1.

A PATIENT IS ADMITTED TO THE HOSPITAL FOR REPAIR OF AN OPEN

FRACTURE, TYPE I, OF THE HEAD OF THE LEFT FEMUR. THE PATIENT HAS
BEEN PREVIOUSLY DIAGNOSED WITH SYMPTOMATIC HIV. APPLYING THE
CODING CONCEPT FROM ICD-10-CM GUIDELINES I.C.1.a.2.b, WHAT ICD-10-CM
CODE(S) IS/ARE REPORTED FOR THE ADMISSION?
A. B20
B. S72.052B
C. B20, S72.052B
D. S72.052B, B20

2. A 22-YEAR-OLD FEMALE IS ADMITTED TO ICU FOR ACUTE RENAL (KIDNEY) FAILURE DUE TO
SEPSIS (CASUAL ORGANISM UNKNOWN). APPLYING THE CODING CONCEPT FORM ICD-10-CM
GUIDELINE I.C.1.d.1.b WHAT ICD-10-CM CODES ARE REPORTED (IN THE CORRECT
SEQUENCING)?
A. A41.9, R65.20, N 17.9
B. N17.9, R65.20, A 41.9
C. R65.21, A41.9, N17.9
D. N17.9, R65.21, A41.01

3. A 32 year old female had a mastectomy for breast cancer. The mastectomy completely
removed the breast cancer with no further treatment. On a follow up visit to her
oncologist, it is determined the cancer has metastasized to the right lung. The patient is
now undergoing a lung resection for the lung cancer. What codes are reported?
A. C50.911, C78.01,
B. Z85.3, C78.01
C. C78.01, C50.911
D. C78.01, Z85.3

4. A PATIENT IS ADMITTED TO THE HOSPITAL WITH PNEUMONIA. TESTING

INDICATES THE PATIENT'S PNEUMONIA IS DUE TO STAPHYLOCOCCUS AUREUS
AND IS METHICILLIN RESISTANT (MRSA). APPLYING THE CODING CONCEPT
FROM ICD-10-CM GUIDELINES I.C.1.e.1.a, WHAT ICD-10-CM CODES ARE
REPORTED?
A. J18.9
B. J15.212
C. J15.212, A49.02
D. J18.9, A49.02

5. A 45 year old female with ovarian cancer visits her oncologist to receive an injection of
Procrit. The procrit has been prescribed to her for treatment of her anemia resulting from
antineoplastic chemotherapy treatment. What codes should be reported?
A. D64.81, C56.9, T45.1X5A
 B. D64.81, C56.9
C. C56.9, D64.81
D. T45.1X5A, D64.81, C56.9

6. Mr. Mcfarland visits his oncologist for prostate cancer. He is reporting more fatigue than
usual. Lab test determine the patient has anemia due to cancer. Applying the coding
concept from ICD-10-CM guideline I.C.2.c.1, What codes should be reported?
A. C61, D63.0
B. C61, D64.81
C. D63.0, C61
D. D64.81, C61

7. A mother brings her son into the doctor because he has been getting into trouble in
school for his behavior. He is not paying attention or following the instructions. He is
constantly losing his pencil and forgetting to bring in his homework. After evaluating the
child, the provider diagnoses him with attention deficit hyperactivity disorder (ADHD),
predominately inattentive type, and sends the patient for a consultation with a
psychiatrist to see if medication can help. Select the diagnosis code.
A. F90.0
B. F90.9
C. F90.8
D. F90.2

8. Referencing ICD-10-CM guidelines I.C.6.b.1.a, when should a code from category G89
be reported as a first listed code?
A. Whenever it is documented
B. When the pain control or pain management is the purpose of the encounter
C. Only within the first 72 hours of continuos pain
D. When the pain is chronic.

9. A patient with a Pancoast's tumor in the left lung arrives at the oncologist office for
chemotherapy. Applying the coding concept from ICD-10-CM guideline 1.C.2.e.2, what
ICD-10-CM codes should be reported? Note: Use the ICD-10-CM Alphabetic Index
insead of the Table of Neoplasms to locate the code for a Pancoast's tumor.
A. C34.12
B. Z51.11
C. C34.12, Z51.11
D.Z51.11, C34.12

10. Mr. Elliot visits the surgeon for evaluation for a wedge resection of left lung cancer. During the
admission, the patient pain in the chest due to the malignancy. Applying the coding concept
 from ICD-10-CM code(s) should be reported?
A. C34.92
B. C34.92, G89.3
C. G89.3, C34.92
D. G89.3

11. When using a code from category D63 it is also necessary to code what first?
A. The hematocrit level of the patient
B. A primary (first-listed) diagnosis
C. The chronic condition causing the anemia
D. The acute condition presented in the patient encounter

12. Mr. Timmins fell off a roof and suffered a spinal injury. As a result of the injury, he has
been suffering from chronic pain in his lower back for several years. Today, he presents
for insertion of a neurostimulator for pain control. Applying the coding concept form ICD
guidelines I.C.6.b.1.a and I.C.6.b.1.b.ii, what ICD codes should be reported for the pain?
(Do not code the external cause).
A. M54.9, G89.21
B. M54.5, G89.11
C. G89.21, M54.5
D. G89.29, M54.9

13. A patient presents with pigmentary glaucoma bilaterally, moderate stage on the right, mild
stage on the left. Reference ICD guideline I.C.7.a.3. What ICD code(s) are reported?
A. H40.1332
B. H40.1312, H40.1322
C. H40.1332, H40.1331
D. H40.1312, H40.1321

14. Mrs. Fryer visits her nephrologist for an erythropoietin infection for her anemia. She has
stage 3 chronic kidney disease, which is the cause of anemia. Applying the coding
concept from ICD guidelines I.A.13, what Codes should be reported for the EPO
injection?
A. D63.1
B.N18.3, D63.1
C. D63.1, N18.3
D. N18.3

15. A mother takes her child to the pediatrician because her right eye is red, itchy, with a mucus
discharge coming from the eye. The provider documents the child has pink eye. What ICD code
 is reported?
A. H10.011
B. H10.021
C. H10.013
D. H10.023

16. Name an example of when a problem caused by diabetes is NOT sequenced after the
code for diabetes. Refer to ICD guidelines I.C.4.a.5.a.
A. When a patient's insulin pump malfunctions
B. When the patient has type 2 diabetes
C. When the patient has type 1 diabetes
D. When the patient has end stage renal disease caused by diabetes

17. A patient is having phacoemulsification of an age-related nuclear cataract of the left eye. What
ICD code is reported?
A. H25.12
B. H26.032
C. H26.9
D. Q12.0

18. A 12 year old's diabetes mellitus is well controlled with oral antidiabetic medications. The
patient has no complications. Applying the coding concept from ICD guidelines I.C.4.a.1,
I.C.4.a.2, and I.C.4.a.3, what ICD codes is/are reported?
A. E11.9, Z79.84
B. E10.9
C. E13.9, Z79.84
D. E08.9, Z79.84

19. A patient presents with right ear pain and fever. The provider diagnoses acute otitis media.
What ICD code(s) are reported?
A. H92.01, R50.9
B. H66.90
C. H92.01
D. H66.91

20. A type 2 diabetic patient with diabetic retinopathy visits his ophthalmologist for blurred
vision. After performing a visual acuity test and a dilated eye exam, the provider states
the patient has macular edema. Applying the coding concept from ICD guideline I.C.4.a,
what ICD code is reported?
 A. E11.311
B. E11.3219
C. E08.311
D. E10.311

A patient sees her provider for spontaneous episodes of vertigo lasting 30 minutes each,
fluctuating hearing loss, and tinnitus. The provider performs a hearing test and confirms hearing
loss in the right ear. The provier documents the patient has Meniere's disease in the right ear.
What ICD code is reported?
A. R42, H91.91, H93.11
B. H81.01
C. H93.8X1
D. H81.01, H81.41, H91.21, H93.11

A patient with a four-year history of eating disorders is seen in the physicians office due to
significant weight loss over the past three months. She went from 82 pounds down to 53 pounds
due to restricting her food intake. She is diagnosed with anorexia nervosa. Select the diagnosis
codes.
A. F50.02
B. F50.02, R63.4
C. F50.01, R63.4
D. F50.01

A patient sees his family practitioner for a muted feeling in his ears. The provider determines there is
impacted cerumen in both ears. What ICD codes are reported?
A. H61.23
B. H61.21, H61.22
C. H61.23, H90.5
D. H61.21, H61.22, H90.5

A patient presents to her physician and tells him she drinks each night when she gets home
from work. She asks her physician to recommend an alcohol treatment center because her life
has become unmanageable and she wishes to quit drinking. The patient is diagnosed with
uncomplicated alcohol dependence. Select the diagnosis code.
A. F10.221
B. F10.20
C. F10.239
D. F10.288

Applying the coding concept form ICD guideline I.C.9.a.5, how do you code hypertensive
retinopathy?
A. First code the hypertension, then the retinopathy
B. First code the retinopathy, then the heart disease
C. First code the heart disease, then the retinopathy
D. Sequencing is based on the reason for the encounter

If an ST elevation myocardial infarction converts to a non-ST elevation myocardial infarction in the

course of thrombolytic therapy, how is it coded? (Reference guideline I.C.9.e.1)
A. Sequence STEMI first, then NSTEMI
B. Sequence NSTEMI first, then STEMI
C. Code only STEMI
D. Code only NSTEMI

Which of the following does NOT require documentation for a cause and effect
relationship to be coded? (Reference guidelines I.C.9.a.2 and I.C.9.a.3)
A. Cerebrovascular hemorrhage due to an operation
B. Hypertension and chronic kidney disease
C. Hypertension and encephalopathy
D. All require cause and effect to be documented
B. Hypertension and chronic kidney disease
Rationale: ICD-10-CM Official Coding Guidelines, Section 1.C.9.a.2 - Section I.C.9.a.3,
state that hypertension has a presumed cause-and-effect

What is an acute exacerbation of asthma or COPD? (Reference ICD guideline I.C.10.a.1)

A. Uncomplicated asthma or COPD
B. Worsening or decompensation of asthma or COPD
C. An infection superimposed on asthma or COPD
D. When a condition is severe enough to be admitted to a hospital

A 12-year-old child presents to the ED with an acute exacerbation of asthma. The patient is
wheezing and is having difficulty breathing. She is not responding to the therapy. The physician
documents as the final diagnosis asthma with status asthmaticus. What ICD code is reported?
A. J45.52
B. J45.901
C. J45.902
D. RO6.2, J45.901

A patient with COPD visits the physician with acute bronchitis. What ICD codes should be reported?
A. J20.9
B. J44.9
C. J44.9, J20.9
D. J20.9, J44.0

A 39-year-old patient underwent a left femoral hernia repair. The postoperative diagnosis was recurrent
left femoral hernia. What is the diagnosis code for this encounter?
A. K41.41
B. K41.91
C. K41.21
D. K40.91

A patient presents for a liver transplant. The provider documents the patient has Laennec's cirrhosis
associated with long term alcohol dependent use. What are the diagnosis codes for this encounter?
A. K74.60, F10.99
B. K70.30, F10.20
C. K76.89, F10.20
D. K70.0, F10.99

A patient presents with abdominal pain. The physician performs an abdominal ultrasound and discovers
the patient has gallstones and inflammation of the gallbladder. Select the diagnosis codes.
A. R10.9
B. K80.10, K80.20
C. K80.10
D. K80.70

NDICATION: Patient has a hypertrophic scar on the posterior side of the left leg, at the level of
the knee. This has begun to restrict his mobility. His physical therapy trial was unsuccessful.
PROCEDURE: After the proper induction of anesthesia, the subcutaneous tissue of the patient's
left leg beneath the scar was infiltrated with crystalloid solution containing epinephrine to
minimize blood loss. The scar was then excised down to viable dermis. Hemostasis was
obtained with epinephrine soaked pads. Skin was created by the surgery. The graft was
secured with skin staples, and then dressed with fine mesh guaze followed by medication-
soaked gauze. The donor site was dressed with mesh followed by Adaptic followed by a dry
dressing and an Ace wrap.
A. 15110-52, 15002
B. 15100, 11406
C. 15100, 15002
D. 15110, 15002

NDICATIONS: 15-yr-old boy was burned in a fire & assessed to have received burns to 75% of
his total body surface area. He was transferred to a burn center for definitive treatment. Once
stable, he was brought to the OR. PROCEDURE: Due to extent of the patients burns & lack of
sufficient donor sites, his full-thickness burns will be excised & covered with xenograft (skin
substitute graft), & a split-thickness skin biopsy will be harvested for preparation of autologous
grafts to be applied in the coming weeks, when available. After induction of anesthesia,
extensive debridement of the full-thickness burns was undertaken. Attention was first directed to
the patients face, neck, & scalp. A total of 500 sq cm in this area received full-thickness burns.
The eschar involving this area was excised down to viable tissue. Hemostasis was achieved
using electrocautery. Attention was then turned to the trunk. A total of 950 sq cm in this area
received full-thick burns. The eschar involving this area was excised down to viable tissue.
Hemostasis was achieved. Attention was then turned to the arms & legs. A total of 725 sq cm
received full-thick burns. The eschar involving this area was excised down to viable tissue.
Hemostasis was achieved. Attention was then turned to the hands & feet. A total of 300 sq cm
in this area received full-thick burns. The eschar involving this area was excised down to viable
tissue. All involved areas were then covered with xenograft. Finally a split thickness skin graft of
0.015 in, in depth was harvested using a dermatome from a separate donor site. A total of 85 sq
cm was recovered. What procedures codes would be reported service?
A. 15200, 15201 x 123, 15004, 15005, 15002, 15003
B. 15275, 15276 x 31, 15271, 15272 x 66, 15004, 15005 x 16, 15002, 15003 x 7
C. 15277, 15278 x 7, 15272, 15274 x16, 15004, 15005 x7, 15002, 15003 x 16, 15040
D. 15130, 15131 x 7, 15135, 15136 x 16, 15004, 15005 x 7, 15002, 15003 x 16

The physician is called in to perform repairs for a 17-year-old girl involved in a motor vehicle
accident. She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her right
cheek, a 4 cm laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm
laceration to her chest. The wound on her chin required a layered closer. All other wounds
required complex closure.
A. 13132, 13133 x 4, 13101, 12052
B. 13132, 13133 x 3, 13133-52, 13101, 13102, 12052
C. 13132, 13133 x 3, 13101, 13102, 12052
D. 13131, 13132, 13133 x 3, 13101, 13102, 12052

The left breast was prepped & draped in a sterile fashion. An incision from the 3 around to the 9
o'clock position on the areolar border on its inferior aspect was made in the skin & extended to
the subcutaneous tissue. The breast mass was excised by sharp dissection. The mass was
found to be approximately 1.5-2 cm in maximum dimension. Hemostasis was made adequate
using electrocautery & the Argon beam coagulator. After this was accomplished, the skin
margins were reapproximated w/running inverted 3-0 Vicryl subcuticular suture. Select
procedure & diagnosis codes.
A. 19120, N63
B. 19301, D49.3
C. 19125, N60.82
D. 19101, N64.51
A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions on his face are
destroyed and five actinic keratoses on his left arm are destroyed.
A. 17000, 17003
B. 17000, 17003 x 4, 17110
C. 17110
D. 17260 x 5, 17110 x 3

INDICATIONS: 55-yr-old female had a sizeable 1.5 cm basal cell carcinoma on the right upper
lip. She had a 2 cm defect. After excision, it was reconstructed in a first stage with a nasolabial
cheek flap. The margins were clear & she planned for the second stage. OPERATIVE
PROCEDURE: Under intravenous sedation, patient in supine position, the ace was prepped &
draped. Division performed to the bridge between the base of the flap of the upper lip. Unfurled
the base of the flap that was excised until it was soft & pliable. It is defatted & laid back onto the
cheek with interrupted 5-0 Monocryl & running 6-0 plain catgut. Similar procedure was
performed on the redundant portion of the flap & permanently set into the upper lip. Steri-strips
applied.
A. 15758-79
B. 15630-58
C. 15758-76
D. 15630-78

Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac
injection at an ambulatory surgery center. After sterile prep, the patient is placed prone position.
A needle is placed under fluoroscopic guidance into the SI joint and a mixture of 20 mg of
Celestone and Marcaine is injected for pain relief.
A. 27096, 77003-26
B. 20611
C. 20552
D. 27096

25-yr-old male has a ruptured distal biceps tendon at the proximal end of the radius. An incision
is made overlying the antecubital fossa. The biceps tendon was tagged using #1 Vicryl-suture.
The second incision made on the superior border of the ulna. The supinator was incised deep to
expose the radial tuberosity. Drill holes are made at the radial tuberosity in which sutures & the
distal biceps tendon are placed in the hole of the radial tuberosity. Two sutures are placed in the
biceps tendon in horizontal mattress type fashion pulled tight & secured. The distal biceps
tendon is reattached to the radius to restore elbow function. Closure was then accomplished
with sutures & staples. What is the correct code for this procedure?
A. 24342
B. 24340
C. 23430
D. 23440
Patient is seen in the hospital's outpatient surgical area witha diagnosis of a displaced
comminluted closed fracture of the lateral condyle, right elbow. An ORIF procedure was
performed, which included the following techniques: An incision was made in the area of the
lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was
easily exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees.
It was possible to manually reduce the quite easily, and the manipulation resulted in an almost
anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut
off below skin level The wound was closed with plain catgut subcutaneously and 5-0 nylon for
the skin. Dressings and a long arm cast were applied.
A. 24579-RT, 29065-51-RT, S42.451B
B. 24577-RT, S42.451A
C. 24579-RT, S42.451A
D. 24575-RT, S42.451B

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

A 35-year-old female patient with acute onset of severe pain since October. Her workup has
revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative findings
were consistent with two large fragments of free disk fragments in the foramen at C5-C6 on the
right side. After general anesthesia, the patient was placed on the operative table in the supine
position. All pressure ???????????????????????ed and a transverse skin incision was
fashioned under fluoroscopic guidance over the C5-C6 disc space. Dissection through the
platysma eventually allowed for exposure of the anterior entrance to the vertebral body of C5
and C6 and retractors were inserted to maintain adequate exposure. ?????????????????
allowed exposure. A complete discectomy was performed at C5-C6 by using endplate curets
pituitary rongeurs and Kerrison rongeurs. The posterior longitudinal ligament was resected and
beneath the posterior longitudinal ligament, two significant sized disc fragments were noted in
the foramen at C5-C6. These were removed using pituitary and Decker instruments. The
endplates were then decorticated so that they were parallel to each other and a midline keel
was performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody Kineflex-C device
was placed under fluoroscopic guidance. Satisfied with the positioning of the device, the
decision was made to close.
A. 63075
B.63081
C. 22856
D. 22554
A grade I, high velocity type 1 open right femur shaft fracture was incurred when a 15-yr-old
female pedestrian was hit by a car. She was taken to the operating room within four hours of her
injury for thorough irrigation & debridement, including excision of devitalized bone. The patient
was then re-prepped, re-draped, & repositioned, intramedullary rodding was then carried out
with proximal & distal locking screws. What are the correct codes for this diagnosis &
procedure?
A. 27506, 11044-51, S72.301B, V03.90XXA, Y93.01
B. 27506, 11012-51, S72.301B, V03.90XXA, Y93.01
C. 27507, 11012-51, S72.301A, V03.90XXA, Y93.01
D. 27507, 11044-51, S72.91XA, V03.90XXA, Y93.01

OPERATION: Dual chamber transvenous implantable pacing cardioverter-defibrilator system

implantation with leads.
INDICATIONS: A 67-year-old white gentleman has significant underlying ischemic
cardiomyopathy with EF of 25 percent, prior infarcts, remote history of syncope, and at a high
risk for malignant ventricular arrhythmias. He has had a recent T wave alternans test which was
clearly abnormal. He has had episodes of resting bradycardia, also noted. He meets Madit II
criteria for insertion of a transvenous implantable pacing cardioverter-defibrilator (ICD)
PROCEDURE: After informed consent had been obtained, the patient was brought to the
outpatient hospital lab in the fasting state. The left anterior chest was prepped and draped in a
sterile fashion. Intravenous sedation and local anesthetic were given. After local anesthetic were
given. After local anesthetic, a 5 cm incision was made at the left deltopectoral groove. With
blunt dissection and cautery, this was carried down through the prepectoralis fascia. The
cephalic vein was identified and ligated distally. Through the venotomy, a subclavian venogram
was performed to provide a roadmap. The atrial and ventricular leads were then advanced into
the vessel to the level of the right atrium under fluoroscopic guidance. The ventricular lead was
maneuvered to the right ventricular outflow tract, and then through the RV apex where it was
actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored
to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in
diaphragmatic capture. The atrial lead was maneuvered to the anterolateral right atrial wall
where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead
was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did
not result in diaphragmatice capture. A subcutaneous pocket was created with good hemostasis
achieved. The pocket was subsequently irrigated with solution of Bacitracin. The generator was
connected to the lead, and then placed in the pocket with no tension on the lead. The deep
fascial layer was closed with interrupted 2-0 Vicryl suture. The subcutaneous closure wa made
with running 4-0 Vicryl suture. Steri-strips were applied. Ventricular fibrillation was induced with
a T wave shock. This was successfully sensed and terminated with a 15 joule shock to sinus
rhythm. High voltage impedence was 39 ohms. Dry dressing was placed over the wound. The
patient returned to the floor in stable condition without apparent complications.
A 33200
B.33249, 76000-26
C. 33241, 33242, 33249
D. 33249
This 25-yr-old male presents with deviated nasal septum. After intubation, a left hemitransfixion
incision was made with elevation of the mucoperichondrium. Cartilage from the bony septum
was detached & the nasoseptum was realigned & removed in a piecemeal fashion from the
obstructed perpendicular plate of the ethmoid. Thereafter, 4-0 chronic was used to approximate
mucous membranes. A small amount of silver nitrate cautery was used to achieve hemostasis.
A dressing consisted of a fold of Telfa with a ventilating tube for nasal airway on each side
achieved good hemostasis, patient went to recovery in good condition. What is the correct code
for this procedure?
A. 30520
B. 30420
C. 30620
D. 30450

The patient comes in today to have an arteriovenous fistula created to facilitate dialysis. The surgeon
performs an upper arm basilic vein transposition based on the patient's previous arterial duplex scan
A. 36825
B. 36830
C. 36818
D. 36819

A 67-yr-old female has CAD, atrial fibrillation, claudication & several chronic conditions that
have been marginally controlled with medication. The doctor decided that the benefits outweigh
the risks for her having a single vessel cardiopulmonary bypass using an arterial graft. Her
medication Heparin has been stopped for several days. She was admitted in the hospital a day
before the surgery. In the operating room, general anesthesia was administered. After the chest
is opened the patient begins to hemorrhage & drops in blood pressure. The decision is made to
stop the procedure & close the chest. How should this service be coded?
A. Service is not coded due to not completing the procedure
B. 33533-52
C. 33533-74
D. 33533-53

56-year-old with lung cancer developed an effusion that is suspicious for malignancy. Needle
aspiration is performed to obtain a sample of the fluid for pathological examination. A needle is
inserted between the ribs and into the pleural space, and the fluid is withdrawn. The specimen is
sent to pathology.
A. 32554
B. 32555
C. 32551
D. 32400
Mr. Y presents to outpatient surgery for placement of a dual chamber pacemaker after multiple
attempts to manage his bradycardia medically. Atrial & ventricular leads were placed under
fluoroscopic guidance via the subclavian vein. Testing confirmed appropriate placement &
conduction. The left chest was then infiltrated with epinephrine & a pocket was opened for
placement of the generator. The leads were attached to the generator & the generator was
programmed. Appropriate pacing was confirmed. The skin pocket was closed in layers &
dressing placed. Select the appropriate CPT codes.
A. 33208
B. 33213, 33217
C. 33235, 33208
D. 33214

A 67-year-old male patient is referred for a flex sigmoidoscopy exam to remove polyps. The physician
found three polyps in the rectosigmoid junction. They were removed by biopsy forceps. The path report
indicated the polyps were benign.
A. 45333
B. 45315
C. 45384
D. 4534644

A 62-yr-old female with three-vessel disease & supraventricular tachycardia, which has been
refractory to other management. She previously had pacemaker placement & stenting of the
coronary artery stenosis, which has failed to solve the problem. She will undergo CABG with
autologous saphenous vein & a modified MAZE procedure to treat the tachycardia. The risks &
benefits have been discussed & the patient wishes to proceed. She is brought to the cardiac OR
& placed supine on the OR table. She is prepped & draped & adequate endotracheal
anesthesia is assured. A median stemotomy incision is made & cardiopulmonary bypass is
initiated. The endoscope is used to harvest an adequate length of saphenous vein from her left
leg. This is uneventful & bleeding is easily controlled. The vein graft is prepared & cut to the
appropriate lengths for anastomosis. Three bypasses are performed, on to the LAD, one to the
circumflex & another distally on the circumflex. A modified maze procedure was then performed
& the patient was weaned from bypass. Once the heart was once beating on its own again, we
attempted to induce an arrhythmia & this could not be done. At this point, the sternum was
closed with wires & the skin reapproximated with staples. The patient tolerated the procedure
without difficulty & was taken to the PACU. Choose the procedure code(s) for this service.
A. 33512, 33254-51, 33508
B. 33535, 33254-51, 33508
C. 33512, 33257, 33508
D. 33512, 33257-51, 33508-51

PROCEDURE: Endoscopic retrograde cholangiopancreatogram with stent placement and antral

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

PREOPERATIVE DIAGNOSIS: History of prior colon polyps. POSTOPERATIVE DIAGNOSIS:

Colon polyps diverticulosis, hemorrhoids. PROCEDURE: A rectal exam was performed &
revealed small external hemorrhoids. The video colonoscope was passed without difficulty from
anus to cecum. The colon was well prepped. The instrument was slowly withdrawn with good
views obtained throughout. There was a 3 mm polyp in the proximal ascending colon. This
polyp was removed with hot biopsy forceps & retrieved. There was a 4 mm rectal polyp located
10 cm from the anus in the proximal rectum. The polyp was removed by hot biopsy forceps.
There was also moderate diverticulosis extending from the hepatic flexure to the distal sigmoid
colon. Code the CPT procedure(s).
A. 45384
B. 45385
C. 45388
D. 45384 x 2, 45378-59

A patient with rectal bleeding underwent a proctosigmoidoscopy that showed she had two
internal hemorrhoids. The anus was prepped and draped. A field block with marcaine 0.25%
was then placed. There was an internal prolapsing hemorrhoid in the anterior midline. This was
rubber band ligated by applying two bands. In the posterior midline, there was another internal
hemorrhoid that was banded in the same manner.
A. 0249T
B. 46221
C. 46945
D. 46930

A patient with esophageal cancer is brought to the OR for subtotal esophagectomy. A

thoracotomy incision is made & the esophagus is identified. The tumor is carefully dissected
free of the surrounding structures. No invasion of the aorta or IVC is identified. The cervical
esophagus is controlled with pursestring sutures & then transected above the sternal notch. The
esophagus is then dissected free of the stomach & the entire specimen is removed from the
chest cavity & sent to pathology. The stomach is then pulled into the chest cavity &
anastomosed to the remaining cervical esophageal stump. The anastomosis is tested for
patency & no leaks are found. Hemostasis is assured. The chest is examined for any signs of
additional disease but is grossly free of cancer. The check is closed in layers & a chest tube is
place through a separated stab incision. The patient tolerated the procedure well & was taken to
the PACU in stable condition.
A. 43101
B. 43117
C. 43107
D. 43112

Patient with RUQ pain & nausea suspected of having a stone or other obstruction in the biliary
tract is brought in for ERCP under radiologic guidance. PROCEDURE: The patient was brought
to the outpatient endoscopy suite & placed supine on the table. The mouth & throat were
anesthetized. Under radiologic guidance, the scope was inserted thru the oropharynx,
esophagus, stomach, & into the small intestine. The ampulla of Vater was cannulated & filled
w/contrast. It was clear that there was an obstruction in the common bile duct. The endoscope
was advanced retrograde to the point of the obstruction, which was found to be a stone that was
removed with a stone basket. The rest of the biliary tract was visualized & no other obstructions
or anomalies were found. The scope was removed without difficulty. The patient tolerated the
procedure well.
A. 47554, 74363-26
B. 43264, 74328-26
C. 43265, 74328-26
D. 43275, 74329-26

A neonatal male had an elective circumcision before being discharged home from the newborn
nursery. The physician uses a ring block for the local anesthetic and the foreskin is placed over
the glans. A clamp is selected for the size of the glans and a constricting circular ring is placed
over the foreskin to compress and devascularize the foreskin. The devascularized foreskin is
excised with a scalpel and the clamp is left in place.
A. 54150
B. 54160
C. 54161
D. 54150-52

A 30-year-old disable Medicare patient is scheduled for surgery due to the discovery of what
looks like an ovarian mass on the right ovary. On entering the abdomen, the surgeon finds an
enlarged ovarian cyst on the right, but the ovary is otherwise normal. The left ovary is necrotic
looking. The decision is made, based on the patient's age to remove the cyst from the right
ovary and to remove the entire left ovary and fallopian tube.
A. 58920, 58940-51
B. 58925, 58720-59
C. 58925-50, 58720-50-59
D. 58920-50, 58700-50-59

A patient comes in for surgery today to address complications from his previous partial
enterectomy performed 5 mos. ago. Upon reopening the patients previous incision the surgeon
resected the ileum & a portion of the colon. An ileocolostomy was performed to complete the
procedure with no complications. The appropriate CPT code is?
A. 44144
B. 44160
C. 44150
D. 44205

The patient is a 25-year-old G2P1 female at 13 weeks with a molar pregnancy. She has had
irregular bleeding for one week. Ultrasound was performed yesterday and the physician
confirms a 16 week size uterus with hydatidiform molar pregnancy. She is admitted today for an
evacuation and curettage.
A. 59870, O01.9
B. 59812, O02.89
C. 57505, O02.0
D. 59160, O01.9

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

55-year-old man with complaints of an elevated PSA of 6.5 presents to the outpatient surgical
facility for prostate biopsies. The patient is placed in the lateral position. Some calcifications
were found in the right lobe, with no obvious hypoechogenic abnormality. The base of the
prostate was infiltrated and random ?????? performed under ultrasonic guidance by the
physician. His interpretation was reported in the record.
A. 10022
B. 55706
C. 55700, 76942-26
D. 55705, 76942-26
A laparoscopic assisted total hysterectomy is planned for a patient who has severe intramural
fibroids. After inserting the laparoscope, extensive adhesions are noted to the extent that the
ligaments supporting the uterus cannot be visualized. The physician decides to convert the
procedure to an open abdominal hysterectomy in which the uterus & cervix are removed. What
CPT code(s) should be reported?
A. 58262, 58570-53
B. 58150
C. 58260, 58550-22
D. 58570

An injection is performed to anesthetize a nerve located between two ribs to block chest wall pain.
A. 64415
B. 64421
C. 64413
D. 64420

Patient has consented for further testing to determine the extent of her cervical dysplasia. A
cervical cone biopsy of endocervical tissue was cut using a laser. It was tagged with a single
stitch. Dilation & curettage was performed. Small amount of tissue was obtained & sent to
pathology. Which procedure code(s) should be used?
A. 57520, 58120
B. 57461
C. 57520
D. 57500, 57505

A 65-year-old patient presented with actropion of the right eyelid. Repair with tarsal wedge
excision is performed of correction. Attention was then directed to the left eye. The patient also
had an ectropion of the left lower lid, which was repaired by suture.
A. 67916-50
B. 67916-E4, 67914-E2
C. 67914-50
D. 67141

58-yr-old female has lumbar degenerative spondylolisthesis with severe stenosis & instability.
The spinous process of L4 & L5 are decompressed bilaterally by performing a laminectomies,
right-sided forminotomies & then left-sided facetectomy completely decompressing the nerve
roots as well as the dura. How is this procedure reported?
A. 63047, 63048
B. 63030-50, 63035-50
C. 63017
D. 63047-50, 63048-50
OPERATION: Replacement of shunt valve with medium pressure ventriculo-peritoneal shunt
assembly with in-line 0-25 Aesculap Shunt Assistant Implant ICP Monitor. PROCEDURE: After
obtaining general anesthesia, patient prepped & draped. Right parietal scalp incision was
reopened & shunt catheter identified. The shunt reservoir was delivered from the wound & the
distal catheter freed from it. Abdominal incision reopened, shunt passer was used to bring the
distal catheter from the head wound to the abdominal wound. The old ventricular catheter was
removed. A new ventricular-catheter was inserted into the tract of the old catheter & fed. Good
flow seen. It was then attached to the shunt reservoir that was then seated after attaching a 0-
25 shunt assistant valve to it. The distal catheter was then fed into the peritoneal cavity.
Subcutaneous tissues were closed in multi-layer fashion & skin with staples. Patient tolerated
the procedure well & taken to PICU in stable condition. Code this procedure.
A. 62223, 62225-51
B. 62258, 62160
C. 62230, 62225-51
D. 62256, 62225-51

A 42-year-old patient was in the hospital three days ago in which a lumbar puncture was
performed to find the etiology of the patient's headaches. Today his is in the neurology clinic
because after having the lumbar puncture the headaches have increased in intensity over the
past three days. The neurologist examines the patient and finds a CSF leak from the lumbar
puncture. A blood patch is performed by epidural injection to repair the leak.
A. 62272
B. 62273
C. 62270, 62273
D. 62270, 62282

A 63-year-old woman presented to the eye clinic as with symptoms of flashing lights and
floaters in the right eye for two days. The opthalmologist dilates her eyes and checking her with
an indirect opthalmoscope, revealing peripheral retinal break. The physician explains to the
patient that there is high likelihood of retinal detachment. The patient agrees to have the
procedure done. The physician lasers the retinal tear and tells the patient to come back in 24
hours for follow-up.
A. 67210
B. 67145
C. 67220
D. 67141

Physician is performing an intracapsular cataract extraction. The anterior chamber of the eye is
entered performing an anterior capsulotomy using forceps. The lens nucleus was
hydrodissected & loosened. Using phacoemulsification unit, the lens nucleus was divided &
emulsified. Cortical & capsular fragments were removed. The anterior chamber & capsule bag
inflated. Using lens inserter an intraocular lens prosthesis, Cystalens, was inserted & rotated to
the horizontal position. Topical solution applied, conjunctiva repositioned over the wound with
wet field cautery & patch applied. Which CPT code(s) should be used?
A. 66984, 66985
B. 66983, 66985
C. 66985
D. 66983

The patient is a 35-year-old male who presents to the emergency department (ED) after several
hours of low back pain, nausea and chills. The ED physician takes a detailed history and
performs a comprehensive examination. A urinalysis lab and CT of the abdomen is ordered.
The results of the CT show two small kidney stones. The ED physician discusses the results
with the patient and tells him the stones are small and will pass on their own. Medical decision
making (MDM) of moderate complexity is made with the patient being discharged, with a
prescription of pain medication, and a diagnosis of kidney stones.
A. 99285, N20/0, M54.5, R11.2, R68.83
B. 99284, M54.5, R11.2, R68.83, N20.0
C. 99283, N20.0
D. 99284, N20.0

Physician performs a medical review & documentation on an 83-yr-old patient who has been in
the hospital for the last two days with confusion. Problem focused exam where she is alert &
oriented x 3 today. Low medical decision making by ordering an echocardiogram & to continue
IV fluids. Patient is not safe to return home. What CPT code should be reported for this visit?
A. 99231
B. 99221
C. 99224
D. 99234

A 63-year-old man wants a second opinion for his sleep apnea. He decides to go to another
physician. The physician documents a detailed history. He has had it for the past five months.
Sleep is disrupted by ???????????? and getting worse due to anxiety and snoring. Current
medication that he is on now is not helping him. Physician also performs a comprehensive exam
and moderate MDM.
A. 99204
B. 99203
C. 99243
D. 99214

A plastic surgeon is called to the ED at the request of the ED physician to evaluate a patient that
arrived w/multiple facial fractures that may need surgery. Patient was in an auto accident & an
opinion is needed for reconstructive surgery. The plastic surgeon arrived at the ED, obtains
detailed history & performs a detailed exam. The plastic surgeon performs a moderate medical
decision making, in deciding that the patient needs major surgery to repair the injuries. The
plastic surgeon schedules the patient for surgery the next day & documents her full note
w/findings in the ED chart. The E/M service reported by the plastic surgeon is:
A. 99284-57
B. 99243-32
C. 99243-57
D. 99284-32

A 65-year-old established patient is coming in for a pre-op visit. He is getting a liver

transplant due to cirrhosis. The physician performs an expanded problem-focused
history, detailed exam, and moderate MDM. Patient agrees with his physician's
recommendations and the transplantation will take place as scheduled. After the
evaluation, the patient expresses a number of concerns and questions for the
prospective liver transplant. Physician spends an additional 45 minutes, excluding the
time spent performing the E/M service, in answering questions and addressing his
concerns regarding the surgery and discussing possible outcomes.
A. 99213, 99403
B. 99214, 99358
C. 99213, 99356
D. 99214, 99354
D. 99214, 99354

At the request of the mother's obstetrician, a neonatologist is called to attend the birth of an
infant being delivered at 29 weeks gestation. During delivery, the neonate was pale &
bradycardic needing resuscitation. Neonatologist performs the suctioning & bag ventilation on
this 1000 gram neonate was performed with 100 percent oxygen. Brachycardia worsened,
requiring endotracheal intubation & insertion of an umbilical line for fluid resuscitation. Later this
critically ill neonate was moved from the delivery room & admitted to the NICU with severe
respiratory distress & continued hypotension. What are the appropriate procedure codes
reported by the neonatologist?
A. 99465, 99468
B. 99465, 99464, 99468-25, 31500-59, 36510-59
C. 99468, 99464
D. 99465, 99468-25, 31500-59, 36510-59

A 56-year-old receives general anesthesia for an open pleura biopsy. An anesthesiologist

medically directs two other cases, and medically directs a CRNA on this case. What are the
anesthesia codes and modifiers reported for the anesthesiologist and CRNA.
A. 00540-AA, 00540-QZ
B. 00540-QK, 00540-QX
C. 00541-AA, 00540-QZ
D. 00541-QK, 00541-QX
Patient is admitted in labor for delivery. She received a labor neuraxial epidural for a vaginal
delivery. The baby goes into fetal distress & a cesarean section is performed. Following delivery
the patient starts to hemorrhage. The physician decides, with family approval, to perform a
hysterectomy. Code the anesthesia services.
A. 01967, 00840
B. 01962
C. 01968
D. 01967, 01969

A patient is given general anesthesia by the anesthesiologist for a carpal tunnel nerve release.
After the surgery the anesthesiologist is called to perform an axillary block for postoperative pain
management on the same patient.
A. 01829, 64417-59
B. 01840, 64417-59
C. 01840, 64417-59
D. 01830, 64417-59

Angiograms reveal three artery blockages. The patient has COPD, which is a severe systemic disease. The
patient undergoes a CABG x 3 venous grafts on cardiopulmonary bypass & cell saver. Code the
anesthesia service.
A. 00562-P3
B. 00560-P4
C. 00567-P3
D. 00566-P4

A healthy 45-year-old is having a needle thyroid biopsy. The anesthesiologist begins to prepare
the patient for surgery at 009:00 am. The surgery begins at 09:16 am and ends at 09:45 am.
The anesthesiologist turns over the patient's care to the recovery room nurse at 10:00 am.
What is the appropriate anesthesia code and what is his time?
A. 00320, One hour
B. 00320, 45 minutes
C. 00322, 45 minutes
D. 00322, One hour

A healthy 11-month-old patient with bilateral cleft lip & palate undergoes surgery. The surgeon
performs a bilateral cleft lip repair, single stage. Code the anesthesia service.
A. 00170-P1, 99100
B. 00102-P1
C. 00102-P1, 99100
D. 00170-P1
A 32-year-old pregnant female has gestational diabetes at 34 weeks gestation. Her
doctor is concerned about decreased fetal movement. The patient is sent to the
radiology department of the hospital for a biophysical profile (BPP). The radiologist
performs and interprets four elements scored by the ultrasound and is was reassuring.
8/8. A non-stress test will be performed by the obstetrician at the patient's next office
visit. What is the correct code for the fetal profile.
A. 76818
B. 76815
C. 76819
D. 76820

A 78-yr-old with lower back pain & leg pain is scheduled for a MRI of lumbar spine w/out
contrast. Following the MRI, the patient is diagnosed with spinal stenosis of the lumbar region.
What are the procedure & diagnosis codes?
A. 72020-26, M54.5, M79.606, M48.06
B. 72149-26, M48.06
C. 72148-26, M48.06
D. 72158-26, M48.07, M54.5, M79.606

The physician performs a selective catheterization of the right renal artery and renal angiography. The
puncture site was the right femoral artery.
A. 36251-RT, 36200-51, 75625-26
B. 36245-RT
C. 36215-RT, 36200-51, 75625-26
D. 36251-RT

22-yr-old driver lost control of her car & crashed into a light pole on the highway. She arrived at
the hospital, had CT scans w/out contrast of the brain & chest. She had X-rays of the AP & PA
views of her left ribs & AP & PA views of her right ribs with a posterioanterior view of the chest.
The CT scan of the brain showed a fracture of the skull base with no hemorrhage of the brain.
The CT of the lung showed no puncture of the lungs. The X-ray showed fractures in the R & L
2nd, 3rd, & 5th ribs. What CPT & ICD-10-CM codes should be reported?
A. 70450-26, 71250-26, 71101-26, S02.10XA, S22.43XA, V47.32XA, Y92.411
B. 70450-26, 71260-26, 71110-26, S02.01XA, S22.49XB, V47.0XXA, Y92.411
C. 70450-26, 71250-26, 71111-26, 71010-26, S01.10XA, S22.49XA, V47.32XA, Y92.411
D. 70450-26, 71250-26, 71111-26, S02.10XA, S22.43XA, V47.52XA, Y92.411

A patient with colon cancer receives five sessions of radiation treatments. During the course of
treatments, the physician views the port films, reviews the treatment parameters, and assesses
the patient's response to the treatment. The patient receives two more treatment sessions when
ending the course of treatment. Code the radiation treatment management.
A 77427
B. 77431 X 7
C. 77427 x 2
D. 77427, 77431

Physician orders an ultrasound on patient 25 wks pregnant with twins to access fetal heart rate & fetal
position. Select the code(s).
A. 76805, 76810
B. 76811, 76812
C. 76816 x 2
D. 76815

A surgical specimen was removed from the proximal jejunum during a resection for adenocarcinoma
and was submitted to surgical pathology for gross and microscopic examination.
A. 88307
B. 88309
C. 88304
D. 88305

Patient presents to the ED w/crushing chest pain radiating down the left arm & up under
the chin. There are elevated S-T segments on EKG. The cardiologist sees & admits the
patient to CCU. He orders three serial CPK enzymes levels w/instructions that the tests
are also to be done with isoenzymes if the initial tests are elevated for that date of
service. The CPK enzyme levels were elevated, the lab codes would be:
A. 82550, 82552, 82550-76 x 2, 82552-76 x 2
B. 82550, 82552, 82552-91 x 2
C. 82550, 82550-91 x 2, 82552, 82552-91 x 2
D. 82550 x 3, 82554 x 3

The physician performs the following tests on her automated equipment: HDL, total serum cholesterol,
triglycerides, and a quantitative glucose.
A. 83718, 82465, 84478, 82947
B. 83721, 82465, 82951
C. 80061, 82947
D. 80061. 82950

22-yr-old has had no prenatal care. Fundal height indicates a term fetus & by dates it is
determined she is 38 weeks pregnant. Few hours prior to admission to Labor & Delivery her
membranes ruptured spontaneously. She does not have a fever, but the physician performs a
rapid antigen test for group B strep. An enzyme immunoassay method is performed. Physician
obtains a lower vaginal swab, then observes that it visually shows the patient is negative for the
antigen. If clinical risk factors appear, intrapartum antibiotics will be initiated. Which lab test is
reported?
A. 87802
B. 87653
C. 86317
D. 87450

A patient with a manic depressive disorder is being treated with lithium. The physician orders a
therapeutic drug test to measure the level of lithium.
A. 80178
B. 80375
C. 80302
D. 80299

Which of the following coding combinations is an example of unbundling?

A. 80048, 80061
B. 80076, 80300
C. 80061, 83718, 84478
D. 82310, 82355, 82374

A patient presents to her oncologist's office for scheduled chemotherapy. The patient is severely
dehydrated. The physician decides to schedule the chemotherapy for another day and orders
hydration therapy to be performed today instead of the chemotherapy. The therapy is ordered
and administered for one hour and 10 minutes.
A. 96413-53, 96360
B. 96360
C. 96360, 96361
D. 96413, 96361

The patient presents with burning urination & frequency. Physician performs a UA dipstick,
which shows elevated WBC. He orders a urine culture with identification for each isolate to
determine which antibiotic to give to the patient for the infection. What are the appropriate lab
codes?
A. 81000, 81007
B. 81002, 87088
C. 81001, 87086
D. 87086, 87088
Left heart catheterization retrograde from the femoral artery with injection procedures for
selective coronary angiography and selective left ventriculography, including imaging
supervision and interpretation with report, are performed. The cardiologist performed all of the
services at the hospital
A. 93458-26
B. 93459-26
C. 93452-26
D. 93460-26

69-yr-old female has been having chest tightness. Cardiologist orders percutaneous
transluminal coronary angioplasty (PCTA) of the right coronary artery & left anterior descending
coronary artery. The procedure revealed atherosclerosis in the native vessel of the left anterior
descending coronary artery & right coronary artery. Stents were inserted in both arteries to keep
the arteries opened. Patient was placed under moderate conscious sedation during the
procedure for a total of 30 minutes. What CPT codes should be reported for this procedure?
A. 92928-LT, 92929-RT
B. 92928-LD, 92929-RC, 99144
C. 92928-LD, 92928-RC
D. 92928-LD, 92928-RC, 99144

A patient is coming in to have osteopathic manipulative treatment (OMT) performed on two root lesions
in his cervical region and three root lesions in the throracic region. Which code is reported by the
physician for the OMT.
A. 98927
B. 98940
C. 98940
D. 98925

A two-month-old returns for a well checkup & several shots (Rota, DTaP-HepB-IPV,
Pneumococcal PCV13) with her pediatrician. He offers suggestions to the mom, completes the
exam, & counsels her on the vaccinations. How should this be coded?
A. 99391-25, 90460, 90461 x 2, 90680, 90723, 90670
B. 99381-25, 90471, 90472 x 2, 90474, 90680, 90700, 90648, 90670
C. 99381-25, 90471, 90472 x 3, 90680, 90723, 90670
D. 99391-25, 90460 x 3, 90461 x 4, 90680, 90723, 90670

The patient is admitted to the hospital for a radio 16 channel EEG to determine the focus of her cerebral
seizures. The test also consists of video recording and interpretation with nurse attendance. The EEG is
performed in 12 hours.
A. 95950-26
B. 95953-26-52
C. 95951-26
D. 95956-26-52

Mary, who has food allergies, came to her physician for her weekly allergen immune
therapy that consists of two injections prepared & provided by the physician. The correct
code is?
A. 95125
B. 95117
C. 95144
D. 95146

What is orchitis?
A. Inner ear imbalance
B. Lacrimal infection
C. Inflammation of testis
D. Inflammation of an ilioinguinel hernia

While playing softball a 12-yr-old boy sustains a blowout fracture. What is the anatomical location?
A. Orbit
B. Clavicle
C. Patella
D. Femur

A pediatrician examines an adolescent that has a thoracic curvature of the spine which is called?
A. Sclerosis
B. Osteochondrosis
C. Kyphosis
D. Neurofibromatosis

The patient is a 16-year-old female with pelvic pain. Her ultrasound is normal. A laparoscopy found
several small cysts in the area of the fallopian tubes. These cysts are called:
A. Follicle cysts
B. Myomas
C. Paratubal cysts
D. Accessory ovary cysts
Which of the following patients might be documented as having meconium staining?
A. Woman with renal failure
B. Teenage boy with sickle cell anemia
C. Newborn with pneumonia
D. Man with alcoholic cirrhosis of liver

The root metr/o means?

A. Menstruation
B. Breast
C. Mammary gland
D. Uterus

Which of the following anatomical sites have septums?

A. Nose, heart
B. Kidney, lung
C. Sternum, coccyx
D. Orbit, ovary

According to the CPT Appendix L, when performing a selective vascular catheterization, which
vessels would you pass through to place the catheter into the right middle cerebral artery?
A. Innominate, right common carotid, right external carotid
B. Innominate, right subclavian & axillary
C. Left common carotid, left internal carotid
D. Innominate, the right common, & internal carotid

Lordosis is a disorder of which anatomical site?

A. Spine
B. Hand
C. Male genitalia
D. Nasal sinus

42-yr-old male was previously treated with external fixation of an ankle trimalleolar fracture. He is now
presenting with a nonunion fracture of the trimalleolar. What is the ICD-10-CM code to report?
A. S82.853D
B. S82.853S
C. S82.853K
D. S82.53XA
A 35-year-old female returns to her primary care provider for follow up of an upper respiratory
infection diagnosed the previous week. Her condition has not improved and her cough has
increased. She has a long history of smoking and currently smokes one pack a day. She uses a
bronchodilator for her chronic bronchitis which is caused by her smoking history. The physician
changes her antibiotics to treat both her chronic and acute bronchitis.
A. J44.9, Z72.0
B. J20.9, J41.0, Z72.0
C. J20.9, Z72.0
D. J41.0, J20.9, Z72.0

Mr. Jones is here today to receive an intercostal nerve block to mitigate the debilitating pain of his
malignancy. His treatment is for the cancer that has metastasized to his right lung. Select ICD-10-CM's?
A. G89.3, C78.01
B. C34.91, G89.3
C. G89.3, C34.91
D. C78.01, G89.3

Following the MUGA scan, the physician documents that the patient has developed congestive
heart failure as an adverse affect of the Trastuzumab she received as a treatment for her breast
cancer. Thetrastuzumab antineoplastic antibiotic therapy is being discontinued while the heart
failure management is attempted pharmaceutically.
A. I50.9, T45. 1X4A, Z85.3
B. I50.9, T45. 1X1A, C50.919
C. I50.9, T45. 1X5A, C50.919
D. ?????????????????????

55-yr-old female presents to the office with ongoing history of diabetes which has been
controlled with insulin. During the exam the physician notes that gangrene has set in due to the
diabetes on her left great tow. Patient is recommended to see a general surgeon for treatment
of the gangrene on her left great toe. Select the diagnosis codes to report.
A. E10.610,Z79.4
B. E11.52, Z79.4
C. E10.52, Z79.2
D. E11.610, Z79.2

32-yr-old delivered a baby girl one week ago via cesarean section. She is in the obstetrician's
office with complaint of her cesarean would bleeding. The wound is cleaned & a small
hematoma removed. The edges are pulled with steri-strips, & a clean dressing is applied. What
ICD-10-CM code reported?
A. L76.02
B. O90.1
C. O90.2
D. O82

The patient has a history of symptomatic HIV and has been treated for an HIV related illness.
A. Z21
B. B20
C. Z26.6
D. B75

The mother, at 38-weeks gestation, advances to severe pre-eclampsia during labor. Fetal heart
rate decelerations during contractions are not improved with the administration of oxygen, so
low traverse cesarean section is performed in the hospital. There is evidence of intrauterine
growth retardation. The male infant weighs 1587 gm and has Apgars of 3 and 5. Select the ICD-
10-CM codes for the newborn's chart.
A. Z37.0, P00.0, P03.811, P05.9
B. Z38.01, P00.0, P03.810, P05.9
C. Z38.01, P00.0, P03.811, P05.9
D. Z37.0, P00.0, P03.810, P05.9

70-yr-old had fallen breaking her jaw. She has had difficulty eating after having her jaw wired.
Her doctor ordered a stationary parenteral nutrition infusion pump for her TPN. A seven day
supply of a parenteral home mix nutrition supply kit was also given. What HCPCS Level II codes
are reported?
A. B9000, B4220 x 7
B. B9004, B4222
C. B9006, B4222 x 7
D. B9006, B4172

A 67-year-old newly diagnosed with DM type 1 is being seen in the office today for dietetic
training with the office's dietitian. The training was for an hour and covered special diet
instructions, blood glucose monitoring, and instruction on how to administer daily insulin
injections. Which HCPCS Level II codes(s) will be reported for this session.
A. G0108 x 2
B. G0109 x 2
C. A9275, A4211
D. S9214

A patient has an insulin pump of 100 units. The pump is filled. Which code reports the supply?
A. J1817
B. J1815 x 20
C. J1817 x 2
D. J1835

Which of the following Z codes categories can only be reported as a first listed diagnosis code?
A. Z67
B. Z69
C. Z58
D. Z03

When coding for a patient who has had a primary malignancy of the thyroid cartilage that was
completely excised a year ago, which of the following statements is TRUE?
A. When the cancer is surgically removed with no further treatment provided & there is no
evidence of any existing primary malignancy, code Z85.80.
B. When further treatment is provided & there is evidence of an existing metastasis, code first
Z85.80 & then C32.9.
C. Any mention of extension, invasion, or metastasis to another site is coded as a D49.1,
Z85.80.
D. When the cancer is surgically removed but the patient is receiving chemotherapy treatment
report Z85.80

What is the full CPT code description for 61535.

A. Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for
long-term seizure monitoring; for removal of epidural or subdural electrode array, without
excision of cerebral tissue (separate procedure)
B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array,
without excision of cerebral tissue (separate procedure)
C. For removal of epidural of subdural electrode array, without exicision of cerebral tissue
(separate procedure)
D. For excision of epileptogenic gocus without electrocorticography during surgery; for removal
of epidural or subdural electrod array, without excision of cerebra tissue (separate procedure)

In order to use the critical care codes, which of the following statements is TRUE?
A. Critical care services can be provided in an internist's office.
B. Critical care services provided for more than 15 minutes but less than 30 minutes should be
billed with 99291 & modifier 52.
C. Time spent reviewing laboratory test results or discussing the critically ill patient's care with
other medical staff in the unit or at the nursing station on the floor cannot be included in the
determination of critical care time.
D. Physician can provide services to another patient during the same time providing critical care
services to a critically ill patient.
Which of the following place of service codes is reported for fracture care performed by an orthopedic
physician in the ED?
A. 11
B. 20
C. 22
D. 23

Which of the following statements regarding advanced beneficiary notices (ABN) is TRUE:
A. ABN must specify only the CPT code that Medicare is expected to deny.
B. Generic ABN which states that a Medicare denial of payment is possible, or the internist is
unaware whether Medicare will deny payment or not is acceptable.
C. An ABN must be completed before delivery of items or services are provided.
D. An ABN must be obtained from a patient even in a medical emergency when the services to
be provided are not covered.

Which of the following is an example of fraud?

A. Reporting the code for ultrasound guidance when used to perform a liver biopsy
B. Reporting a biopsy and excision performed on the same skin lesion during the same
encounter
C. Failing to append modifier 26 on an X-ray that is performed and interpreted in the physicians
office
D. Reporting a lab panel with an additional lab test that is not included in the lab panel

Which of the following services are covered by Medicare Part B?

A. Inpatient chemotherapy
B. Minor surgery performed in a physician's office
C. Routine dental care
D. Assisted living facility