99213 C. 99212 D. 99214

B. 99213

A 28-year-old female patient is returning to her provider’s office with complaints of RLQ pain and heartburn with a temperature of 100.2. The provider performs a medically appropriate history and exam. Abdominal ultrasound is ordered and the patient has mild appendicitis. The provider prescribes antibiotics to treat the appendicitis in hopes of avoiding an appendectomy. What are the correct CPT® and ICD-10-CM codes for this encounter? A. 99204, K37 B. 99203, R10.31, K37 C. 99214, K37, R12 D. 99204, R50.9, R12, R10.31, K37

C. 99214, K37, R12

A patient with cardiac arrhythmia has a pacemaker system with electrodes in the atrium and ventricle. The patient visits his cardiologist for evaluation of the battery, leads, capture and sensing function, heart rhythm and programmed parameters of the system which included connection, recording, and disconnection of the pacemaker. Analysis, review, and a report were performed by the physician and placed in the record. What CPT® code is reported? A. 93287 B. 93280 C. 93279 D. 93288

D. 93288

A patient has an open wound on his left lower leg caused by a cat bite. The animal tested negative for rabies, but the wound has failed to heal and became infected by Clostridium perfringens. The patient underwent hyperbaric oxygen therapy attended and supervised by the provider. What CPT® and ICD-10-CM codes are reported? A. 97597, S81.001A, T63.891A B. 99183, S81.852A, B96.7, W55.01XA C. 97597, S81.852A, W55.01XA D. 97605, S81.802A, B95.5, W55.03XA

B. 99183, S81.852A, B96.7, W55.01XA

A 49-year-old female was brought to the emergency department. She was lethargic, but awake. She is four years post liver transplant. Neurology was consulted who determined the patient was encephalopathic with altered mental status. There was some question whether she had a seizure. An EEG and WADA test were performed. What CPT® and ICD-10-CM codes are reported? A. 95958, G93.40, R41.82, Z94.4 B. 95717, 95958-59, R41.82, Z94.4 C. 95958, G92.8, Z96.89 D. 95957, 95958, R41.82

A. 95958, G93.40, R41.82, Z94.4

A female patient reports repeated falls. She has no known head trauma or other injuries. She noticed some slight stiffness in her joints and weakness in her lower extremity muscles, with slight stiffness in her arm joints. The provider decided to test for possible multiple sclerosis (MS). She was sent to a clinic providing somatosensory studies. The testing included upper and lower limbs. What CPT® and ICD-10-CM codes are reported? A. 95926, M62.81, M25.60, R29.6 B. 95925, 95926, G35 C. 95926, G35 D. 95938, M62.81, M25.60, R29.6

D. 95938, M62.81, M25.60, R29.6

# NEED TO FIX This 36-year-old female presents with an avulsed anterior cruciate ligament off the femoral condyle with a complete white on white horizontal cleavage tear of the posterior horn of the medial meniscus, causing instability. A general endotracheal anesthesia was performed, and the patient was placed supine on the operating table. The right lower extremity was prepped with Betadine and draped free. Standard arthroscopic portals were created, and the knee was systematically examined and probed. The posterior horn of the medial meniscus was noted to be buckled and frayed. This area was carefully probed and found to be irreparable. It was decided that our best option was to proceed with a limited partial meniscectomy, with the goal being to leave as much viable meniscal tissue as possible. Therefore, a medial infrapatellar portal was developed with a longitudinal stab wound. A series of straight-angled and curved basket punches was used to perform a saucerization of the damaged portion of the meniscus, leaving the intact portion of the medial meniscus in place. Debris was meticulously removed with the 4.0 meniscal cutter. Approximately 50% of the medial meniscus remained. Next, our attention was turned to the ACL repair. Through a 5 cm longitudinal anterior incision, a central one-third tendon bone was harvested. A 10 mm graft was taken and bone plug sculpted. Anterolateral notchplasty was done with a curette and polished with the burr. All debris was removed and instruments were used to ensure proper isometry. The graft was tightened in extension about 2.5 mm and actually lengthened in flexion, and this was considered acceptable. Endoscopic guides were used to create the tibial and femoral tunnels, and the edges were rasped smooth. Using a percutaneous guide pin, the graft was placed retrograde to the knee and secured proximally with an 8 x 25 mm interference screw. The knee was put through range of motion, and with the leg in 30 degrees of flexion with the posterior drawer applied to the proximal tibia; an 8 x 20 mm interference screw was used to secure the bone plug distally. The graft was tight, isometric and without adverse features. The wound was copiously irrigated with Kantrex1. Cancellous bone fragments from bone plugs were used to graft the donor site defect in the patella. The paratenon was closed over this to house the graft with a running #1 Vicryl. The edge of the distal bone plug was beveled with the rongeur. The subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. Steri-Strips, sterile dressing, cryo cuff and hinged knee brace were applied. The patient was awakened and taken to the recovery room in satisfactory condition. What CPT® codes are reported? A. 29888 -RT, 29882-51-RT B. 29888-RT, 29880-51-RT C. 29888-RT, 29881-51-RT D. 29889-RT, 29880-51-RT

C. 29888-RT, 29881-51-RT

Procedure: Colectomy with a take-down of splenic flexure. The patient was taken to the operating room, placed in the dorsal lithotomy position, and then prepped and draped in the usual sterile fashion. A vertical paramedian incision was made along the left side of the umbilicus from the symphysis and taken up to above the umbilicus. This incision was carried down to the rectus muscles, which were separated in the midline. The peritoneal cavity was entered with findings as described. The ascitic fluid was removed and hand-held retractors were used to assist in surgical exposure. The malignant intra-abdominal tumor was resected from the hepatic flexure into the mid transverse colon. The resection was extended into the left upper quadrant and the attachments were also clamped, cut and suture ligated with 2-0 silk sutures in a stepwise fashion until mobilization of the tumor mass could be brought medial and hemostasis was obtained. Attempts to find a dissection plane between the malignant tumor mass and the transverse colon were unsuccessful as it appeared the tumor mass was invading into the wall of the bowel with extrinsic compression and distortion of the bowel lumen. Given the mass could not be resected without removal of bowel, attention was directed to mobilization of the splenic flexure. Retroperitoneal dissection was started in the pelvis and continued along the left paracolic gutter. The ligamentous and peritoneal attachments were taken down with Bovie cautery in a stepwise fashion around the splenic flexure of the colon until the entire left colon was mobilized medially. Similar steps were then carried on the right side as the right colon and hepatic flexure were mobilized. The peritoneal and ligamentous attachments were taken down with Bovie cautery. Vascular attachments were clamped, cut, and suture ligated with 2-0 silk until the right colon was mobilized satisfactorily. The GIA stapler was introduced and fired at both ends to dissect the tumorous bowel free. The bowel was delivered off the operative field. Attention was then directed towards re-anastomosis of the colon. Linen-shod clamps were used to gently clamp the proximal and distal segments of the large bowel. The staple line was removed with Metzenbaum scissors and the colon lumen was irrigated. The silk sutures were used to divide the circumference of the bowel into equal thirds, and the proximal and distal edges of the bowel were reapproximated with silk sutures. The posterior segment of the bowel was then retracted and secured with a TA stapler, ensuring a full thickness bowel wall insertion into the staple line. The additional two-thirds were also isolated and, with the TA stapler, clamped, ensuring that all layers of the bowel wall were incorporated into the anastomosis. A third staple line was fired and the integrity of the anastomosis was checked. First, complete hemostasis was noted. There was well beyond a finger width lumen within the large bowel. The linen-shod clamps were released and gas and bowel fluid were moved through the anastomosis aggressively with intact staple line; no leakage of gas or fluid. The abdomen was then irrigated and water was left over the anastomosis. The anastomosis was manipulated with no extravasation of air. The abdomen and pelvis were then irrigated aggressively. The Mesenteric trap was then re-approximated with interrupted 3-0 silk suture ligatures. All sites were inspected and noted to be hemostatic. Attention was directed towards closing. Pathology report showed intra-abdominal cancer. Transverse colon and hepatic flexure cancer were also indicated. The origin of the cancer could not be determined from the specimen given. What is the correct CPT® and ICD-10-CM coding for this report? A. 44147, 44139, C76.2, C18.8 B. 44140, C79.89, C78.5 C. 44140, 44139, C76.2, C18.8 D. 44160, C18.8

C. 44140, 44139, C76.2, C18.8

# NEED TO FIX Diagnosis: Bulbar urethral strictures Procedure: Cystoscopy and dilation of urethral stricture. Medical Necessity: A very pleasant 36-year-old male with post void hematuria. Description: A 17 French cystoscope was introduced in the patient's urethra up to the level of the stricture, but I was unable to pass the urethral stricture with a Super Stiff wire, so I first passed over the Glidewire, removed the cystoscope, placed a Pollock catheter over the Glidewire, and exchanged the Glidewire for a Super Stiff wire. We then removed the Pollock catheter leaving the Super Stiff wire in place as our safety wire. I dilated the patient's urethra to 26 French without difficulty. We reintroduced the cystoscope and noted ablation of the stricture. No masses were noted within the bladder. What CPT® code(s) is/are reported for this service? A. 52000, 53605 B. 52281 C. 53620 D. 53605

A. 52000, 53605

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. 32663 B. 32663, 32607-51 C. 32671, 32609-51 D. 32480

A. 32663

ICU - CC: Multi-system organ failure INTERVAL HISTORY: Patient remains intubated and sedated. Overnight events reviewed. Tolerating tube feeds. Systolic pressures have been running in the low 90s on LEVOPHED. Cultures remain negative. Kidney function has worsened, but patient remains non-oliguric. PHYSICAL EXAM: BP 96/60, Pulse 112, Temp 100.8. Lungs have anterior rhonchi. Heart RRR with no MRGs. Abdomen is soft with positive bowel sounds. Extremities show moderate edema. LABS: BUN 89, creatinine 2.6, HGB 10.2, WBC 22,000. ABG: 7.34/100/42 on 50% FiO2. CXR shows RLL infiltrate. IMPRESSION Hypoxic respiratory failure Community acquired pneumonia Septic shock Non-oliguric acute renal failure PLAN: Continue NS at 75 cc/hr. Decrease ZOSYN to 2.25 grams IV Q 6H Follow cultures. Continue tube feeds. Titrate LEVOPHED to maintain SBP > 90 Usual labs ordered for tomorrow. Critical care time: 35 minutes What CPT® code(s) is/are reported? A. 99291 B. 99233 C. 99232 D. 99291, 99292

A. 99291

A 65-year-old was admitted in the hospital two days ago and is being examined today by his primary care physician, who has been seeing him since he has been admitted. Primary care physician is checking for any improvements or if the condition is worsening. CHIEF COMPLAINT: CHF INTERVAL HISTORY: CHF symptoms worsened since yesterday. Now has some resting dyspnea. HTN remains poorly controlled with systolic pressure running in the 160s. Also, I’m concerned about his CKD, which has worsened, most likely due to cardio-renal syndrome. REVIEW OF SYSTEMS: Positive for orthopnea and one episode of PND. Negative for flank pain, obstructive symptoms or documented exposure to nephrotoxins. PHYSICAL EXAMINATION: GENERAL: Mild respiratory distress at rest VITAL SIGNS: BP 168/84, HR 58, temperature 98.1. LUNGS: Worsening bibasilar crackles CARDIOVASCULAR: RRR, no MRGs. EXTREMITIES: Show worsening lower extremity edema. LABS: BUN 56, creatinine 2.1, K 5.2, HGB 12. IMPRESSION: 1. Severe exacerbation of CHF 2. Poorly controlled HTN 3. Worsening ARF due to cardio-renal syndrome PLAN: 1. Increase BUMEX to 2 mg IV Q6. 2. Give 500 mg IV DIURIL times one. 3. Re-check usual labs in a.m. Total time: 20 minutes. What E/M category is used for this visit? A. Subsequent Hospital or Observation Visit (99231-99233) B. Inpatient Consultation (99252-99255) C. Initial Hospital or Observation Visit (99221-99223) D. Established Patient Office/Outpatient Visit (99211-99215)

A. Subsequent Hospital or Observation Visit (99231-99233)

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. 67515-LT, H05.812 C. 67405-LT, D18.1 D. 67415-LT, H05.812

D. 67415-LT, H05.812

# NEED TO FIX INDICATIONS FOR CORONARY INTERVENTION: Acute inferior myocardial infarction. Documented mildly occlusive plaque with much clot in the right coronary artery. PROCEDURE: Insertion of temporary pacemaker in the right femoral vein. Primary stenting of the right coronary artery with a 4.5 x 16 mm Express stent. Angio-Seal to the vessels of the right common femoral artery post procedure, and also Angio-Seal of the right common femoral vein. TECHNIQUE: Judkins percutaneous approach from the right groin with Perclose at the arterial puncture site post procedure. CATHETERS: 4 French Angio-Jet catheter device, insertion of a 5 French temporary pacing wire, a 4.5 x 16 mm Express stent. PRESSURES: Aortic Pressure: 107/78 RESULTS: Coronary stenting procedure of the right coronary artery: The right coronary artery was primarily stented with a 4.5 x 16 mm Express stent. It was expanded to 12 atmospheres. There was no residual stenosis. IMPRESSION: Successful Angio-Jet and stenting of the distal right coronary artery with no residual stenosis. Angio-Seal to the right femoral vein post procedure. PROCEDURE: Through the femoral artery sheath, the EBU was advanced to the right coronary. Following this a PT graphic intermediate wire was used to cross the lesion. Following this angioplasty of the lesion was performed, utilizing a 2.5 x 20-millimeter CrossSail balloon at multiple sites to ten atmospheres. Following this there was a fair result; however, there was a significant stenosis and significant calcification at the area, and the decision was made to pursue trying to stent the lesion. Multiple stents were attempted, including a 2.5 x 9-millimeter zipper MX and a 2.5 x 13-millimeter Guidant stent. This was abandoned, and in switching out to a balloon for further ballooning, the patient became hypertensive and with difficulty in terms of her respiratory status. Angiography revealed an occlusion of the mid left anterior descending and thrombus throughout the proximal left anterior descending extending into the left main. Recheck of ACT showed the ACT to be at eight seconds. This likely represented subtherapeutic range for her anticoagulation. A check of her medications revealed that instead of Angiomax, the patient had been given ReoPro without antithrombotic agent. She was therefore given IV heparin up to 12,000 units, and her ReoPro was continued. The lesion was then rewired, and an AngioJet was used to try to suction out this area of thrombus. Unfortunately, the AngioJet was unable to cross the mid left anterior descending lesion and therefore was somewhat limited in its use for a more distal thrombus, although it did suction out the proximal left anterior descending thrombus. At this point, the patient was emergently intubated, and multiple pressors were started, including dopamine, Levophed, vasopressin, and epinephrine. Following this, a laser was attempted to cross the lesion an excimer laser X80 Spectranetics 0.9 Vitesse; however, this laser was unable to cross the lesion. Therefore, a long balloon, a 2.0 x 40-millimeter CrossSail balloon, was used to cross the lesion and inflate multiple segments of the mid left anterior descending up to a maximum inflation pressure of ten atmospheres. This improved flow though by no means restored it back to normal. Therefore, following this, longer balloon inflations were performed utilizing a 2.0 x 20-millimeter CrossSail balloon up to fourteen atmospheres for one and a half minutes. This did not improve significantly the flow distally, and therefore the decision was made to try to stent the mid segment with a 2.5 x 9-millimeter zipper MX stent to a maximum inflation pressure of fourteen atmospheres. This resolved the issue in terms of the mid left anterior descending lesion; however, beyond the stent there continued to be residual stenosis, and multiple balloons were used to balloon this up to a 2.5 x 20-millimeter balloon up to fourteen atmospheres. The final result in the left anterior descending revealed a lesion in the mid-left anterior descending that was approximately 40 percent, there was TIMI III flow throughout the proximal and mid left anterior descending. However, at the level of the apex, there was TIMI 0 flow. Throughout the angioplasty, the patient had episodes of bradycardia, and a temporary pacemaker was placed, and this was removed at the end of the procedure. IMPRESSION: Successful stent to the mid left anterior descending, complicated by thrombotic event in the left anterior descending system. Final result was a successful stent to the mid left anterior descending with residual TIMI 0 flow in the distal left anterior descending. We returned to the right coronary artery and successfully employed a 4.5 x 16 mm Express sent. At the end of the case, an intra-aortic balloon pump was placed in the left femoral artery sheath, and the patient was sent to the Coronary Care Unit on multiple pressors including epinephrine, vasopressin, Levophed and dopamine. What CPT® coding is reported? A. 92928-RC, 92928-LD, 33967, 92973 B. 92928-RC, 92929-LD, 92973 C. 92928-RC, 92929-LD D. 92928-RC, 92929-LD, 33967, 92973-RC

C. 92928-RC, 92929-LD

Operative Report: Pre-Operative Diagnoses: Basal Cell Carcinoma, forehead Basal Cell Carcinoma, right cheek Suspicious lesion, left nose Suspicious lesion, left forehead Post-Operative Diagnoses: Basal Cell Carcinoma, forehead with clear margins Basal Cell Carcinoma, right cheek with clear margins Compound nevus, left nose with clear margins Epidermal nevus, left forehead with clear margins INDICATIONS FOR SURGERY: The patient is a 47-year-old white man with a biopsy proven basal cell carcinoma of his forehead and a biopsy proven basal cell carcinoma of his right cheek. We were not quite sure of the patient’s location of the basal cell carcinoma of the forehead whether it was a midline lesion or lesion to the left. We felt stronger about the midline lesion, so we marked the area for elliptical excision in relaxed skin tension lines of his forehead with gross normal margins of 1-2 mm and I marked the lesion of the left forehead for biopsy. He also had a lesion of his left alar crease we marked for biopsy and a large basal cell carcinoma of his right cheek, which was more obvious. This was marked for elliptical excision with gross normal margins of 2-3 mm in the relaxed skin tension lines of his face. I also drew a possible rhomboid flap that we would use if the wound became larger. He observed all these margins in the mirror, so he could understand the surgery and agree on the locations, and we proceeded. DESCRIPTION OF PROCEDURE: All four areas were infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion of the forehead measuring 6 mm and right cheek measuring 1.3 cm as I had drawn them and sent in for frozen section. The biopsies were taken of the left forehead and left nose using a 2-mm punch, and these wounds were closed with 6-0 Prolene. Meticulous hemostasis was achieved of those wounds using Bovie cautery. I closed the cheek wound first. Defects were created at each end of the wound to facilitate primary closure and because of this I considered a complex repair and the wound was closed in layers using 4-0 Monocryl, 5-0 Monocryl and 6-0 Prolene, with total measurement of 2.1 cm. The forehead wound was closed in layers using 5-0 Monocryl and 6-0 Prolene, with total measurement of 1.0 cm. Loupe magnification was used and the patient tolerated the procedure well. What ICD-10-CM codes are reported? A. C44.319, D04.39, D48.5, D22.39 B. C44.202, C44.309, D48.5, D49.2 C. C44.202, C44.40, D22.23, D22.39 D. C44.319, D22.39

D. C44.319, D22.39

# NEED TO FIX A 23-year-old woman delivers her second child by cesarean delivery. Her first child was delivered by cesarean (vertical incision) and the decision is made early in her pregnancy for a repeat cesarean. The patient started her antenatal (prenatal) care in Arizona and then moved to Wisconsin when her husband was transferred to a new job. She had two antenatal visits during the first trimester in Arizona and 10 more antenatal visits with her new provider in Wisconsin before the repeat cesarean delivery was performed. She delivered a healthy baby girl. She will follow up with her Wisconsin physician after discharge for postpartum care. What are the procedure and diagnosis codes for her Arizona physician and her Wisconsin physician including her antenatal care, delivery and postpartum care procedures? A. Arizona: 59425 – Z34.00; Wisconsin: 59510 – O82, Z37.0 B. Arizona: 2 E/M codes, one for each visit – Z34.81; Wisconsin: 59515– O34.212, Z3A.00, Z37.0, 59426 – Z34.81 C. Arizona: 2 E/M codes, one for each visit – Z34.00 (both visits); Wisconsin: 59426 – Z34.00: 59622 – O82, Z3A.00, Z37.0 D. Arizona: 2 E/M codes one for each visit – O34.211, Z34.00; Wisconsin: 59426 – O34.211; 59514 – O34.211, Z37.0

B. Arizona: 2 E/M codes, one for each visit – Z34.81; Wisconsin: 59515– O34.212, Z3A.00, Z37.0, 59426 – Z34.81