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CPT Coding Practice Answers

1. During the surgical session, the pathologist received and performed analyses on three separate
biopsies from the vaginal wall and one from the cervix. How should the surgical pathologist code
for this service?

A. 88305, 88307 B. 88305 (X3) C. 88305 (X4) D. 88305 (X3), 88307

Answer: C - The surgical pathologist should code for this service with 88305 (with 4 units).
Code 88305refers to the four separate biopsies performed during the surgical session. The three
vaginal biopsies should be coded separately because they account for the three separate samples.
Furthermore, the vaginal biopsies fall within the Level IV surgical pathology section. The
cervical biopsy should also be coded with a Level IV surgical pathology code because it also
falls within that category. If the sample was a conization of the cervix, it should have fallen
within the Level V surgical pathology category and coded with 88307.
2. A 20-month-old with end-stage renal disease was receiving dialysis twice a week, awaiting a
kidney transplant. During the last month of life, the patient received dialysis once per day.
Dialysis was administered between June 1 and June 14. The patient's parents received daily face-
to-face counseling regarding the patient's care and ESRD status. What is the correct code for the
patient's dialysis care?

A. 90968 (X14) B. 90960 C. 90967 (X14) D. 90964

Answer: C - The correct code for the patient's dialysis care is 90967 (X14) (ESRD-related
Services for Dialysis Less than an Full Month of Service, Per Day; for Patients Younger than 2
Years of Ages).Code 90967 (X14) is used because the patient only received dialysis services
from June 1 to June 14. In addition, code 90967 (X14) needs to be reported with 14 units, in
reference to the 14 individual days of service.
3. A 32-year-old woman with repeat urinary tract infections presented to the office with painful
urination. Suspecting another UTI, the physician sent a urine sample to the lab to identify the
bacteria causing the infection. The physician's office billed for the laboratory service themselves,
even though they sent the sample to an outside lab for the test. What modifier is appropriate in
this case?

A. Modifier -99 B. Modifier -90 C. Modifier -52 D. No modifier would be

necessary
Answer: B - Modifier -90 (Outside Laboratory) is the appropriate modifier in this case. Modifier
-90 is used when the physician's office bills for the laboratory service, even though they sent the
lab sample to an outside laboratory. When the insurance company pays the physician for the lab
sample, the physician's office reimburses the lab for the cost of the service.
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4. A physician took an impression of a 47-year-old woman's left orbital socket and created a
custom prosthesis. What is the correct code for this service?

A. 21076 B. 21089 -LT C. 21088 -LT D. 21077 -LT

Answer: D - The correct code for this service is 21077 (Impression and Custom Preparation;
Orbital Prosthesis). According to the CPT guidelines, code 21077 is used when a physician or
other qualified health care professional designs and prepares the prosthesis. The modifier -LT
should be appended to indicate that the prosthesis was created for the left orbital socket.
5. A forensic pathologist performed a gross post-mortem examination on a stillborn infant. The
exam included the infant's brain, but did not include the infant's spinal cord. How should the
pathologist code for this service?

A. 88005 B. 88012 C. 88025 D. 88014

Answer: D - The pathologist should code for this service using code 88014 (Necropsy, Gross
Examination Only; Stillborn or Newborn with Brain). Code 88025 is not correct because it refers
to gross and microscopic examinations, whereas, in this case, the pathologist only performed a
gross examination. Codes 88005 and 88012 are also incorrect because they do not refer to the
examination of a stillborn infant.
6. The physician ordered tests to evaluate a three-year-old patient for cystic fibrosis. The test
results came back as suspicious so the physician ordered additional tests to confirm the
diagnosis. The physician ordered his nurse to call the patient's parents to discuss the patient's
results and any other recommended tests. The phone conversation lasted 20 minutes during
which time the nurse scheduled a follow-up appointment for the next morning at 10:00 AM.
How should you report the telephone services for this phone call?

A. No telephone consultation service code should be reported B. 98967 C. 98968

D. 99442
Answer: A - No telephone consultation service code should be reported because the call resulted
in an appointment the next day. The code 98967 (Telephone Assessment and Management
Services Provided by a Qualified Non-Physician HealthCare Professional to an Established
Patient, Parent, or Guardian not Originating from a Related Assessment and Management
Service Provided within the Previous 7 Days nor Leading to an Assessment and Management
Service or Procedure within the Next 24 Hours or Soonest Available Appointment).In this case,
the 11-20 minutes of medical discussion should not be reported because the telephone
conversation resulted in an appointment the next morning.
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7. What is the appropriate ICD-9 code for a diagnosis of a personal history of heart attacks?

A. V15.9 B. 412 C. V12.50 D. V17.3

Answer: B - The appropriate ICD-9 code for a diagnosis of a personal history of heart attacks is
412. A heart attack is technically known as a myocardial infarction, and code 412 (Old
Myocardial Infarction)is used when the patient has experienced a past myocardial infarction, but
is no longer presenting any symptoms. It is also used when the patient has a healed myocardial
infarction. In either case, code 412 is the appropriate code.
8. A physician performed a lymphangiography with insertion of radioactive tracer for
identification of sentinel node. What is the correct code for this procedure?

A. 38790 -50, 75803 B. 38790, 75801 C. 38792 -50, 75803 D. 38792, 75801
Answer: D - The correct code for the procedure is 38792 (Injection Procedure; Radioactive
Tracer for Identification of Sentinel Node) which is the primary procedure. Code 75801
(Lymphangiography, Extremity Only, Bilateral, Radiological Supervision and Interpretation)
also needs to be reported to indicate the radiological guidance for the lymphangiography
procedure. The procedure is not indicated as a bilateral procedure, which would exclude code
75803, which is a bilateral procedure and modifier -50, which indicates that the procedure was
bilateral.
9. Debbie has Type II diabetes, and has been working with her physician to develop diet and
exercise techniques that help control her symptoms. Today her doctor also put her on a new
medication, which may help control her blood sugar levels better. What is the correct ICD-9
code for Debbie's diabetes?

A. 250.0 B. 250.00 C. 250.02 D. 250.80

Answer: B - The correct ICD-9 code for Debbie's diabetes is 250.00. All diabetes codes require
a fifth digit in order to make them as specific as possible. This fifth digit indicates the type of
diabetes the patient has, as well as if the diabetes is considered controlled or uncontrolled. In
Debbie's case, she has Type II diabetes, and even though it is poorly controlled, it is still
considered controlled, so the correct diagnosis code is 250.00 (Diabetes Mellitus Without
Mention of Complication, Type II, Not Stated as Uncontrolled).
10. Dr. Brown, a dermatologist, opened and drained multiple complicated acne pustules and
comedones on a 19-year-old patient with severe acne. For one of the more complicated acne
pustules, Dr. Brown incised, drained, and marsupialized the acne cyst by suturing the right and
left sides, leaving the cyst open for drainage. What is the correct code for the procedure?

A. 10060 B. 10061, 10040 C. 10040 D. 10061

Answer: C - The correct code for the procedure is 10040 (Acne Surgery). This is the only code
necessary, as it includes the opening of acne comedones, cysts, and pustules. It also includes the
marsupialization of the acne cysts. Codes: 10060 and 10061 are used for the incision and
drainage of unspecified abscesses or cysts, rather than acne cysts.
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11. A 10-year-old boy was running through his house and ran into a sliding glass door, breaking
the glass and suffering severe lacerations on his trunk and arms and minor lacerations on his face
and legs. The emergency department physician performed the simple closure of one 2 cm
laceration on the boy's cheek and two 2.3 cm lacerations on the boy's left leg. The physician
performed the simple closure of one 4 cm laceration on the right arm and the layered closure of
two lacerations on the left arm, which were 1.5 and 3 cm, respectively. The physician treated the
5 cm laceration on the boy's chest, which required the removal of particulate glass and a single
layer closure. What are the correct codes for the wound repair performed by the emergency
department physician?

A. 12001, 12002 (X2), 12032 (X2)

B. 12005, 12011-51, 12032-51

C. 12004, 12011-51, 12032 (X2)

D. 12004, 12011-51, 12034-51

Answer: D - The correct codes for the wound repair performed by the emergency department
physician are 12004, for the simple repair of the 4.6 cm and 4 cm lacerations of the left leg and
right arm; 12011 for the simple repair of the 2 cm laceration of the cheek; and 12034 for the
intermediate repair of the 4.5cm and 5cm lacerations of the left arm and chest. According to CPT
guidelines, when multiple wounds are repaired, the coder must "add together the lengths of those
in the same classification and from all anatomic sites that are grouped together into the same
code descriptor." the repair of the chest laceration is an intermediate repair because it required
the removal of particulate matter (glass).
12. The lymphatic system contains four organs:

A. Spleen, tonsils, bone marrow, and thymus

B. Spleen, Peyer's patches, and tonsils
C. Spleen, tonsils, Peyer's patches, and thymus
D. Tonsils, Peyer's patches, thymus, and bone marrow

Answer: C - The lymphatic system contains for organs: the spleen, tonsils, Peyer's patches, and
thymus gland. The spleen is a part of the hemic system, which creates and stores red blood cells.
The tonsils are an initial line of defense against bacteria entering through the throat. Peyer's
patches are located in the small intestine and help prevent bacteria from infecting the intestines.
The thymus gland produces T-cells, which are used in the immune system and also aid in auto-
immunity or keeping the body from attacking itself.
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13. What is the difference between biopsy codes located in the integumentary section and those
found in the musculoskeletal section?

A. The biopsy codes found in the integumentary section are only for codes related to
malignant neoplasms

B. There are no biopsy codes found in the musculoskeletal section

C. The codes in the musculoskeletal system include biopsies for bone only, whereas the
biopsy codes found in the integumentary section include codes for biopsies of subcutaneous
structures including bone

D. The biopsy codes found in the integumentary section are for biopsies of the skin and
subcutaneous structures whereas the biopsy codes found in the musculoskeletal section are for
deeper structures
Answer: D - The difference between biopsy codes located in the integumentary section and
those found in the musculoskeletal section is that the biopsy codes found in the integumentary
section are for biopsies of the skin and subcutaneous structures whereas the biopsy codes found
in the musculoskeletal section are for deeper structures. Both of the sections include codes for
biopsies, but all of the codes in the musculoskeletal section are for deeper structures underlying
skin and subcutaneous structures such as muscles and bones.
14. The physician performed the excision of two 1.5 cm malignant lesions on a patient's upper
back. During the surgery, the physician noted four additional lesions, which looked to be pre-
malignant. These lesion excisions were 0.3, 0.7, 1.0, and 1.45 cm, respectively. The suspect
lesions were sent to pathology lab, where they were determined to be benign. What are the
appropriate codes for the service?

A. 11400 (X4), 11602 (X2)

B. 11400, 11401 (X2), 11402

C. 11404, 11603

D. 11400, 11401 (X2), 11402, 11602 (X2)

Answer: D - The appropriate codes for the service are: 11400, for the excision of the 0.3 cm
benign lesion, 11401 (X2) for the excision of both 0.7 and 1.0 benign lesions, 11402 for the
excision of the 1.45 cm benign lesion, and 11602 (X2) for the excision of both of the 1.5 cm
malignant lesions. CPT coding guidelines state that each malignant/benign lesion excised needs
to be reported separately; therefore each lesion removal needs to be coded separately.
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15. Sylvia was seen in the office and was diagnosed with acute bronchitis with Chronic
Obstructive Pulmonary Disease. What is the correct ICD-9 diagnosis code for her condition?

A. 466.0 B. 491.22 C. 466.0, 491.22 D. 491.21

Answer: B - The correct ICD-9 diagnosis code for Sylvia's condition is 491.22. According to
ICD-9 coding guidelines, only code 491.22 (Obstructive Chronic Bronchitis with Acute
Bronchitis) should be assigned. It is not necessary to also assign code 466.0 (Acute Bronchitis).
In addition, code 491.21 (Obstructive Chronic Bronchitis with Acute Exacerbation) is
inappropriate because it only indicates an exacerbation of the chronic bronchitis, not acute
bronchitis.
16. A pediatric patient presented to the office with a severe asthma attack. The pediatrician
ordered a pulse oximetry to check the patient's blood oxygen saturation level and a spirometry to
evaluate her lung capacity. The physician interpreted the results and ordered an albuterol
nebulizer treatment and a post-spirometry to check the patient's responsiveness to the albuterol
treatment. What are the correct codes for this office visit?

A. 99214, 94060, 94760, 94640, A7015, A4616, J7630

B. 99214, 94010 (X2), 94760, 94640, A7015, A4616, J7630

C. 99214, 94060, 94640, A7015, A4616, J7630

D. 99214, 94010, 94760, 94640, A7015, A4616, J7630

Answer: A - The correct codes for this office visit are: 99214 (E&M service), 94060
(Bronchodilation Responsiveness, Spirometry), 94010 (Pre and Post Bronchodilator
Administration), 94760 (Pulse Oximetry Reading) and 94640 (Nebulizer Treatment). Codes
A7015, A4616, and J7630 are nebulizer treatment supply codes. Code 94010 is incorrect because
it does not include both the before and after nebulizer treatment spirometry.
17. The patient returned to the office one month later for removal of cast on her left lower arm.
The original attending physician removed the cast. The physician also examined the arm and
determined that no further casting or follow-up was necessary. What is the appropriate code for
this service?

A. 25250 B. 99214 C. No code would be reported D. 29799

Answer: C - No code should be reported for this service. According to CPT guidelines, the
removal of a cast should only be reported when the application of the cast was performed by one
physician and the removal of the cast by another physician. The physician who removed the cast
was the same that applied the cast so no service should be reported.
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18. The respiratory system subsection in the CPT manual contains, but is not limited to
procedure codes for the following body areas:

A. Nose, mouth, and throat

B. Nose, accessory sinuses, and trachea/bronchi

C. Accessory sinuses, mouth, and stomach

D. Lungs, pleura, and heart

Answer: B - The respiratory system subsection in the CPT manual contains, but is not limited to,
the nose, accessory sinuses, and trachea/bronchi. Procedure codes for the mouth, throat, and
stomach are located in the digestive system subsection, while procedure codes for the heart are
located in the cardiovascular system subsection.
19. After careful selection and testing of bone marrow donors, a potential candidate was found
for a patient with severe leukemia. The physician collected a small sample of the potential
donor's bone marrow via aspiration technique. This sample was then sent to pathology to
determine whether or not it would be a match for the patient's bone marrow. What is the correct
code for the procedure performed by the physician?

A. 38221 B. 38220 C. 38230 D. 38232

Answer: B - The correct code for the procedure performed by the physician is 38220 (Bone
Marrow; Aspiration Only). This is the appropriate code because the physician was not harvesting
the marrow from the donor. Harvesting codes, such as 38230 and 38232 are only used when the
bone marrow is harvested in large amounts in order to transplant the marrow into the patient. In
this case, the physician was only aspirating a small sample to test (to see if the donor and the
patient were matches).
20. HIPAA was created to:

A. Protect patient privacy B. Enact ways to uncover fraud and abuse C. Create
standards of electronic transactions D. All of the above E. Only options A and B
Answer: D - All of the above, HIPAA was created to protect patient privacy, enact ways to
uncover fraud and abuse, and to create standards of electronic transactions. HIPAA protects
patient privacy through its strict standards of confidentiality, allows organizations like the OIG to
uncover fraud and abuse, and gives these organizations the power to investigate and prosecute
suspected fraud and abuse cases. HIPAA also creates standards of electronic transactions, such
as the ANSI 5010 update and requires encryption and passwords on websites that contain patient
data.
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21. The patient is being evaluated for spinal curvature problems of the lower back. She has been
sent to the radiologist for a set of spinal x-rays. The radiologist takes x-rays from 4 different
views of her spine (standing straight, bending forward and from each side) along with three
additional views. These films are sent to the patient's PCP for interpretation and report. What
code should the radiologist report?

A. 72114 -TC B. 72110 -TC, 72120 -TC C. 72114 D. 72110, 72120

Answer: A - The only code that the radiologist should report would be 72114 (Radiologic
Examination, Spine, Lumbosacral; Complete, including Bending Views, Minimum of 6 Views)
with modifier -TC appended. Modifier -TC indicates that the procedure consisted of taking the x-
rays only and not the interpretation of the x-rays. The radiologist sent the x-rays to the patient's
PCP for interpretation; therefore the only part of this service that was provided was the technical
portion.
22. A pediatrician performed a lumbar puncture on a 2-day-old premature infant weighing 2.3 kg
with possible meningitis. What is the correct code for this service?

A. 62272 B. 62270 C. 62270 -63 D. 62272 -63

Answer: C - The correct code for this service is with 62270 (Spinal Puncture, Lumbar,
Diagnostic) combined with modifier -63 to indicate that the patient weighed less than 4 kg. Code
62270 (Spinal Puncture, Therapeutic, for Drainage or Cerebrospinal Fluid) is incorrect because
the lumbar puncture was performed to evaluate the spinal column fluid not treat the spinal
column by performing the lumbar puncture.
23. A physician performed a thoracoabdominal diaphragmatic hernia repair on 45-year-old male
patient with the implantation of prosthetic mesh for support. What is the correct code for this
procedure?

A. 39531 B. 39530 C. 43336 D. 43337

Answer: D - The correct code for this procedure is 43337 (Repair, Paraesophageal Hiatal
Hernia, via Thoracoabdominal Incision, Except Neonatal; with Implantation of Mesh or Other
Prosthesis). Code 39531 was deleted and replaced with code 43337, as indicated by the notes
within the mediastinum and diaphragm section. Code 43336 is inappropriate because it does not
take into account the implantation of mesh, while code 43337 does.
24. The patient was seen in the emergency department for a severe laceration to the right
forearm, following a work injury. The on-call physician performed an expanded problem-
focused history assessment and examination, and then sutured the complicated wound using 25-0
vicryl sutures in three subcutaneous layers. The patient was prescribed prophylactic antibiotics
and released from the emergency department. The patient was instructed to return to his PCP in
one week for a follow-up appointment. The MDM was moderate. What is the correct level of
E&M service?

A. 99284 B. 99282 C. 99283 D. 99291

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Answer: C - The correct level of E&M service is 99283 (Emergency Department Visit, Level
Three). Code 99291 is not correct because it represents critical care services, not emergency
department services. The note states that both the history assessment and examination were
expanded problem-focused, and that the MDM was of moderate complexity. In the emergency
services category, these three factors make up a level three visit, which should be reported using
the code 99283.
25. A 47-year-old male patient with advanced cancer of the lower left mandible presented to the
hospital for surgical removal of the lower left jawbone with secondary insertion of mandibular
prosthesis. In order to perform surgery, the patient had to be intubated through a tracheostomy.
After anesthesia, the surgeon performed the tracheostomy by incising the cricothyroid membrane
horizontally along the trachea and inserting the intubation device. The surgeon completed the
primary surgical procedure on the patient's mandible. What is the correct code for the intubation?

A. 31605 B. 31600 C. No code would be used for the intubation D. 31603

Answer: C - No code should be used for the intubation procedure. The correct code in this case
is 31600 (Tracheostomy, Planned (Separate Procedure)).This code is designated as a separate
procedure, so it should only be reported if it was the only procedure performed during a surgical
session. The primary procedure performed was the mandibular excision and reconstruction;
therefore the tracheostomy should be bundled into the major procedure. The intubation should
not be reported separately.
26. When selecting an evaluation and management code, what is the first thing that the coder
needs to determine?

A. The time the provider spent with the patient

B. The appropriate category of E&M service

C. Whether the patient was new or established3

D. How long the discharge took

Answer: B - When selecting an evaluation and management code, the first thing that the coder
needs to determine is the appropriate category of E&M service. This means that the coder needs
to determine where the service was provided (i.e., hospital inpatient, office/outpatient, hospital
observation, etc.). Whether the patient was new or established would only be a question in
certain categories. In addition, the time spent with the patient is only a determining factor in
certain categories.
27. A physician performed craniotomy on a patient with a severe head trauma and intracerebral
hematoma. Due to the patient's condition the procedure was extremely difficult, requiring a
significant amount of extra time and effort. What is the correct code for this procedure?

A. 61315 B. 61313 C. 61313 -22 D. 61315 -23

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Answer: C - The correct code for the procedure is 61313 (Craniectomy or Craniotomy for
Evacuation of Hematoma, Supratentorial; Intracerebral) combined with modifier -22 to indicate
that the procedure was an increased procedural service. Code 61315 is inappropriate because it is
used for an infratentorial, intracerebellar hematoma.
28. Diaphragmatic hernia repair codes are divided based upon what?

A. The age of the patient and whether or not mesh was used
B. The age of the patient and whether or not the hernia is acute or chronic
C. The stage of the hernia and the site of the hernia
D. The age of the patient and the site of the hernia
Answer: B - Diaphragmatic hernia repair codes are divided based upon the age of the patient and
whether or not the hernia is acute or chronic. There are only three hernia codes, 39503 (Neonatal
Diaphragmatic Hernia Repair) and codes 39540 and 39541 (Diaphragmatic Hernia Repair for
other than a Neonate). The codes 39540 and 39541 are divided into traumatic acute and
traumatic chronic hernias.
29. A radiographic image of the colon's interior is referred to as which of the following?

A. Colonography B. Colonoscopy C. Duodenoscopy D. Cholangiography

Answer: A - A radiographic image of the colon's interior is referred to as a colonography. A
colonoscopy occurs when an endoscope is passed into the colon for visualization, while a
duodenoscopy occurs when the endoscope is passed from the colon into the duodenum. A
cholangiography is a radiographic image of the bile duct..
30. What is the difference between meningitis and encephalitis?

A. Meningitis is the inflammation of the spinal cord, and encephalitis is the inflammation of
the lining of the brain
B. Meningitis is the inflammation of the lining of the brain and encephalitis is the
inflammation of the brain
C. Meningitis is the inflammation of the lining of the brain and encephalitis is the swelling
of the spinal cord
D. Meningitis is a respiratory infection and encephalitis is the inflammation of the nervous
system
Answer: B - The difference between meningitis and encephalitis is that meningitis is the
inflammation of the lining of the brain and encephalitis is the inflammation of the brain itself.
Myelitis is the inflammation of the spinal cord, and encephalomyelitis is a combination of the
inflammation of the brain and spinal cord. Generally speaking, when coding for any of the above
conditions, the coder should report the organism responsible for the inflammation first and the
inflammation second.
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31. PREOPERATIVE DIAGNOSIS: Cyst of Mediastinal Wall

POSTOPERATIVE DIAGNOSIS: Tumor of Mediastinal Wall

A physician removed 1.5 cm mass from mediastinal wall, along with appropriate margins. The
tumor was sent to pathology to determine the malignancy status. What is the correct code for this
procedure?

A. 39200 B. 39220 C. 39000 D. 39010

Answer: B - The correct code for this procedure is 39220 (Resection of Mediastinal Tumor).
There are only two codes for the removal or resection of a mediastinal mass. Code 39200 is for
the removal of a mediastinal cyst, whereas code 39220 is for the removal of a tumor. The
postoperative diagnosis states that the mass is a tumor; therefore code 39220 is the most
appropriate code for this service.
32. What is the difference between anterior nasal packing versus posterior nasal packing
procedure codes?

A. None, they are the same codes

B. Posterior packing is done in the larynx, whereas anterior packing is done at the back of
the throat

C. There are no nasal packing procedure codes in the CPT manual

D. Anterior packing is applied pressure and gauze and posterior packing is the insertion of a
balloon into the back of the nasal cavity
Answer: D - The difference between anterior nasal packing versus posterior nasal packing
procedure codes is that anterior packing applies pressure and gauze to the front of the nose, and
posterior packing inserts a balloon into the back of the nasal cavity. Posterior packing includes
packing the nose with gauze and applying pressure to the posterior aspect of the nasal cavity.
This can include inserting a balloon to the back of the throat, which is inflated to block blood
from draining into the back of the throat.
33. A 65-year-old female patient with atherosclerosis receives an abdominal aortography via
serialography. The patient's cardiologist reviews and interprets the findings. What is the
appropriate code for this service?

A. 75625 B. 75625 -26 C. 75605 D. 75630

Answer: A - The appropriate code for this service is 75625 (Aortography, Abdominal, by
Serialography, Radiological Supervision and Interpretation). Code 75625 does not need to be
appended with the modifier -26 because modifier -26 indicates radiological supervision and
interpretation. Code 75625 already states that the service was just for the supervision and
interpretation. To append modifier -26 would be repetitive.
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34. Which of the following is always the payer of last resort?

A. Medicare B. Medicaid C. Worker's Compensation Insurance D. Commercial

Insurance
Answer: B - Medicaid is always the payer of last resort. This means that if a patient has more
than one type of insurance coverage, and one of the insurances is Medicaid, then the biller must
bill the other insurance first and Medicaid second. Medicaid will never pay first, if the patient
has more than one type of insurance coverage.
35. When a doctor manipulates a dislocated joint back into place, he:

A. Reduces the subluxation B. Manipulates the fracture C. Suspends the dislocation

D. Reduces the suspension
Answer: A - When a doctor manipulates a dislocated joint back into place he reduces the
subluxation. A subluxation is a joint dislocation and the manipulation of a joint back into place is
commonly referred to as a reduction.
36. During delivery, an episiotomy may be performed in order to allow a larger opening for the
baby to pass through. In this procedure, the obstetrician will incise which area?

A. Vagina B. Labia Minora C. Labia Majora D. Perineum

Answer: C - In an episiotomy, the obstetrician will incise the perineum. The perineum is the
area between the vaginal opening and the anus. This procedure is usually performed to allow a
larger area for the baby to pass through during delivery, and is not considered a separate
procedure during delivery. It is only reportable as a separate service, if it is performed by any
physician other than the attending OB.
37. If a patient is in the prone position, he is:

A. Lying flat on his back B. Lying flat on his stomach C. Sitting up straight D.
Lying flat on his back with his feet elevated
Answer: B - If a patient is in the prone position, he is lying flat on his stomach. If the patient lies
flat on his back he is in the supine position. If the patient lies flat on his back with his feet
elevated he is in the Trendelenburg position. If the patient is sitting up straight he is in the
Fowler's position.
38. A 23-year old woman, pregnant with her second child, received antepartum care from her
physician in Atlanta, GA. After 9 visits with her physician in Atlanta, the patient moved to
Albuquerque, NM where she continued her prenatal care with a new doctor. The new physician
saw the patient for the remaining antepartum visits. The new physician also performed vaginal
delivery and postpartum care, which included the 6-week postpartum checkup. How should the
physician in Atlanta code for his services?
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A. 59426 B. 59425 C. 59410 D. 59430

Answer: A - The physician in Atlanta should code for his services with code 59426 (Antepartum
Care Only, 7 or More Visits).The patient only saw her Atlanta physician 9 times, therefore the
Atlanta physician can only code for the antepartum care that he provided. Code 59425 is only 4-
6 antepartum visits. Codes 59410 and 59430 are also incorrect because they refer to postpartum
care, which in this case, was provided by the physician in Albuquerque.
39. A physician has been treating a patient with endocarditis for the past two weeks. Due to the
patient's chronic inflammation of the heart's lining, the physician sent a blood sample to the lab,
which detected trace amounts of the bacteria staphylococcus. Now that the physician knows the
bacterium that is causing the endocarditis, he can prescribe an appropriate antibiotic to fight the
infection and treat the condition. What are the correct diagnosis codes for this patient's
condition?

A. 421.0, 041.10 B. 041.10, 421.0 C. 041.11, 421.0 D. 421.0, 041.00

Answer: A - The correct diagnosis codes for this patient's condition are: 421.0 (Endocarditis)
and 041.10 (Infectious Organism). The codes need to be sequenced in this order because there is
a note under the endocarditis category 421.0 that states to "use additional code to identify an
infectious organism." In this case, the infectious organism is unspecified staphylococcus, code
041.10, which needs to be sequenced after the endocarditis code.
40. Mr. Johnson, a 46-year-old male, has smoked cigars for the last 20 years of his life. He has a
suspicious lesion on his lower lip and is being seen for treatment. The physician suspects that it
may be malignant. The physician performed a shave biopsy of the patient's lower lip. What is the
correct code for this procedure?

A. 40490 B. 40500 C. 11100 D. 11600

Answer: A - Code 40490 (Biopsy of Lip) is the correct code for this procedure. Code 40500
(Vermilionectomy (Lip Shave), with Mucosal Advancement) is not correct because it is a more
extensive procedure than what was performed at the visit, which was just a biopsy. Code 11100
(Biopsy of Skin) is also not correct because the code 40490 is used for the lip, which is more
specific.
41. Sheila took her 5-year-old daughter to the pediatrician's office for an annual well-child exam.
She has a commercial Blue-Cross Blue-Shield insurance plan, through her work, which covers
her daughter. Sheila also has Medicaid coverage on her daughter, due to her low-income status.
Which one of her insurances is billed for the well-child exam?

A. You bill Blue-Cross Blue-Shield first and Medicaid second B. You bill Medicaid only
C. You bill Blue-Cross Blue-Shield only D. You bill Medicaid first and Blue-Cross Blue-
Shield second
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Answer: A - You bill Blue-Cross Blue-Shield first as the primary payer, and send a secondary
claim to Medicaid, once the primary insurance has paid. Medicaid is always the payer of last
resort, and as such is always billed after a commercial insurance processes the claim.
42. PROGRESS NOTE
PATIENT: JOHNSON, GOLDIE
AGE: 36
DATE: 01/13/2017

A 36-year-old woman with a history of multiple complicated ectopic pregnancies presented to

her OB/GYN's office. She took an at-home pregnancy test two weeks ago, which was positive,
and experienced a heavy bleed in the middle of the night last night. She presented this morning
with complaints of excessive vaginal bleeding and pain in the abdominal area. After
confirmation of the pregnancy via urinalysis, the physician performed a pelvic examination.
After examination, the OB suspected that the pregnancy was ectopic and ordered an ultrasound
confirmation. The ultrasound confirmation, performed later that day, showed an advanced
interstitial uterine ectopic pregnancy. The estimated age of the pregnancy was 12 weeks. The OB
discussed the risks of the ectopic pregnancy with the patient, who then decided to have an
excision of the ectopic pregnancy and a total hysterectomy. The OB spent 45 minutes counseling
the patient and the patient was scheduled for an abdominal hysterectomy in two days.

How should the OB code for the procedure performed in the office?

A. 99214, 76801 B. 99215-57, 81025, 76801 C. 99214-57, 81025 D. 99215,

81025, 76805
Answer: B - The OB should code for the procedure performed in the office with 99215 to
represent the evaluation and management service. The physician spent over 40 minutes
counseling the patient on the decision for surgery (which is indicated by modifier -57), therefore
the level of E/M service can be determined on this basis alone, and in this case it is a level 5
visit. Code 81025 also needs to be included on the claim to indicate that the OB completed a
confirmation urinalysis test for pregnancy in the office. The last code that needs to be included
on the claim is 76801, for the abdominal ultrasound, which was also provided in the office on the
same day to confirm the ectopic pregnancy status.
43. This condition occurs when the lining of the esophagus becomes inflamed. It is generally
caused by an infection or irritation of the esophagus. What is the name of this condition?

A. Esophagitis B. Barrett's Esophagus C. Esophageal Varices D. Mallory-Weiss

Tear
Answer: A - The condition that occurs when the lining of the esophagus becomes inflamed and
is generally caused by an infection or irritation of the esophagus is called esophagitis. In medical
terminology, the suffix "itis" means inflammation so esophagitis literally means "inflammation
of the esophagus."
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44. A pacemaker or pacing cardioverter-defibrillator that has pacing and sensing functions in
three or more chambers of the heart is considered a:

A. Multiple Lead B. Dual Lead C. Single Lead D. Triple Lead

Answer: A - A pacemaker or pacing cardioverter-defibrillator that has pacing and sensing
functions in three or more chambers of the heart is considered a multiple lead system. Pacemaker
or cardioverter-defibrillator systems have electrical stimulation leads that help shock the heart
into rhythm. Depending on the individual needs of the patient, some systems may have only one
lead, while others may have two, three, or more electrical leads. Correct code selection depends
on how many leads the system has.
45. The tympanic membrane is often referred to as:

A. A taste bud B. The ear drum C. The stirrup D. The inner ear
Answer: B - The tympanic membrane is often referred to as the ear drum. Taste buds are on the
tongue and have nothing to do with the auditory system. The stirrup or stapes is a small bone in
the middle ear and the inner ear is the internal part of the auditory system.
46. A 14-year-old patient with an abscessed tooth presented to the physician's office with
possible sepsis. The tooth had gone untreated for two weeks, and now the patient is experiencing
a high fever, severe headaches and toothaches and malaise and fatigue. The physician suspects
that the bacteria from the tooth has spread to the patient's blood and is now a systemic infection.
As part of the office procedure, the physician orders a CBC in order to examine the bacterial
levels in the patient's blood. After the physician writes the orders, the nurse performs a
venipuncture on the patient in order to obtain a blood sample. What is the correct code for the
collection of the blood only?

A. 36416 B. 36415 C. 36410 D. 36406

Answer: B - The correct code for the collection of the blood is 36415 (Collection of Venous
Blood by Venipuncture). This code is used when a nurse performs the venipuncture in the office,
for the purposes of collecting a blood sample. Code 36416 refers to a capillary blood sample that
is obtained from the tip of the finger or heel of an infant. Codes 36406 and 36410 are used for
the collection of blood when it necessitates the skill of a physician not a nurse.
47. A physician harvested a viable left cornea, liver, and heart from a declared brain-dead
patient. What anesthesia services should have been provided?

A. 01990 B. No anesthesia services should have been performed on a brain-dead patient

C. 33930, 47133-51, 65110-51 D. 01990-P6
Answer: D - The anesthesia service that should have been reported is 01990-P6, (Physiological
support for harvesting or organ(s) from brain-dead patient). Modifier -P6 also should have been
reported to indicate that the patient's physical status, which in this case, is a declared brain-dead
patient whose organs were being removed for donor purposes.
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48. A physician performed a cystourethroscopy with an ejaculatory duct catheterization and

irrigation. Duct radiography was also performed to visualize ejaculatory duct system. What CPT
codes should be reported?

A. 52000, 52010 B. 52000, 52010, 74440 C. 52010, 74440 D. 52010

Answer: C - The CPT codes that should be reported are 52010 (Cystourethroscopy, with
Ejaculatory Duct Catheterization, with or without Irrigation, Instillation, or Duct Radiography,
Exclusive of Radiologic Service) and 74440 (Vasography, Vesiculography, or Epidemiography,
Radiological Supervision and Interpretation) Duct radiography was performed, therefore the
radiological S&I also needs to be reported. In parenthesis under code 52010, it directs the coder
to code 74440, the appropriate radiological S&I code.
49. What does the suffix "-megaly" refer to, as in cardiomegaly?

A. Inflammation, as in inflammation of the heart

B. Pain in, as in heart pain
C. Enlargement of, as in enlargement of the heart
D. Softening of, as in softening of the heart

Answer: C - The suffix "-megaly" refers to the enlargement of, as in enlargement of the heart.
The suffix for inflammation is "-itis." The suffix for pain is "-algia." The suffix for softening is
"-malacia."
50. The time reported for an anesthesia service begins __________________, and ends
__________________.

A. When the anesthesiologist administers the anesthetic agent; when the patient leaves the
operating table.
B. When the anesthesiologist begins prepping the patient; when the anesthesiologist is no
longer in personal post-operative attendance.
C. When the physician begins the procedure; when the physician ends the procedure.
D. When the anesthesiologist begins prepping the patient; when the patient leaves the
hospital.

Answer: B - The time reported for an anesthesia service begins when the anesthesiologist begins
prepping the patient and ends when the anesthesiologist is no longer in personal post-operative
attendance. According to anesthesia coding conventions, the time reported for an anesthesia
service begins when the anesthesiologist begins in the pre-operative session, remains throughout
the operative session, and ends in the post-operative session when the patient is no longer under
the care of an anesthesiologist and can be transferred to post-operative supervision.
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