Question 1

Gary sees Dr. G on Monday regarding his atrial fibrillation. Gary is a new patient, and Dr. G performs a medically appropriate history and examination, and moderate medical decision making. Dr. G decides to insert a permanent dual-chamber pacemaker. The pacemaker is inserted on Tuesday. Dr. G sees Gary in the hospital on Wednesday and discharges Gary on Thursday. Which of the following is the correct coding of Gary's visits and procedures for Monday through Thursday?

Accepted Answer

The correct coding includes 99204-57 for the new patient visit with decision for surgery, and 33208 for the insertion of the dual-chamber pacemaker. Modifier -57 is used to indicate that the decision for surgery was made during the visit. The other codes for subsequent hospital visits and discharge are not needed in this context as they are bundled into the global surgical package.

Question 2

A female patient had breast cancer 3 years ago, underwent a radical mastectomy, and received radiation and chemotherapy. She has not had treatment in the last 20 months. How is the status of the cancer reported for the patient?

Accepted Answer

D

Question 3

Gavin presents to the hospital for an outpatient procedure for a diagnostic arthroscopy of the right knee. As the physician is performing the procedure, she identifies a medial meniscal tear and repairs it at that time. Choose the correct CPT and ICD-10-CM codes for this procedure:

Accepted Answer

The correct CPT code for a diagnostic arthroscopy where a medial meniscal tear is identified and repaired is 29882 with the RT modifier indicating the right knee. The correct ICD-10-CM code for a medial meniscal tear of the right knee is S83.241A.

Question 4

The patient underwent radical neck dissection with laryngectomy for carcinoma of the larynx and true vocal cords. Choose the correct codes:

Accepted Answer

The correct codes are 31365 for the radical neck dissection with laryngectomy and C32.0 for carcinoma of the larynx and true vocal cords.

Question 5

Michael, a 40-year-old male, presented for insertion of a permanent pacemaker by transvenous approach. A pocket was created for the insertion of the generator, and the electrodes were placed in the right atrium and ventricle. Michael is diagnosed with atrial fibrillation. Select the correct codes:

Accepted Answer

33208 is the correct code for the insertion of a dual-chamber pacemaker, which matches the description of electrodes placed in both the right atrium and ventricle. I48.91 is the correct diagnosis code for atrial fibrillation, unspecified.

Question 6

Sarah, a 24-year-old female, was walking her dog this morning, and when she wasn't paying attention, she tripped and fell over the curb. The patient states that she fell to the ground using her right hand and arm to brace herself. She states that she heard a "crunch"; the resultant x-ray indicated a compound fracture to the ulna of her right arm. With the patient under general anesthesia, the area was opened and irrigated. The shaft of the ulna was fractured and had to be repaired using screws to hold it into place. The surrounding tissue was repaired, irrigated, and closed in a usual manner. Select the correct CPT code for the repair of the ulna:

Accepted Answer

The correct CPT code for the repair of the ulna with a compound fracture, where the fracture was opened, irrigated, and repaired using screws, is 25545. This code is specific for open treatment of ulnar shaft fractures, which includes internal fixation when performed.

Question 7

The patient presents for submucous resection of the middle turbinate, complete. Select the appropriate CPT code:

Accepted Answer

The answer of The patient presents for submucous resection of...

Question 8

Amy presents to the office for destruction of a malignant 2.3-cm lesion of the skin of the neck. Select the appropriate ICD-10-CM and CPT codes for today's encounter:

Accepted Answer

The correct ICD-10-CM code for a malignant lesion of the skin is C44.40, which specifies a malignant neoplasm of skin of the scalp and neck, unspecified. The correct CPT code for the destruction of a malignant lesion 2.3 cm in size is 17273, which is used for lesions 2.1 to 3.0 cm.

Question 9

A chronic or acute infection of the bone usually caused by bacteria or fungi is called:

Accepted Answer

Osteomyelitis is the correct term for a bone infection, which can be either acute or chronic and is most commonly caused by bacteria or fungi.

Question 10

Operative Report
Postoperative diagnosis:
1) Retained hardware, left foot.
2) Decreased range of motion, left ankle.
Procedure: The patient was placed under general anesthesia; her left lower extremity was prepped and draped in a sterile fashion. A time-out procedure was performed.
The patient then had a hardware removal performed on the transcutaneous K-wires, followed by examination of her ankle, which had approximately 5 to 10 degrees lacking of neutral. Gentle manipulation was performed, giving her dorsiflexion to 10 degrees. C- arm fluoroscopy was introduced to the field, taking confirmatory x-ray, and at this point the patient had a sterile dressing applied and was awakened from general anesthesia.
Select the appropriate CPT codes:

Accepted Answer

The correct CPT codes are 20670-LT for the removal of superficial hardware (transcutaneous K-wires), 27860-LT for the ankle manipulation under anesthesia, and 76000-26 for the fluoroscopy (C-arm) with the professional component (indicated by -26).

Question 11

Which of the following great vessels carries deoxygenated blood from the right ventricle to the lungs?

Accepted Answer

The pulmonary arteries carry deoxygenated blood from the right ventricle of the heart to the lungs for oxygenation.

Question 12

Timmy, a 5-year-old, was playing with his toys and decided to stick a bead from his sister's necklace up his nose. The bead was lodged in his nasal passage, and after several unsuccessful attempts by his mother and father to remove it, they took him to the emergency room. After triaging the patient, the physician utilized a surgical instrument to help remove the bead from Timmy's nasal passage. Code the physician services:

Accepted Answer

30300 represents the removal of a foreign body from the nasal passage without an incision, which is the procedure described. T17.1XXA is the ICD-10 code for a foreign body in the nose, initial encounter, which matches the scenario provided.

Question 13

A patient is diagnosed with deep vein thrombosis of a lower extremity. Which of the following veins could be involved?

Accepted Answer

The popliteal vein is a deep vein located in the lower extremity and is commonly involved in deep vein thrombosis (DVT).

Question 14

Operation: Left transaxillary subpectoral mammoplasty with saline-filled implant.
Preoperative diagnosis: Left hypomastia.
Postoperative diagnosis: Left hypomastia.
Anesthesia: General.
Procedure: After first obtaining a suitable level of general anesthesia with the patient in the supine position, the breasts were prepped with Betadine scrub and solution. Sterile towels, sheets, and drapes were placed in the usual fashion for surgery of the breasts. Following prepping and draping, the anterior axillary folds and the inframammary folds were infiltrated with a total of 20 cc of 0.5 percent Xylocaine with 1:200,000 units of epinephrine.
After a suitable hemostatic waiting period, transaxillary incisions were made, and dissection was carried down to the edge of the pectoralis fascia. Blunt dissection was then used to form a bilateral subpectoral pocket. Through the subpectoral pocket a sterile suction tip was introduced, and copious irrigation with sterile saline solution was used until the irrigant was clear.
Following completion of irrigation, 250-cc saline-filled implants were introduced. They were first filled with 60 cc of saline and checked for gross leakage; none was evident. They were overfilled to 300 cc of saline each. The patient was then placed in the seated position, and the left breast needed 10 cc of additional fluid for symmetry.
Following completion of the filling of the implants and checking the breasts for symmetry, the patient's wounds were closed with interrupted vertical mattress sutures of 4-0 Prolene. Flexan dressings were applied, followed by the patient's bra. She seemed to tolerate the procedure well.
Choose the appropriate CPT and ICD-10-CM codes:

Accepted Answer

The correct CPT code for this procedure is 19325-LT, which represents augmentation mammoplasty with a prosthetic implant, and the procedure was performed on the left side, hence the modifier -LT. The ICD-10-CM code N64.82 corresponds to hypomastia, which matches the preoperative and postoperative diagnosis.

Question 15

Which of the following is the area of the sinus that is located at the top of the nasal cavities between the eyes?

Accepted Answer

The ethmoid sinus is located at the top of the nasal cavities between the eyes.

Question 16

If the starting point is catheterization of the aorta, to which of the following order branches in the vascular family reporting would the left internal carotid artery belong?

Accepted Answer

The answer of If the starting point is catheterization of...

Question 17

A 35-year-old female patient receives biopsies of both breasts. The biopsies are done using fine-needle aspiration without imaging guidance. What is the correct CPT code to use for this procedure?

Accepted Answer

10021-50 is the correct CPT code for fine-needle aspiration biopsy without imaging guidance, and the modifier -50 indicates that the procedure was performed bilaterally.

Question 18

Amara presents to the office today as an established patient to have irritated skin tags removed from her neck and shoulders. Dr. Rose prepped her for the procedure and removed 20 skin tags using liquid nitrogen. Select the appropriate CPT code(s) for Amara's visit today:

Accepted Answer

The correct CPT codes for the removal of 20 skin tags using liquid nitrogen are 11200 for the removal of up to 15 skin tags and 11201 for each additional 10 skin tags or part thereof. Since 20 skin tags were removed, 11200 covers the first 15, and 11201 covers the additional 5.

Question 19

Jeremy presents to the clinic today for severe wrist pain. After Dr. Wilkins examines it, she diagnoses him with a ganglion cyst of the right wrist. Dr. Wilkins decides to give Jeremy a cortisone injection as a treatment plan. Code the correct CPT and ICD-10-CM:

Accepted Answer

The correct CPT code for aspiration or injection of a ganglion cyst is 20612. The ICD-10-CM code M67.431 is for a ganglion cyst of the right wrist.

Question 20

The patient presents for a direct repair of an aneurysm and graft insertion without a patch graft for an aneurysm of the common iliac artery. Select the appropriate CPT code:

Accepted Answer

The correct CPT code for a direct repair of an aneurysm and graft insertion without a patch graft for an aneurysm of the common iliac artery is 35131. This code specifically covers the procedure described.

Quiz 24: Coding for Surgical Procedures on Integumentary, Musculoskeletal, Respiratory, and Cardiovascular/Lymphatic Systems