Question 1

Laparoscopic retroperitoneal lymph node biopsy

Accepted Answer

Laparoscopic retroperitoneal lymph node biopsy is coded as 38570.

Question 2

Patient presents to the hospital with a diagnosis of femoral artery atherosclerotic disease. The patient is taken to the operating room and undergoes an aortofemoral popliteal bypass.

Accepted Answer

The correct code is 35551 because it is the code for aortofemoral popliteal bypass.

Question 3

Patient is admitted with alcohol cirrhosis and has a TIPS procedure performed.

Accepted Answer

The most appropriate code for TIPS procedure is 37182. Codes 35476 and 36011 are for other types of vascular embolization procedures and code 36481 is for thrombectomy procedures. Code 37183 is used for revision or repositioning of TIPS when done separately from the initial procedure. Code 37140 is not appropriate as it is used for ligation of the portal vein.

Question 4

Patient has breast carcinoma and is now undergoing sentinel node biopsy. Patient was injected for sentinel node identification and two deep axillary lymph nodes showed up intensely. These two lymph nodes were completely excised. Path report was positive for metastatic carcinoma.

Accepted Answer

CPT code 38589 is used for sentinel lymph node biopsy, which involves the identification and excision of sentinel lymph nodes for examination. The scenario describes a sentinel node biopsy with excision of lymph nodes, making 38589 the appropriate code.

Question 5

Patient has a history of hiatal hernia for many years, which has progressively gotten worse. The decision to repair the hernia was made and the patient was sent to the operating room where the repair took place via the thorax and abdomen.

Accepted Answer

The answer of Patient has a history of hiatal hernia...

Question 6

Patient presents to the operating room where a CABG x 3 is performed using the mammary artery and two sections of the saphenous vein.

Accepted Answer

The correct codes for a CABG using one arterial graft (mammary artery) and two venous grafts (saphenous vein) are 33533 for the arterial graft and 33518 for the two venous grafts.

Question 7

Patient has recurrent spontaneous pneumothorax which has resulted in a chemical pleurodesis by thoracoscopy.

Accepted Answer

The correct code for chemical pleurodesis by thoracoscopy is 32650, which includes the procedure of pleurodesis performed via thoracoscopy.

Question 8

Trauma patient is rushed to the operating room with multiple injuries. The patient had his spleen, removed due to massive rupture with repair of lacerated diaphragm.

Accepted Answer

The answer of Trauma patient is rushed to the operating...

Question 9

Bronchoscopy with multiple transbronchial right upper and right lower lobe lung biopsy with fluoroscopic guidance

Accepted Answer

The correct codes are 31628-RT for bronchoscopy with biopsy of a single lobe and 31632-RT for each additional lobe biopsy. Fluoroscopic guidance is included in these codes.

Question 10

Patient returns to the operating room following open-heart bypass for exploration of blood vessel to control postoperative bleeding in the chest.

Accepted Answer

Exploration of blood vessel to control postoperative bleeding in the chest is included in the description of 35820.

Question 11

Patient diagnosed with cystic hygroma of the axilla, which was excised.

Accepted Answer

The appropriate CPT code for the excision of a cystic hygroma from the axilla is 38550. This code describes a simple excision of a lesion with a diameter of 1.0 cm or greater.

Question 12

Laparoscopy with multiple biopsies of retroperitoneal lymph nodes

Accepted Answer

Laparoscopy with multiple biopsies of retroperitoneal lymph nodes is coded as 38570.

Question 13

Patient has a bone marrow aspiration of the iliac crest and of the tibia.

Accepted Answer

The procedure code 38220 is used for bone marrow aspiration. Since the aspiration was performed at two different sites (iliac crest and tibia), the modifier -59 is used to indicate a distinct procedural service.

Question 14

Patient presents to the operating room and undergoes an endovascular repair of an infrarenal abdominal aortic aneurysm utilizing a unibody bifurcated prosthesis.

Accepted Answer

The answer of Patient presents to the operating room and...

Question 15

Patient undergoes construction of apical aortic conduit with an insertion of a single-ventricle ventricular assist device.

Accepted Answer

The procedure described involves the construction of an apical aortic conduit (typically coded as 33975) with the insertion of a ventricular assist device (VAD). The specific type of VAD is not provided, but the insertion of a single-ventricle VAD would be included in the base code for 33975. Therefore, code 33977 (insertion of a VAD in conjunction with another cardiac procedure) would not be necessary. Code 33400 (construction of conduit) is not specific enough to capture the full extent of the procedure, as it does not include the insertion of the VAD. Therefore, the best choice would be 33975.

Question 16

Patient complains of recurrent syncope following carotid thromboendarterectomy. Patient returns 2 weeks after initial surgery and undergoes repeat carotid thromboendarterectomy.

Accepted Answer

The appropriate code for repeat carotid thromboendarterectomy is 35301, which involves a re-exploration of the carotid artery to remove any residual plaque or emboli. The other codes (33510 and 35201) are not appropriate for this scenario. 35390 is an add-on code that is used when additional procedures are performed during the same surgical session as the primary procedure, and is not applicable in this case.

Question 17

The physician punctures the left common femoral to examine the right common iliac.

Accepted Answer

The correct code is 36245, which is used for catheter placement in the first order, such as when accessing the right common iliac artery via the left common femoral artery.

Question 18

Laryngoscopic stripping of vocal cords for leukoplakia of the vocal cords

Accepted Answer

The answer of Laryngoscopic stripping of vocal cords for leukoplakia...

Question 19

Excision of mediastinal cyst

Accepted Answer

The correct code for excision of mediastinal cyst is 39200. The other codes listed are for different procedures and are not applicable for this scenario.

Question 20

Eighty-year-old patient has carcinoma and presents to the operating room for placement of a tunneled implantable centrally inserted venous access port.

Accepted Answer

This is the correct code for placement of a tunneled implantable venous access port. The age of the patient and the presence of carcinoma do not affect the code selection.

Exam 1: Registered Health Information Administrator