Question 1

Mohs surgery will be performed on a 56 year-old who has basal cell carcinoma on the neck. The
gross tumor was completely excised. Tissue was divided into two tissue blocks which were
mapped and color coded at their margins; frozen sectioning was performed. A full thickness graft
was used to harvest skin from the patient’s left axilla for an area of 5 sq cm. The appropriate
CPT® codes are:

A. 26115, 15260
B. 11600, 15240
C. 17311, 15240
D. 17313, 15260

Question 2

A patient has a 4.3 cm x 2 cm lesion on the left thigh that was excised. Due to the size and
location of the lesion, the decision was made to harvest a full thickness skin graft from his left
lower leg. An excision of 5 cm x 5 cm full thickness graft was obtained and grafted onto the
defect and sewn. The pathology finding confirmed that the lesion was basal cell carcinoma. The
CPT® code(s) to report is (are):

A. 14021
B. 11406, 15100-51
C. 11606, 15220-51, 15221
D. 11606, 15150-51

Question 3

A 10 year-old who fell off her bike sustained a 7 cm laceration to her brow and an 8.5 cm
laceration to her upper arm. Her parents requested the suturing was to be done by a plastic
surgeon. The left arm was irrigated and devitalized skin was sharply debrided. The subcutaneous
fat, which had been avulsed, was sharply debrided, as well. Fascial defects in the arm were
reapproximated with 2-0 Vicryl sutures. A large good flap was tacked down with Vicryl sutures.
A large portion of this wound was unable to be covered. A wet-to-dry dressing was then placed
over the wound and wrapped. The facial laceration was then closed in multiple layers with 5-0
PDS and 5-0 fast-absorbing gut suture with extensive undermining. The eyebrow was
reapproximated. The wound was closed in layers to achieve a good reapproximation. The CPT®
codes for this service are:

A. 12053, 12034-59
B. 12014, 12004-59
C. 13121, 12053-59, 13122
D. 13132, 13121-59, 13122

Question 4

The patient has a torn medial meniscus of the left knee. An arthroscope was placed through the
anterolateral portal for the diagnostic procedure. The patellofemoral joint showed some grade 2
chondromalacia on the patella side of the joint only, and this was debrided with the 4.0-mm
shaver. The medial compartment was also entered and a complex posterior horn tear of the
medial meniscus was noted. It was probed to define its borders. A meniscectomy was carried out
back to a stable rim. CPT® codes for this service are:

A. 29882-LT
B. 29880-LT, 29877-59-LT
C. 29870-LT, 29879-59-LT
D. 29881-LT

Question 5

A 63-year-old man sustained a gunshot wound through the right maxillary sinus that penetrated
through the right neck. CT scan revealed no hard evidence of arterial injury but a bullet was
directly in line with the internal jugular vein. He was sent to the operating room for neck
exploration to rule out vascular injury and injury to the aero digestive tract. A
sternocleidomastoid incision was performed and carried down through the platysma muscle.
There was no penetration of the internal jugular vein, but a foreign body was identified resting
on the internal jugular vein at approximately the level of the angle of the mandible and removed.
The parotid gland was noted to have a blast injury near the tail. This was not surgically repaired
or resected. Once all bleeding was controlled, a 10 French round drain was placed in the wound.
The wound was copiously irrigated. The platysma muscle was closed and the skin was closed
with subcuticular closure. Select the appropriate CPT® code for this procedure:

A. 20525
B. 20100
C. 35201
D. 21899

Question 6

A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture
while on vacation. The patient was put under general anesthesia and the elbow was reduced and
was stable. The medial elbow was held in the appropriate position and was reduced in acceptable
position and elevated to treat non-surgically. A long arm splint was applied. The patient is
referred to an orthopedist when she returns to her home state in a few days. What procedure
codes are reported?

A. 24575-54-RT, 24615-54-51-RT
B. 24576-54-RT, 24620-54-51-RT
C. 24577-54-RT, 24600-54-51-RT
D. 24565-54-RT, 24605-54-51-RT

Question 7

A 77-year-old patient who was found to have a huge aneurysm underwent a coronary artery
bypass graft. A median sternotomy was made and the left internal mammary artery was
harvested from the left chest wall. The saphenous vein was harvested from the left leg and
bypassed distally as it ran in the left ventricular muscle. Next, a second saphenous vein segment
was placed to the diagonal vessel and then the left internal mammary artery was placed to the
mid LAD. The LAD was bypassed in the mid aspect of the LAD and good flow was measured in
the graft. What CPT® codes describe this
procedure?

A. 33533, 33518
B. 33510, 33517
C. 33534, 33518
D. 33511, 33517

Question 8

The patient is an 83-year-old female with a new onset of atrial fibrillation that has developed into
a tachy-brady syndrome. Her cardiologist decided to insert a pacemaker. The left chest was
incised and a subcutaneous pocket was formed above the fascia. The left subclavian vein was
accessed with an 18 gauge needle times two. The atrial and ventricular leads were then placed
through the sheaths, positioned and secured to the pectoral fascia. The pacemaker leads were
then connected to the pacemaker coiled and placed in the previously made pocket. What CPT®
code describes this
procedure?

A. 33213
B. 33217
C. 33208
D. 33206
Question 9

A 45-year-old’s blood pressure was progressively trending downward, and it was determined
that an emergent central venous access was needed for fluid resuscitation. A non-tunneled
catheter was used to access the subclavian vein and secured into place to infuse medication. Due
to the patient's low blood pressure and anticipated need for vasopressor agents, a radial arterial
line was also desired. The left radial artery pulse was easily palpable, and the skin was punctured
by a needle and the Angiocatheter was placed in the left wrist. What are the codes for these
procedures?

A. 36555, 36625-51
B. 36556, 36620-51
C. 36558, 36640-51
D. 36569, 36620-59

Question 10

A 55 year-old patient underwent a repair of an initial left inguinal hernia. An incision was made
at the groin and a hernia sac was readily identified and cleared from the surrounding tissue and
inverted into the preperitoneal space and plugged. Mesh was tacked to the surrounding muscle
layers then placed over the entire floor. The correct CPT® code(s) is
(are):

A. 49500-LT
B. 49505-LT
C. 49520-LT
D. 49525-LT

Question 11

A 79-year-old male has acute cholecystitis and an abnormal liver function test. He has elected to
go in for surgery. A laparoscope was placed through an epigastric incision with the insertion of
two lateral 5 mm ports. The gallbladder was elevated and the cystic duct was located and
dissected out. In the process of transecting the duct the gallbladder tore and several gallstones
were released and these were removed with a gallstone retriever along with the removal of the
gallbladder. The cystic duct stump was tied off and the common bile duct was incised and a large
stone was seen and removed. The common bile duct is closed connected to a drainage tube
placed outside of the abdomen wall into a bowel bag. What are the codes for this procedure?

A. 47420, 47562-51
B. 47480, 47564-51
C. 47420, 47564-51
D. 47480, 47562-51

Question 12

An elderly gentleman presented with a high-grade small bowel obstruction. A midline abdominal
incision was done encountering fairly dense adhesions. Using a combination of sharp dissection
and electrocautery, a full adhesiolysis was done on several of adhesions up to the anterior
abdominal wall, which appeared to be the culprit for this patient’s small bowel obstruction. In
dissecting out this mat of adhesions, an enterotomy was made performing a limited small bowel
resection, dividing the intervening mesentery and a double-stapled anastomosis. What CPT®
coding is
reported?

A. 44120, 44005-51
B. 44125
C. 44120
D. 44130, 44005-51

Question 13

A 55 year-old female presents with right hydronephrosis. A 23 French cystoscope is introduced

into the urethra and passed into the bladder. The bladder was carefully inspected and no tumors
or stones were visualized. The first effluxed urine from the bladder was sent for urine cytology.
Then a 6 French access catheter was passed into the right ureteral orifice requiring a 0.35 guide
wire to help cannulate the right ureteral orifice because of the angulation. There was some
stiffness in the intramural portion of the ureter, and then the catheter popped through into a more
dilated ureter. Contrast was injected and there were no filling defects, fixed tumors, or stones
noted. There was mild hydroureteral nephrosis against the bladder. The renal pelvis was
barbotaged with saline and the renal pelvis urine was drained and sent to pathology for urine
cytology. After the retrograde pyelogram was performed the access catheter was removed and
there was brisk efflux of the contrast and drained very well. The bladder was then drained and
the patient was awakened and transferred in stable condition to the recovery room. What CPT®
code should be reported?

A. 52005
B. 52327
C. 52010
D. 52281

Question 14
A 65-year-old male presents with a medium size bladder tumor on the posterior wall of the
bladder behind the trigone and has an elevated PSA. Six needle biopsies of the right and left lobe
of the prostate were performed. Each biopsy core was performed under transrectal ultrasound
guidance and sent for pathologic review. Then using the cutting mode of the Bovie through the
loop a resection was performed on 2.2 cm bladder tumor. The procedure is performed in an ASC.
Which CPT® codes should be used for the physician’s services?

A. 55700, 52234-51,76942-26
B. 55706, 52310-51
C. 55706, 52315-51
D. 55700, 52235-51, 76942-26

Question 15

A pregnant patient delivers twins at 30-weeks gestation. The first baby is delivered vaginally, but
during this delivery, the second baby has turned into the transverse position during labor. The
decision is made to perform a cesarean to deliver the second baby. Both babies are healthy.
There were two placentae and two amniotic sacs. The physician performing the deliveries also
performed the prenatal and postpartum care. Code the procedure and diagnosis
codes.

A. 59400, 59514, O32.2XX2, Z3A.30, Z38.31

B. 59510, 59409-51, O32.2XX2, O30.043, Z3A.30, Z37.2
C. 59510-22, O32.2XX1, Z33.1, Z38.31
D. 59510, 59409-51, O32.2XX2, O30.043, Z33.1, Z37.2

Question 16

A 30 year-old male has displacement of the lumbar intervertebral disc. Under fluoroscopic
guidance, the affected nerve in the facet joints of the lumbar region was destroyed by a
neurolytic agent in the right segmental medial branches of L3, L4, and L5. Select the appropriate
procedure codes.

A. 64493, 64494, 64495

B. 64635, 64636 x 2
C. 64483, 64484-51 x 2
D. 64633, 64634 x 2

Question 17
A patient has spinal stenosis and disc displacement in the L3-L4 and L4-L5 and underwent a
removal of the posterior arch of a vertebra to provide additional space for the nerves and widen
the spinal canal. The back was prepped and an incision was made down to the deep fascia and
the spinous processes of L5, L4 and L3 were identified performing the laminectomy of L4 up to
L3 and a resection of the flavum ligament. There was resection of the facet and decompression
was carried out laterally to the level of the medial border of the pedicle. Foraminotomies of L3-4
and L4-5 were performed with the Kerrison punch and there was plenty of room for the nerve
roots to exit in these regions with no further stenosis above or below this area. What procedure
code(s) are reported?

A. 63047, 63048
B. 63042, 63044
C. 63017
D. 63005

Question 18

Parents of a three year-old male who has been having chronic serous otitis media in the right ear
have consented to surgery. Patient is placed under general anesthesia and the physician makes an
incision in the tympanic membrane. Fluid is suctioned out from the middle ear and a ventilating
tube is placed in the ear to provide a drainage route to help reduce middle ear infections. What
CPT® and ICD-10-CM codes are reported?

A. 69420-RT, 69433-51-RT, H65.21

B. 69421-RT, 69436-50, H65.91
C. 69421-RT, 69436-51-RT, H65.21
D. 69420-RT, 69433-RT, H65.04

Question 19

A 33 year-old white male was admitted to the hospital on 12/17/XX from the ER, following a
motor vehicle accident, to have a splenectomy done. Patient is being discharged from the
hospital on 12/20/XX. During his hospitalization he was experiencing pain and shortness of
breath, but with an antibiotic regimen of Levaquin, he improved. Physician performed final
examination and reviewed chest X-ray that revealed possible infiltrates and a CT of the abdomen
that ruled out any abscess. He was given a prescription of Zosyn. Patient told to follow up care
with PCP or return back to the hospital for any pain or bleeding. Physician spent 20 minutes.
Select the appropriate CPT® code for 12/20 visit:

A. 99283
B. 99221
C. 99231
D. 99238
Question 20

The physician was notified to go to the hospital floor for medical management of a 56-year-old
patient admitted one day ago by an associate of the same specialty for aspiration pneumonia and
COPD. A medically appropriate history was documented indicating no chest pain at present, but
still SOB and some swelling in his lower extremities. An exam with the lungs revealed course
crackles in both bases, right worse than left. The physician ordered continuation of drug
management of intravenous antibiotic treatment and respiratory support. Also ordered a chest X-
ray, CBC, and BMP. Patient is slightly improving and a pulmonary consultation has been
requested. Final Diagnosis: Aspiration pneumonia and COPD with exacerbation. What CPT®
code should be
reported?

A. 99236
B. 99223
C. 99231
D. 99232

Question 21

An established patient presents to the office with a recurrence of bursitis in both shoulders to
have a scheduled injection. Examination is only limited to the shoulder in which range of motion
is good and full, but he has tenderness in the subdeltoid bursa. Both shoulders were injected in
the deltoid bursa with 120mg Depo-Medrol. Select the appropriate CPT® coding for this visit:

A. 99212-25, 20610-50
B. 20610-50
C. 99212-25, 20611-50
D. 20611-50

Question 22

A 75 year-old established patient is brought in by his son to have a physical screening done to be
enrolled in a group home. No new complaints. The patient has an established diagnosis of
Cerebral Palsy and Type 2 diabetes and is currently on his meds. A comprehensive history and
examination is performed along with a moderate MDM. Blood work was ordered. PPD was done
and flu vaccine given. Patient already had a vision exam. No abnormal historical facts or finding
are noted. What CPT® code should be
reported?

A. 99397
B. 99387
C. 99212
D. 99213

Question 23

A 2-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER
physician performs endotracheal intubation, blood gas, and a central venous catheter placement.
The ER physician documents a total time of 30 minutes on this critical infant in which the
physician already subtracted the time for the other billable services.
Select the E/M service and procedures to report for the ER physician?

A. 99291-25, 36555, 31500

B. 99291-25, 36556, 31500, 82803
C. 99285-25, 36556, 31500, 82803
D. 99475-25, 36556

Question 24

A 10 month-old child is taken to the operating room for removal of a laryngeal mass. What is
(are) the appropriate anesthesia
code(s)?

A. 00320
B. 00326
C. 00320, 99100
D. 00326, 99100

Question 25

A patient is having knee replacement surgery. The surgeon requests that in addition to the
general anesthesia for the procedure that the anesthesiologist also insert a lumbar epidural for
continuous infusion for postoperative pain management. The anesthesiologist performs
postoperative management for two postoperative days. Select the appropriate procedure codes
for the
anesthesiologist.

A. 01400-AA, 62326
B. 01402-AA, 62327, 01996 x 2
C. 01402-AA, 62326, 01996 x 2
D. 01400-AA, 62327

Question 26

PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease.

POSTOPERATIVE DIAGNOSIS: Multivessel coronary artery disease.

NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the
LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal. The
patient is placed on heart and lung bypass during the procedure. Anesthesia time: 6:00 PM to
12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and
anesthesia time?

A. 00567, 6 hours
B. 00566, 6 hours
C. 00567, 5 hours and 30 minutes
D. 00566, 5 hours and 30 minutes

Question 27

A physician manages radiation therapy treatments for a patient with small cell lung cancer, who
is receiving 18 MeV external beam applications with one port and two blocks. Which CPT®
code is reported for the radiation therapy services?

A. 77402
B. 77412
C. 77385
D. 77401

Question 28

A complete B-scan ultrasound without duplex Doppler of the kidney is performed on a patient
following a kidney transplant. The service is performed in the physician’s office. Which CPT®
coding is reported for this
procedure?

A. 76776
B. 76775-26
C. 76775
D. 76856-26

Question 29

A 6 year-old patient who has been admitted requires a tunneled PICC insertion. The physician
uses ultrasound guidance to perform the insertion. Select the codes for the physician’s services.

A. 36569, 76937-26
B. 36568, 77001-26
C. 36572
D. 36573

Question 30

A 32 year-old patient with a history of illegal drug use arrives at the ER in a coma. The treating
physician orders a presumptive multiple class drug using thin layer chromatography to screen
and detect the presence of drugs. The report comes back positive for opiates. The physician
orders a drug confirmatory test. The correct CPT® codes for the laboratory tests
are:

A. 80307, 80362
B. 80306, 80362
C. 80305, 80361
D. 80307, 80361

Question 31

A surgical removal of two skin lesions, one being a pigmented nodule measuring 2 cm x 2.5 cm
on the left upper back and the second lesion an inclusion cyst measuring 2.5 cm x 3 cm in the
middle of the back. Both specimens were placed in individual containers to surgical pathology
for gross and microscopic examination. Select the appropriate
coding.

A. 88304 x 2
B. 88305 x 2
C. 88304, 88305
D. 88304 x 2, 88329
Question 32

An established patient comes in complaining of nausea and vomiting and states she has not
gotten her menstrual period. A complete CBC and automated differential WBC was ordered.
Also Hepatitis B antigen, Rubella, RPR, Antibody Screen, Blood Typing for Rh and ABO along
with a urine pregnancy test. The correct CPT® code(s) for the laboratory service(s) is
(are):

A. 80055
B. 80081
C. 80055, 81025
D. 85025, 87340, 86762, 86592, 86850, 86900, 86901

Question 33

A 65-year-old stumbled and tripped in her home landing on her side, injuring her left hip. The
ER physician gets the X-ray back showing there is anterior dislocation of the left hip. Consent
has been given for sedation for the reduction of the hip. The ER physician administered
Ketamine (IV) and a nurse was there to assist in the monitoring of the patient for duration of 30
minutes. Abduction was performed on the hip and reduction was successful by the ER physician.
Upon recovery from sedation, the patient states she feels better. The CPT® codes the ER
physician reports
are:

A. 27252-54, 99155, 99157

B. 27266-54
C. 27250-54, 99152, 99153
D. 27257-54

Question 34

A 65 year-old male went into atrial fibrillation in the ER. Anti-arrhythmic drugs fail to convert
the heart back to normal sinus rhythm. A single 150 joule synchronized biphasic shock using AP
paddles did restore him to sinus rhythm in the 80s. He tolerated it well. He will be observed for a
couple hours and discharged home later
today.

A. 92971
B. 92960
C. 92953
D. 92950
Question 35

A patient with advanced gastric cancer receives palliative chemotherapy using Adriamycin for 1
hour and 35 minutes. The patient first receives IV infusion of 1000 cc of D-5-W for hydration for
40 minutes before the chemo. Select the correct CPT® medicine
codes.

A. 96401, 96360, 96361

B. 96413, 96415, 96361
C. 96422, 96423, 96361
D. 96409, 96411, 96361

Question 36

A 45 year-old construction worker requires a physical performance evaluation to determine if he

can tolerate the demands of returning to work after a wrist and knee injury. The physical
therapist evaluated all records he had on the patient. He had the patient participate in a functional
capacity evaluation for a two hour period in one day. The data during the test was collected and
prepared in a written report. The CPT® code for this service
is:

A. 97750 x 8
B. 97755 x 8
C. 97760 x 8
D. 97799

Question 37

Sebaceous glands are a part of which anatomical

system?

A. Circulatory
B. Endocrine
C. Genitourinary
D. Integumentary

Question 38

Complete this series: Incus, stapes, and

__________.
A. Radius
B. Isthmus
C. Meatus
D. Malleus

Question 39

The patient is reported to have hives in his epigastric region. Where are the
hives?

A. Between ribs and buttocks

B. Between inguinal region and umbilicus
C. Between neck and axilla
D. Between umbilicus and sternum

Question 40

Which of the following is a renal

calculus?

A. Pyelectasia
B. Hydroureter
C. Nephrolithiasis
D. Pyonephrosis

Question 41

The patient has a significant low visual impairment (category 1) due to astigmatism in the right
eye. It is corrected with glasses. The left eye has normal vision. Code the patient’s condition
based on this
information.

A. H54.7
B. H52.201, H54.511A
C. H52.221
D. H52.211, H52.201

Question 42

The site of the patient’s cellulitis is within the fold of redundant skin in his apron of fat. It covers
approximately 20 cm of skin. A swab from the site was cultured and found to be methicillin
resistant staphylococcus
aureus.

A. B95.62, L03.311
B. A49.02, L03.311
C. L03.311, B95.62
D. L03.311, A49.02

Question 43

Four years post hepatic transplant, the patient is diagnosed with combined hepatocellular
carcinoma and cholangiocarcinoma of the liver. Code the patient’s
condition.

A. T86.49, C80.2, C22.0, C22.1

B. C22.0, C22.1, T86.49, C80.2
C. C80.2, C22.0, C22.1
D. C22.0, C80.2

Question 44

The patient just turned 50 and is here today for a screening colonoscopy. During the procedure,
two polyps are found and removed from the ascending colon with a snare technique. How is this
reported?

A. Z12.11, D12.2
B. D12.2
C. Z12.11
D. D12.2, Z12.11

Question 45

A 27 year-old man with a 25-year history of type 1 diabetes is admitted to the ICU with diabetic
ketoacidosis brought on by his infection by the H1N1 influenza virus with a URI. Which codes
best report how his consulting endocrinologist reported his
condition?

A. E13.10, J09.X2
B. J10.1, E10.10
C. E10.10, J10.1
D. J09.X2, E13.10
Question 46

Bilateral removable inserts are formed directly to a patient’s feet for use in athletic shoes. This is
to alleviate the patient’s back pain associated with collapsed arches. What is the HCPCS Level II
code that reports the orthotic
device?

A. L3050
B. L3070
C. L3030 x 2
D. L3001 x 2

Question 47

Which of the following HCPCS Level II codes is used to report 2.5 cm of collagen matrix nerve
wrap?

A. C9359
B. C9362 x 5
C. C9361 x 5
D. C9355

Question 48

What value is the OIG Workplan to a physician

practice?

A. It provides information on coverage rules for Medicare.

B. It reports on areas of billing noncompliance targeted for review.
C. It is an annual report on the financial health of the Medicare program.
D. It sets up the rules for risk adjustment for the upcoming year.

Question 49

Guidelines from which of the following code sets are included as part of the code set
requirements under
HIPAA?

A. CPT® Category Code II Codes

B. ICD-10-CM
C. HCPCS Level II
D. ADA Dental Codes

Question 50

If an AMI is documented as nontransmural or subendocardial, but the site is provided, how is it

reported, according to ICD-10-CM guidelines?

A. As unspecified
B. As a subendocardial AMI
C. As STEMI
D. As NSTEMI