CPT INTEGUMENTARY

1. CPT code for excision of a 0.3 cm benign lesion on each ear.

2. Cpt code for a patient with basal cell carcinoma on the outside of his nose
measuring 0.3 cm with margin, has the lesion excised. The following day the
pathology report is received showing in complete margin. A re-excision is
done two days later.
3. CPT code for complex repair of trunk, 12cm.
4. CPT code for cryosurgical destruction of 14 actinic keratoses.
5. CPT code for right modified radical mastectomy including axillary lymph
nodes without any muscles.
6. Fine needle aspiration biopsy including fluoroscopic guidance 4 lesions.
7. The patient has an ingrown toenail. The physician peformed excision of
ingrown toenail. Which is the correct CPT code for the services provided by
the physician?
8. Patient is genetically at risk for breast cancer. She undergoes a bilateral
modified radical mastectomy, while still in the OR the patient undergoes
bilateral implant insertion immediately after surgery.

1. James suffered a severe crushing injury to his left upper leg. Two days after surgery, Dr.
Barnes completed a dressing change under general anesthesia. How would you report
this service?
a) 16020-LT
b) 15852, 01232, J2060
c) 01232-P6
d) 15852-LT

2. Dr. Jess removed a 4.5 cm (excised diameter) cystic lesion from Amy’s forehead. The
ulcerated lesion was anesthetized with 20 mg of 1% Lidocaine and then elliptically
excised. The wound was closed with a layered suture technique and a sterile dressing
applied. The wound closure, according to Dr. Jess’s documentation, was 5.3 cm. How
would you report this procedure?
a) 11446, 12053-51
b) 11646, 12013-51
c) 11446, J2001 x 2, 12013-59
d) 11313, 12053-59

3. Martha has a non-healing wound on the tip of her nose. After an evaluation by Dr.
Martino, a dermatologist, Martha is scheduled for a procedure the following week. Dr.
Martino documented an autologous split thickness skin graft to the tip of Martha’s nose.
A simple debridement of granulated tissues is completed prior to the placement. Using a
dermatome, a split thickness skin graft was harvested from the left thigh. The graft is
placed onto the nose defect and secured with sutures. The surface area of wound was 75
sq.cm. The donor site is examined, which confirms good hemostasis. How would you
report this procedure?
a) 99213-25, 15050
 b) 15050, 15004, 15005-59
c) 15273, 11042-59
d) 15120

4. A patient had a chest wall tumor excised. The procedure involved the ribs with plastic
reconstruction, and mediastinal lymphadenectomy. How would you report this
procedure?
a) 19285, 32503-59
b) 21603
c) 32503, 19285-59, 21632-59
d) 32440, 19281-51

5. Dr. Alexis completed Mohs surgery on Ralph’s left arm. She reported routine stains on all
slides, mapping, and color coding of specimens. The procedure was accomplished in
three stages with a total of seven blocks in the second stage. How would you report Dr.
Alexis’ services?
a) 17313, 17314-58, 17315-59, 88314-59
b) 17311, 17312 x 7
c) 17313, 17314 x 2, 17315 x 2
d) 17311, 88302, 17314 x 3, 17312 x 7

6. Tina fell from a step ladder while clearing drain gutters at her home. She suffered
contusions and multiple lacerations. At the emergency room she received sutures for
lacerations to her arm, hand, and foot. The doctor completed the following repairs:
superficial repair to the arm of 12.8 cm, a single-layered closure of 7.9 cm that required
extensive cleaning and removal of glass from the hand, and a simple repair to the foot of
9.6 cm How would you report the wound repairs?
a) 12034, 12036, 12046, 12007
b) 12006, 12034-59
c) 12044, 12006-59
d) 12005, 12004 x 2

7. James had a malignant lesion removed from his right arm (excised diameter 4.6 cm).
During the same visit the dermatologist noticed a new growth on James’ left arm. Dr.
Terry took an incisional biopsy of the new lesion and sent it in for pathology. The biopsy
site required a simple closure. How would Dr. Terry report the biopsy procedure?
a) The biopsy is included in the primary procedure and not reported
b) 11106-59
c) 11406, 11106-59
d) 11106, 12001, 11406-51

8. 46-year-old female had a previous biopsy that indicated positive margins anteriorly on
the right side of her neck. A 0.5 cm margin was drawn out and a 15-blade scalpel was
used for full excision of an 8cm malignant lesion. Light undermining of all margins was
performed along with layered closure. The specimen was sent for permanent
histopathologic examination. What are the code(s) for this procedure?
a) 11426
b) B. 11626
 c) C. 11626, 12044-51
d) D. 11426, 13132, 13133

9. 30 year old female is having debridement performed on an infected ulcer with eschar on
the right foot. Using sharp dissection, the ulcer and eschar infection was debrided all the
way to down to the bone of the foot. The bone had to be minimally trimmed because of a
sharp point at the end of the metatarsal. After debriding the area, there was minimal
bleeding because of very poor circulation of the foot. It seems that the toes next to the
ulcer may have some involvement and cultures were taken. The area was dressed with
sterile saline and dressings and then wrapped. What CPT code should be reported?

a) 11000 B. 11011 C. 11044 D. 15004

10. 64 year old female who has multiple sclerosis fell from her walker and landed on a glass
table. She lacerated her forehead, cheek and chin and the total length of these
lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each
extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician
repaired the lacerations as follows: The forehead, cheek, and chin had debridement and
cleaning of glass debris with the lacerations being closed with 6-0 Prolene sutures. The
arm and leg were repaired by layered closure 6-0 Vicryl subcutaneous sutures and
prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select
the appropriate procedure codes for this visit.
a) 12014, 12034-51, 12002-51, 11042-51
b) 12053, 12034-51, 12002-51
c) 12014, 12034-51, 11042-51
d) 12053, 12034-51

11. 53-year-old male for removal of 2 lesions located on his nose and lower lip. Lesions
were identified and marked. Utilizing a 3-mm punch, a biopsy was taken of the left
supratip nasal area. The lower lip lesion of 4mm in size was shaved to the level of the
superficial dermis. What are the codes for these procedures?
A. 11102, 11103
B. 11104, 11310-59
C. 17000, 17003
D. 11440, 11310-51

12. 76-year-old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be

performed on the eyelids. A lower incision line was marked at approximately 5 mm
above the lid margin along the crease. Then using a pinch test with forceps the amount
of skin to be resected was determined and marked. An elliptical incision was performed
on the left eyelid and the skin was excised. In a similar fashion the same procedure was
performed on the right eye. The wounds were closed with sutures. The correct CPT
codes are?
A. 15822, 15823-51
B. 15823-50
C. 15822-50
D. 15820-LT, 15820-RT
13. Patient has basal cell carcinoma on his upper back. A map was prepared to correspond
to the area of skin where the excisions of the tumor will be performed using Mohs
 micrographic surgery technique. There were three tissue blocks that were prepared for
cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue
blocks which were also cut and stained for microscopic examination. The entire base
and margins of the excised pieces of tissue were examined by the surgeon. No tumor
was identified after the final stage of the microscopically controlled surgery. What
procedure codes should be reported?
a. 17313, 17314 x 2
b. 17313, 17315
c. 17260, 17313, 17314
d. 17313,17314, 17315

14. 45 year old male is in outpatient surgery to excise a basal cell carcinoma of the right
nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an
excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the
subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for
hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold
and was advanced into the primary defect. Which CPT code(s) should be used?

A. 14060
B. 11642, 14060
C. 11642, 15115
D. 15574

15. 24 year old patient had an abscess by her vulva which burst. She has developed a soft
tissue infection caused by gas gangrene. The area was debrided of necrotic infected
tissue. All of the pus was removed and irrigation was performed with a liter of saline
until clear and clean. The infected area was completely drained and the wound was
packed gently with sterile saline moistened gauze and pads were placed on top of this.
The correct CPT code is:

A. 56405
B. 10061
C. 11004
D. 11042

16. Indication: 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. 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
harvested from the patient’s thigh in a split thickness fashion and was used to cover the
90 sq cm defect created by the surgery. The graft was secured with skin staples and then
dressed with fine mesh gauze 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

17. 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 closure.
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

18. 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. Code for
the procedures.

A. 17000, 17003 B. 17000, 17003*4, 17110

C. 17110 D. 17280 x 5, 17000, 17003

19. The left breast was prepped and 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 and 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.
Frozen section revealed clear margins. Hemostasis was made adequate using
electrocautery and the Argon beam coagulator. After this was accomplished, the skin
margins were reapproximated with running inverted 3-0 Vicryl subcuticular suture.
Select the procedure.

A. 19120 B. 19301
C. 19125 D. 19101

20. This 37-year-old paraplegic has developed a sacral decubitus ulcer. He is brought to the
OR today for debridement of the pressure ulcer with a split-thickness skin graft to cover
the defect. The patient was placed prone on the operative table after induction of
adequate endotracheal anesthesia. The sacral area was prepped and draped sterilely,
and the ulcer is inspected. The area is debrided extensively to healthy tissue. Involved
bone, including part of the coccyx, was also removed. Once the area was clear of necrotic
tissue, the site was prepared for a skin graft. A split-thickness skin graft was harvested
from the thigh with a dermatome. Total graft size was 25 sq. cm. The graft was sutured
in place using 6-0 Vicryl. The harvest site was closed primarily with skin staples.
Dressings were applied. Needle counts were correct x 2. The patient tolerated the
procedure well. Code the procedure(s).

A. 15002, 15100-51 B. 15937, 15100-51

C. 15937 D. 15937, 15100-51, 15002

21. The patient is a 32-year-old female who was discovered to have breast cancer on the
right side. She was treated with mastectomy followed by chemotherapy and radiation
therapy. She now elects to proceed with reconstruction by TRAM flap. Code for the
reconstruction.

A. 19364 B. 19361
C. 19316 D. 19367

22. A 55-year-old male presents in the office with an ingrown toenail on the right and left
foot. The procedure was discussed in detail and the patient elected to have it performed.
The right foot was prepped and draped in sterile fashion. The right great toe was
 anesthetized with 50/50 solution of 2 percent lidocaine and .05 percent Marcaine. A
mini-tourniquet was placed around the toe for hemostasis. The lateral border was
incised and excised in total. Phenol was then applied, the toe was then flushed.
Tourniquet was released and dressing applied. At this time the patient elected to only
have one performed and will return in two weeks for the left foot. Code the procedure.

A. 11765 B. 11750
C. 11762 D. 11740

23. Pre-Procedure Diagnosis: Basal cell carcinoma, left chin. Procedure: Wide local excision
of 3.0 cm with 0.3 cm margin basal cell carcinoma of the left chin with a 4 cm closure.
Procedure: The patient’s left chin was examined. The site of intended excision was
marked out. The site was then prepped. The patient was then prepped and draped in the
usual fashion. A 15 blade scalpel was then used to make an incision in the previously
marked site. It was carried down to the subcuticular fat. The lesion was then sharply
dissected off underlying tissue bed using a 15-blade scalpel. It was tagged for pathologic
orientation. The hyfrecator was used for hemostasis. The wound edges were then
undermined. The wound was then closed by advancing the tissue surrounding the lesion
and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the
skin. The skin closure was in a running subcuticular fashion. Steri-Strips were then
applied. What are the procedure codes?

A. 11644, 12052-51 B. 11643, 12013-51

C. 11444, 12052-51 D. 11443, 12013-51

24. The physician removes a tumor from the patient’s neck using the Mohs micrographic
surgery technique. During the first stage, the physician takes four tissue blocks and
reviews them under a microscope. The exam of the tissue blocks reveals a second stage
is necessary to remove areas where the tumor is still present. The physician removes
two additional tissue blocks. What are the appropriate CPT® codes for reporting the
procedure?

A. 17311, 17312, 17315 B. 17313, 17315

C. 17313, 17314, 17315 D. 17311, 17312

25. Dr. Smith performed a cryosurgery to destroy three premalignant lesions for a patient.
Which code(s) shouldyou report for this procedure?

A. 17106
B. 17260
C. 17003 x 3
D. 17000, 17003 x 2

26. Which codes should be reported for the following case?

Preoperative diagnosis: Lesion, left hand
Confirmed by pathology postoperative diagnosis: Primary malignant carcinoma, left hand
Procedure performed: Excision of malignant carcinoma, left hand
Anesthesia: General; 40 ml of lidocaine was infiltrated into the wound prior to making the
incision
Procedure: The patient was brought to the operative suite where the left hand was prepped
and dressed. A circular incision was made to include the 1-cm lesion with narrowest
margins of 0.6 cm with dissection down to subcutaneous tissue. Homeostasis was obtained;
the wound was closed with simple mattress sutures. The patient tolerated the procedure
well and was returned to the recovery room in good condition with sterile dressing in place.

a. 11603
b. 11622
c. 11423
d. 11403

27. Nancy underwent a fine needle aspiration with ultrasound imaging guidance for a
lesion in the right breast. During the aspiration procedure, a percutaneous metallic clip
was placed in the right breast with ultrasound guidance. Which codes describe this
procedure?

a. 10005-RT, 19285-RT
b. 10030-RT, 19285-RT
c. 19285-RT
d. 19285-59, 10030-RT

28. Barry underwent a complex incision and drainage due to a postoperative wound
infection, which required an extensive secondary closure of the surgical site. Which
codes describe this procedure?

a. 13160, 10081-59
b. 10121, 12020-51
c. 13160, 10180-51
d. 10061, 12021-59

29. Mark cut his hand and arm while working on his car. Dr. Bill applied sutures to both the
arm and hand wounds. An intermediate closure of 16 cm was placed in the arm and a
simple closure of 3.6 cm was placed in the hand. Which codes should Dr. Bill report?

a. 12004, 12035-59
b. 12035, 12042-59
c. 12035, 12002-59
d. 13132, 12036-51

30. A patient underwent an excision of a 2.1-cm diameter malignant lesion on her nose. An
11.2-sq-cm adjacent tissue transfer was required to repair the primary and secondary
defect sites. How should you code this procedure?

a. 11643, 14061-59
b. 14061
c. 11646, 13152-51, 13153-51
d. 11443, 12054-59