MOCK 1

ANSWERS

1. D – Wound exploration codes are 20100-20103. Directly above these codes is the
wound exploration coding guidelines. In the guidelines it states that the following
components are part of the code's description: surgical exploration and enlargement
of the wound, extension of dissection, debridement, removal of foreign bodies,
ligation, or coagulation of minor subcutaneous and/or muscular blood vessel(s).

2. C – In the CPT book there are two types of descriptions: common and unique. The
common portion of a descriptor follows a code and ends with a semicolon (;). Any CPT
that shares that description is indented beneath the code. Any portion of the
description following the semicolon is the “Unique” portion of the descriptor and only
belongs to a single code. In this case code 24900 contains the common descriptor
“Amputation, arm through humerus”. Codes 24920 through 24931 share that part of
the description and so are indented beneath it with their unique portion of the
descriptor beside them.

3. C – Medical necessity is what adjudicates, or justifies, a claim for payment. If a

physician wants to be paid for a laceration repair (CPT), then the ICD-10 code needs
to describe a situation that says it is necessary (ICD-10 should be a laceration or open
wound).

4. D – Place of service codes are reported on the claim form to identify the site of the
service provided. In this case, the services are rendered in the ED, which is reported
with POS 23. The place of service codes can be found in the CPT manual.

5. D – Appendix E lists all CPT codes that are modifier 51 exempt. Also, add-on codes
should not be appended with modifier 51. Beside each code in the tabular there is a
convention that looks like a circle with a backslash through it. This convention means
that the code next to it is modifier 51 exempt. Code 45392 is the only code not listed
in appendix E and that does not have this convention beside it. Also, this is not an
add-on code

6. A – Category III codes are located between the Category II codes and Appendix A in
the back of the CPT manual. Category III coding guidelines state that these codes are
to be used before assigning an unlisted procedure code from category I codes.
7. A – Just prior to code 22840 there are some code specific coding guidelines. In the
third paragraph it states, “do not append modifier 62 to spinal instrumentation codes
2284022848 and 22850-20938”.

8. D – HIPAA has three rules: Privacy, Security, and Patient Safety. Standards for
transmitting PHI are not regulated by HIPAA but the security of this information while
it is being transmitted is. Once transmission rules are set HIPAA then set the
standards on how this information should be protected.

9. D – Medicare parts A is hospital insurance and helps cover inpatient care in hospitals,
skilled nursing facilities, hospice, and home health care. Medicare part B helps cover
medically necessary services like doctors’ services, outpatient care, home health
services, and other medical services. It also covers some preventive services.

10. B – ABN stands for advanced beneficiary notice and is a document that a patient signs
stating that they will pay for the procedure they are having done if insurance does not
cover it. This is something taught in a medical billing and/or coding class, or
something read in preparation of the exam. This answer is not located in one of the
coding books.

11. B – According to the laceration coding guidelines (above code 12001, titled “Repair
(closure)”), lacerations of the same depth and same anatomical grouping should have
their lengths added together and a single code should be selected. Since the arm
lacerations share the same anatomical location (arm), and both are of the same depth
(layered lacerations), their length is added together (2.5 + 4 = 6.5 cm). Code 12032 is
the correct code because it meets all three specifications: 1) Length = 6.5cm 2) Depth
= layered laceration 3) Anatomical Location = the arm. The facial laceration would
have a separate CPT code because it has a different depth (simple laceration) as well
as a different anatomical location (face). Code 12013 is correct because it also meets
all three specifications: 1) Length = 3cm 2) Depth = Simple 3) Anatomical Location =
Face.
According to the laceration repair guidelines “When more than one classification of
wound is repaired, list the more complicated as the primary procedure and the less
complicated as the secondary procedure, using modifier 59.” Option B correctly
sequences the most complicated code first (12032), followed by the least severe code
(12013) with an appended 59 modifier.

12. A – The easiest way to determine exactly what was done during this procedure is to
look at the information at the very end of the operative note. Here we have the
 information that is most important to us: simple linear closure was performed; two
stages (described as Mohs)were performed, and the number of sections in each stage

are reported. According to the Mohs microsurgery guidelines, repairs are not bundled
into the procedure and can be billed additionally. This means that the repair code
12002 (simple repair, 6.5cm, scalp), is correct and we can eliminate options C and D.
Options A and B share three of the same codes, with one additional code in option A.
So at this point the question is do you need code 17315 or not? Going through the
Stages and sections: Stage I Section 1-5 is coded with 17311; Stage I Section 6 is
coded with 17315; Stage II Section 1-5 (only 2 sections were performed in our
scenario) is coded with; And code 12002 describes the simple, 3.5cm closure of the
scalp.

13. A

14. B

15. A – True. According to the laceration “Repair (closure)”coding guidelines (above code
12001), under the heading “Definitions, intermediate repair”….“Single-layer closure
of heavily contaminated wounds that have required extensive cleaning or removal of
particulate matter also constitutes intermediate repair”

16. C – Code 97597 and 97602 are found in the medicine chapter and describe active
open wound care (Ex. Decubitus ulcers). Beneath the Active Wound Care
Management coding guidelines there is a notation that states “For debridement of
burn wounds, see 16020- 16030). This eliminates options A and B. Code 16030 is used
to describe the removal of dead tissue on second degree (partial thickness) burns.
Not only is the degree of burn different, but in our scenario there was no mention of
tissue removal, only cleansing and incisions. This eliminates option D. Code 16035
describes an Escharotomy (note the suffix – otomy means to “cut into”). An
Escharotomy is a procedure performed on healing third degree burns. Incisions are
made into the thick dead tissue to keep underlying nerves and vessels from being
injured or constricted. Code 16036 is an add-on code which is used in conjunction
with code 16035. This add on code should be used for each additional incision. So
code 16035 describes the first incision and code 16036 x2 describes the second and
third incision.

17. B – Open fractures do not always utilize “open fracture treatment” codes. In the ICD-
10 an open fracture means that the skin has been broken. In the CPT book “open”
and “closed” are terms used to refer to the type of treatment. If the patient is taken
to the operating room and an incision is made in order to visualize the fracture, this
 would be considered “open” treatment. If the physician manipulates the fracture
without creating an opening it is considered “closed treatment”. In this scenario the
patient has an open fracture but “closed fracture treatment” is utilized. Codes 25574
describe an “open treatment” and so options A and C are incorrect. Option B and D
both have the same CPT codes, but different modifiers. Any procedure with a 90
global period can be broken down into three portions: Pre-operative assessment
and/or decision for surgery; Surgical (the actual procedure); Post-operative follow-up
care. In this scenario the fracture care has a 90 global period and can be broken down
into these three portions. The E/M service is considered the preoperative evaluation
and the decision for surgery since the patient has to give consent to proceed, because
of this the E/M should have the 57 modifier appended. The 57 modifier describes
“decision for surgery” (see appendix A). The 25 modifier is also appended to the E/M
because of the additional procedure (12031, laceration repair). The fracture care is
considered the “surgical” portion of the package and so modifier 54 is appended to
the fracture care code. Modifier 54 is used to describe “Surgical care only” (see
appendix A). The HCPCS modifier RT is used to describe which arm was receiving care.
(See appendix A for RT modifier’s full description).

18. D – Knowing medical terminology will help you choose the answer for this question.
Specific medical prefixes usually fall under a specific heading, such as: the prefix
–otomy which means to “cut into”, is usually under the heading “incisions”. The prefix
–ectomy which means “to remove”, is usually found under the “excision” heading.
The prefixes – plasty and –pexy mean to repair, and so terms with these prefixes
usually fall under the heading “repair”, such as Scapulopexy. If you don’t know
medical terminology you can also try looking up the term scapulopexy in the index,
which will lead you to code 23400. Code 23400 is under the heading “Repair,
Revision, and/or Reconstruction”.

19. B – The procedure being performed in this question is a trigger point injection. Codes
64400 and 64520 are used to describe nerve blocks. These are injections involving the
nervous system, instead of injecting muscles, as was done in our scenario. This
eliminates options A and C. Codes 20552 and 20553 both describe trigger point
injections and both codes include multiple injections. Code 20552 describes 1 or more
injections into 1 – 2 muscles, and code 20553 describes 1 or more injections into 3 or
more muscles. Since only one muscle was being injected multiple times, code 20552
is correct.

20. B – In this scenario each answer has the identical codes, only with different modifiers.
Modifiers can be referenced quickly on the CPT book’s front cover, and can be found
with a full description and guidelines in Appendix A. Guidance for this question really
comes from looking at the guidelines above the two codes that were provided.
 According to osteotomy guidelines (above code 22206) when two surgeons work
together as primary surgeons performing distinct parts of an anterior spine
osteotomy each surgeon should report their distinct operative work by appending
modifier 62 to the procedure code.

21. D – “Fracture care”, as described by code 25600, includes pain management,

fracture reduction (if necessary), and initial stabilization. Since the patient came
into the physician’s office with a cast already in place we can deduct that the
patient already received initial fracture care. Coding 25600 would be inappropriate
then, because the patient was already charged for fracture care once. The
physician performed only a cast application, as described by code 29075. Option C
is also incorrect. Although the physician did remove the prior cast, it was never
specified to be a full arm cast. I was most likely a short arm cast, but you cannot
draw assumptions when coding

22. B – Most CPT books (like the one published by the AMA and required by the AAPC for
the CPC Exam), have diagrams with detailed descriptions accompanying these codes.
If your CPT book has their diagrams, reading the detailed captions will direct you to
the correct code selection. In this scenario the diagram provided for code 28290
describes the correct “medial eminence of the metatarsal bone” being removed, but
since there is no mention of the Kirschner wire used to stabilize the joint, this code is
incorrect. The diagram for code 28294 describes a bunionectomy but describes a
tendon transplant being an integral component of this procedure, and this was not
performed in our question. The diagram for code 28298 describes the removal of the
“medial eminence” and the Kirschener wire stabilization, but also includes the
additional removal of several bone wedges from the base of the phalanx. Our
scenario describes the surgeon cutting into the foot, moving tendons and other
structures out of the way, removing the medial eminence, stabilizing the joint with
Kirschner wire, and closing the patient up. This procedure is best described by code
28292, and is accurately depicted in the accompanying diagram.

23. D – Option A and C share the same description and provide different age brackets and
options B and D share the same description and provide different age brackets.
Option A and C are both for kids five years and under. Since our patient is 50 we can
eliminate options A and C. The difference between the remaining options B and D is
the description of a “tunneled” catheter versus a “non-tunneled” catheter. A
tunneled catheter is one that enters the body, tunnels under the skin, and exits the
body in a different place. A non- tunneled catheter is one that enters the body and
resides at the point of entry. Our scenario describes the catheter entering and
residing in/near the point of entry (subclavian). Most CPT books (like the AMA’s
 professional edition) provide diagrams of these procedures above or below the
corresponding codes and include a short description of the process. The diagram for
code 36556 specifically states “the catheter tip must reside in the subclavian,
innominate, or other iliac veins…”

24. A – The right lung has three lobes so when two lobes are removed it is called a
bilobectomy and when the whole lung is removed it is called a total pneumonectomy.
The left lung only has two lobes (so the heart has room to expand). When one lobe of
the left lung is removed it is called a lobectomy and when two lobes are removed it is
called a total pneumonectomy (because the whole lung is being removed). Because
our question describes the left lung, code 32482 is incorrect. Code 32482 describes a
bi-lobectomy, but in the case of the left lung, that would be the entire lung (total
pneumonectomy). A pleurectomy is the removal of the pleura, not the lung or its
lobes (32310). In our scenario a total pneumonectomy was performed, and it was in
an open fashion (not laparoscopically- 32663).

25. A – In our scenario the surgeon took a biopsy of tissue from the mediastinal space
using a scope. Noting that a scope was used we can eliminate options C and D
because these are codes describing open procedures. The difference between option
A and B is the approach used. A thoracoscopy of the mediastinal space (32606)
approaches through the chest wall and then manipulates the scope from the thorax
into the mediastinal space.
Mediastinoscopies (39400) approach by making an incision under the sternal notch at
the base of the throat and enter directly into the mediastinum.

26. C – Reading the notations below several of these codes is how you will choose the
best option here. Code 31237 states beside it “separate procedure”, which means if it
was performed at the same time as another procedure then it cannot be coded and is
bundled into the primary procedure. This means option A and B can be eliminated
because this code is listed. In addition, option B can also be eliminated because code
31201 describes an open ethmoidectomy and in our scenario it was performed
endoscopically. In option C and D code 31255 is correct and accurately describes an
anterior and posterior removal of the ethmoid sinuses. Code 31295 (in option D), was
also performed and correctly coded, however, beneath the code there is a notation
that it should not be used in conjunction with code 31267 (which is one of the correct
codes in the answer too). Code 31267 describes the nasal polyp removal, and since
we know that it cannot be used in conjunction with code 31295, option C is correct.
Option C can also be deduced by reading the multiple notations beneath code 31256.
The third notation states “for anterior and posterior ethmoidectomy (APE), and
frontal sinus exploration, with or without polyp(s) removal, use 31255 and 31276”.
27. D – Code 38308 describes surgery done on a lymphatic channel instead of a lymph
node, so this code is incorrect. What the surgeon performed was a biopsy of a lymph
node in the armpit (axilla). Code 38500 describes a biopsy, but is for a superficial one.
The procedure describes dissection through the fascia (this covers the muscle), and
the full excision of the entire lymph node (which was then sent to pathology). Code
38510 has the correct common descriptor, which begins at code 38500 and reads
“Biopsy or excision of lymph node(s);”. The unique descriptor of this code describes
the location being on the neck instead of the axilla though, so this code is also
incorrect. Code 38525 accurately describes the biopsy/excision of the deep axillary
nodes

28. D – In this question the surgeon placed a permanent dual chamber pacemaker. Code
33240 in option A describes a cardioverter-defibrillator instead of a pacemaker, this
rules out option A. Option B has the correct code 33208 to describe the pacemaker
placement with leads in both the atrial and ventricular chambers. Codes 33225 and
33202 are incorrect though, because according to the pacemaker coding guidelines
(found above code 33202) and the notations below code 33208, transvenous
placement of electrodes is included in code 33208. Codes 33225 and 33202 should
only be used when additional electrodes are placed. Code 33213 in option C describes
only the battery portion of the unit being placed. The notation below this code states
that if electrodes are coded to use 33202 or 33203 (not code 33217, as given in option
C). Option D accurately describes the placement of both the pacemaker generator and
the two transvenous electrode

29. D – The term esophagogastroduodenoscopy (abbreviated EGD) describes the viewing

of the esophagus (esophago), the stomach (gastro), and the duodenum (duodeno),
with a camera/scope (oscopy). Option A, 43202, describes an esophagoscopy with a
biopsy, but does not move farther than the esophagus. Option B, 43206, describes
use of a special type of optical endomicroscopy (not mentioned in the description),
and further, this code does not describe a full EGD. Option C correctly describes an
EGD, but a tissue sample is not the same as obtaining cells through brushing or
washing, since the physician actually took a sample, this code is also incorrect. Option
D, code 43239, uses the same common descriptor in code 43235, but the unique
descriptor (beside code 43239) correctly describes the tissue biopsy. There may also
be a diagram of code 43235 which describes a scope going through the esophagus,
stomach, and to the duodenum. This diagram may also help narrow down the options
to C and D.

30. C – By reading the Endoscopy coding guidelines (above code 45300) and the
Colonoscopy “coding tip”(above code 45355) we can learn that a sigmoidoscopy is an
endoscopy that advances to the descending colon but no further, and a colonoscopy
 is an endoscopy that advances past the splenic flexure , into the cecum, and may go
as far as the terminal ileum. The physician had planned to advance into the cecum,
which means he was going to perform a colonoscopy. He chose not to perform the
entire colonoscopy though, due to unforeseen circumstances (fecal impaction).
According to “coding tip” coding guidelines (above code 45355 in the AMA
Professional Edition), we should still code for the colonoscopy and then add modifier
53 to indicate that the entire procedure was not completed. This means that code
45378 with a 53 modifier is correct.

31. A – The operative note describes the open repair of a unilateral inguinal hernia with
mesh placement (Marlex patch). Code 49505 accurately describes the repair of a
unilateral inguinal hernia (open) and includes the mesh placement (see hernia coding
guidelines above code 49491 which state in the fourth paragraph “With the exception
of the incisional hernia repairs (49560-49566) the use of mesh or other prostheses is
not separately reported”). Beneath code 49507 there is a notation stating that if a
simple orchiectomy (removal of a testicle) is also performed during the hernia repair,
that codes 49505 and/or 49507 should be used in conjunction with code 54520. In
our scenario an orchiectomy was not performed though, so using codes 49505 or
49507 with code 54520 would be incorrect. This eliminates options B and D. Code
49568 describes the use of mesh during the repair of an incisional or ventral hernia
only (our hernia was inguinal), and beneath this code is a list of the CPT codes it
should be used in conjunction with. Code 49505 is not included in that list. Also,
remember the hernia coding guidelines (above code 49491) states that “with the
exception of the incisional hernia repairs (codes 49560-49566) the use of mesh or
other prostheses is not separately reported”.

32. A – The operative note describes an endoscopic percutaneous gastrostomy tube

placement. Code 43246 describes this correctly (see code 43235 for the common
descriptor). Modifier 62 is needed because Dr. Smith only performed the tube
placement. If he were to charge code 43246 with no modifier he would be
reimbursed for the EDG as well. Since Dr. Brown performed the EDG portion of this
code; he would also charge code 43246-62. This way each physician is reimbursed
half. Code 49440 describes a non endoscopic gastrostomy tube placement. Code
43752 is also a non- endoscopic procedure. Code 43653 is a laparoscopic procedure,
which means they created a small incision through which the camera entered the
body; instead of an endoscopic procedure, which enters the body through an existing
opening (ex. mouth).

33. C – Code 43756 is not used for evacuation of stomach contents, but for things like bile
studies. The duodenum is also where the stomach and small intestine connect, which
was not mentioned in our scenario. Code 43752 describes the placement of a
 permanent tube that is meant not for evacuation, but for introducing nutrients or
medication into the body.
Code 43753 is the correct code. Gastric intubation is the introduction of a tube into
the stomach and aspiration is synonymous with evacuation. Some CPT books (like
the AMA’s professional edition) have an added diagram of this code and a detailed
description that includes key terms like: “large-bore gastric lavage tube” and
“evacuation of stomach contents”. It also includes examples of why this code would
be used, including poisonings. Option D describes a gastric intubation as well (which
was performed here), but this code is only performed for diagnostic purposes, not
to correct an already known problem (which would be therapeutic).

34. A – The digestive system is made up of two portions: the alimentary canal, and the
accessory organs. The alimentary canal starts at the mouth and ends at the anus. The
alimentary canal is also what food passes through during the digestive process. Parts
of the alimentary canal include the mouth, esophagus, stomach, and intestines.

Accessory organs are organs that aid in digestion but do not come in direct contact
with the food. Accessory organs include the gallbladder, liver, and pancreas. This
information is not listed in the CPT book. Since the AAPC allows notations to be made
in your books, it is a good idea to make a notation regarding this beside your
digestive system diagram (prior to code 40490 and following code 39599).

35. D – This question describes a patient with renal calculi (kidney stone) and the
procedure that breaks the stone into smaller pieces, which is called lithotripsy. The
term “lith” means stone and the term “trip” means to break. Code 50590 describes
the use of the lithotripsy wave machine (C-Arm image intensifier) to send shock
waves from the outside of the body in (extracorporeal). This code may also have a
diagram describing lithotripsy in more detail. Radiology codes, such as 74425 and
76770 were not utilized here. Code 50081 describes a percutaneous procedure that
enters the kidney from the outside (likely using a needle), and then retrieves the
stone, without destroying it. Codes 50060 & 50130 both describe open procedures.
The suffix –otomy means to cut into. The terms nephrolithotomy and pyelolithotomy
both mean to cut into the kidney (nephro and pyelo both mean kidney) and remove a
stone (lith). Since neither an open procedure nor incisions were made in our scenario,
these codes are also incorrect.

36. B – Code 57155 describes the placement of small radioactive elements, which are left
in the patient for the course of treatment prescribed and then later removed. Code
57156 describes the insertion of a vaginal radiation after loading apparatus for clinical
brachytherapy. This code should be used for the placement of vaginal cylinder rods,
or similar afterloading devices. This procedure is also typically performed in a
 posthysterectomy patient. An “afterloading apparatus” is described as a technique
where the radioactivity is loaded after proper placement of the apparatus has been
confirmed. The rods (or afterloading device) should have an access port on the
outside of the body which can then be hooked up to an external machine which can
deliver either high dose or low dose rate brachytherapy. Although the patient
recently had a hysterectomy it does not state exactly how long ago or by whom, and
since we cannot assume anything modifier 58 is not applied.

37. D – Our scenario in this question is describing a vasectomy. Option A 55250-50 is not
necessary as 55250 can be used for both unilateral and bilateral procedures. Option B
and C are used to describe a vasectomy reversal. As the two suffixes imply; -ostomy
means to create a permanent opening (as in opening a ligated vas deferens) and –
orrhaphy means to repair. Depending on the version of the CPT book you own, you
may be able to locate common terms like these in the front of the manual (ex. AMA
professional edition on page xiv). Code 55250 in option D accurately describes the
performance of a vasectomy, unilateral or bilateral

38. C – PSA is an antigen tested in males to detect prostate cancer. Any reading over 10 is
considered high. In this scenario the patient is having a prostate biopsy performed to
determine if he has prostate cancer or benign prostate hypertrophy. Option A
describes a needle or catheter being placed by the transperineal approach, for the
purpose of entering small radioactive elements into the body to kill cancerous cells.
Option B also describes a transperineal approach with the use of a needle for a
prostate biopsy, however, it also describes a stereotactic template guided saturation
sampling. A saturation biopsy is an alternative technique utilized by urologists to
detect cancer in high risk patients by taking multiple samples (usually 30 or more).
This code also includes the imaging guidance so a 70000 code (like 76942) should not
be coded in addition to it. Code 55705 in option D is used to describe a biopsy taken
by an open procedure. This would include an incision and repair. Code 55700
accurately describes a prostate biopsy, by needle or punch, by any approach
(including retroperitoneal). Notations beneath this code also direct you to code 76942
for ultrasonic guidance if performed.

39. A - A hydrocele is a pathological fluid filled sack within the scrotum. This question
describes a bilateral hydrocelectomy of the tunica vaginalis. What makes this
question more difficult is that medicinally a hydrocelectomy and a hydrocele repair
are sometimes used synonymously. Code 54861in option B describes a procedure
removing both of the Epididymis tubes and has no mention of a hydrocele, so this
easily rules out option B.
Code 55000-50 in option C describes a procedure performed on both tunica vaginalis,
but it is a puncture aspiration (a hole punched with a needle to drain the fluid), so
 this can be ruled out as well since our physician performed an incision and dissection.
Code 55060 in option D and code 55041 in option A comes down to the type of
procedure and its details. Code 55060 is a “bottle type procedure, also known as
“Andrews Procedure''. This procedure requires a 2-3 cm incision in the hydrocele sack
near the superior portion (or top) and requires taking the cut edges around the cord
structures, leaving the everted sac open. Also, when choosing between these two
codes note the heading each one is under. Code 55041 is under the “Excision”
heading and code 55060 is under the “Repair” heading. In a hydrocele excision (code
55041) the majority of the sac is removed. In a hydrocele repair (code 55060) the sac
is cut open and the edges are tacked back. The procedure is also stated as being a
“hydrocelectomy” and the suffix –ectomy means to remove (similar to the excision).

40. B – Code 51797 should not be used without its primary code. Beneath code 51797 it
states that this code should be used in addition to either code 51728 or 51729. Since
options A and C utilized code 51797 without its primary code these two options are
incorrect. Code 51729 utilizes the common descriptor next to code 51726 but also
include its own unique descriptor “with voiding pressure studies”, making its full
description “Complex cystometrogram (i.e. Calibrated electronic equipment); with
voiding pressure studies”. Code 51797 is an add-on code describing the “intra
abdominal” portion and notes that it should be used in addition to code 51729. This
would make the codes in options B and C both correct. According to the Urodynamics
coding guidelines (above code 51725), if the physician did not provide the equipment
and is simply operating it and interpreting the report then modifier 26 should be
added to these codes. Since the physician in our scenario is utilizing hospital
equipment and not his own, adding modifier 26 would be correct.

41. C – Code 62160 in options A and D describe the use of a neuroendoscopy, which was
not mentioned in our scenario, so these options are correct. Options B and C are very
similar, but code 61210 describes a burr hole and code 61107 describes a twist drill
hole. The difference is that a burr hole is created with an electric drill and a special
bit, and the twist drill is a manually operated hand tool that is twisted to make a hole.
Code 61107 also describes a puncture method (performed with a needle) instead of
an incision made with a scalpel.

42. A – Keratoplasty is the term for cornea transplant where the cornea of a donor is
taken, frozen, reshaped and transplanted to the recipient

43. C – The endocrine system codes start with code 6000 and end with code 60699. The
first heading in the endocrine chapter is “thyroid gland”. Following the codes through
the chapter you come to code 60500 and the next (and final) heading (directly above
this code), which reads “Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid
 Body”. The only organ not listed in the endocrine chapter is the Lymph nodes, which
are part of the hemic-lymphatic system located at the end of the 30000 codes.

44. C – The coding guidelines above code 69990 (operating microscope) state that it
should not be coded in addition to multiple codes. Among the codes listed is code
range 65091 – 68850. Since both code 67107 and 67101 are within that code range
the operating microscope should not be coded with them. This eliminates options B
and D. Code 67101 and code 67107 differ little, but code 67107 does include the
terms “scleral buckling” and “with or without implant”. The band placed around the
eye causes scleral buckling and in the scenario there was not an implant. This code is
also further explained in some CPT books that contain diagrams.

45. C – The neurosurgeon performed a craniotomy (he cut into the skull; Cranio means
head and –otomy means to cut into), and drained an intracerebellar hematoma
(which is a collection of blood). Code 61154 describes the burr hole accurately, but no
craniotomy, it also describes the evacuation of the hematoma correctly, but it is
missing the location (intracerebellar). This means you can eliminate options A and D.
Code 61315 correctly describes the scenario, “Craniectomy or craniotomy for
evacuation of hematoma, infratentorial; intracerebellar. Although the neurosurgeon
did create a burr hole during the procedure, notations beneath code 61253 state that

“if burr holes or trephine are followed by a craniotomy at the same operative session,
use 61304-61321; do not use 61250 or 61253”

46. B – The procedure performed is a repair to a fistula in the round window. Code 69666
and code 69667 both accurately describe this procedure, but code 69666 is
performed on the oval window and code 69667 is performed on the round window.
Options A and C can be ruled out, because they describe they utilize the oval window
code instead of the round window code. There are no notations beneath code 69667
excluding modifier 50, and coding guidelines state that if a procedure is not stated as
a bilateral operation (or is not specified in the guidelines), then it is assumed to be
uni- lateral. Since code 69667 is not noted as being bilateral we must assume it is
unilateral. Since the surgeon performed this procedure on both ears, modifier 50
would be correct. Code 69990 has a list of CPT codes it cannot be coded in
conjunction with (see Operating Microscope Coding Guidelines above code 69990),
however, code 69667 is not one of them, therefore, coding 69990 in addition to code
69667 is correct

47. C - This code states that the visit may not (necessarily) require the presence of a
physician or other qualified healthcare professional (such as LPN, MA). However,
physicians or other qualified health care professionals may use this code when they
 provide this type of E/M. Code 99211 would apply in this circumstance since the
patient was seen by an LPN. The description of this code also gives a hint, as it states
this code is for visits that are “typically 5 minutes”.

48. D – Option A and and C are incorrect because the observation codes listed here
(99218) are only for patients who are admitted and discharged on two different
dates. Option B is incorrect because the description beneath this code states it,
“requires these 3 key components: Comprehensive history, comprehensive exam, and
moderate MDM”. The physician performed only a detailed history and exam (not a
comprehensive one). Although his MDM was of moderate complexity he did not
provide the other two key components at the comprehensive level. Since the
requirement of code 99235 is for all three key components to be met and only one
was, option B is also incorrect. Option D is correct because codes 99234-99236 are
used for patients who were admitted and discharged on the same day (see coding
guidelines directly above code 99234). Code 99234 also requires that all 3 key
components are met. In this scenario the first two key components (history and
exam), met the requirement of being “detailed”. The third key component (MDM),
was also met and exceeded, since the physician went beyond straightforward/low
complexity MDM and went to moderate MDM code 99234 can be used.

49. D – If you were to compare the 99291 codes in A and C to the 99471 codes in B and D
you would discover that the critical care code 99291, although good, is incorrect. The
99471 is for initial critical care for an inpatient pediatric (29 day old to 24 months).
This code is more specific since the patient was admitted (inpatient) and is only 20
months old (pediatric). This then narrows down your options between B and D. B is
incorrect because it includes a charge for the intubation, which according to the
pediatric critical care coding guidelines, is a bundled service.

50. D – The physician performed three services: Stand by, resuscitation, and an E/M. By
reading the descriptions of these codes and the guidelines provided for each code,
you can determine which of them can or cannot be code in conjunction with one
another.
The coding guidelines for code 99360 state that the code “should not be used if the
period of standby ends with the performance of a procedure”. Initially you would
think that this would then rule out the use of this code since Dr. Smith did end up
rendering a procedure (resuscitation). However, there is a special notation in
parentheses beneath code 99360 that states “99360 may be reported in addition to
99460, 99465 as appropriate”. The next CPT code 99465 describes newborn
resuscitation in the delivery room. This was the procedure that Dr. Smith provided,
and is correct. The last code is 99460. This code describes the newborn E/M that the
physician provided. This code has no special notations or exclusions and is also
 correct. There is also a notation beneath code 99465 that states “99465 may be
reported in conjunction with 99460”. This means that all three codes can be used
together.

51. D – Comparing code 99387 to 99397: Both are for an annual wellness exam, and
according to their descriptions, include age/gender appropriate history, exam,
counseling (ex. smoking cessation), guidance, risk factors, etc. Code 99387 is for a
new patient though and 99397 is for an established patient (both state the correct
age). Since Mr. Johnson is stated as being an established patient, options A and B can
be eliminated because of code 99387 (new patient). For options C and D you will then
compare codes 99205 and 99215. Both of these codes describe an in-office E/M with
a primary care physician. Code 99205 is for a new patient. This code is incorrect
because the patient is established (not new), and the MDM provided was only of
moderate complexity (this code requires high complexity MDM). Code 99214 is for an
established patient and the MDM for this code states moderate, which the physician
provided. This means option D, which includes both 99397 and 99214, is correct.

52. ANS: C
Rationale: When neonatal services are provided in the outpatient setting, Inpatient
Neonatal Critical Care guidelines direct the coder to use critical care codes 99291
Critical care, evaluation and management of the critically ill or critically injured
patient; first 30-74 minutes and 99292 … each additional 30 minutes (List separately
in addition to code for primary service). Care is documented as lasting 45 minutes
with the physician in constant attendance. The physician also administered
intrapulmonary surfactant (94610), placed an umbilical vein line (36510) and
intubated the patient (31500). These services can be separately billed as they are not
included in 99291.

53. C – The answer to this question is located in the Anesthesia coding guidelines under
the title “Time Reporting”

54. B – The lining surrounding the heart is called the pericardium, knowing this term
helps to narrow down the options. Code 00560 accurately describes the surgery that
was performed, however, this code is meant to be used for patients over the age of 1,
and does not include the oxygenator pump. Code 00561, in answer B, states that this
code is for children under 1 year of age and includes an oxygenator pump. When the
age is specified in the code’s description it is not necessary to add a qualifying
circumstance code (99100), re-stating the extreme age. Also stated directly beneath
code 00561, there is a notation stating “Do not report 00561 in conjunction with
99100, 99116, and 99135”. This eliminates option D. Option C is incorrect because it
 does not describe surgery on the pericardium, but on the great vessels of the heart
instead.

55. C - By recognizing the patient’s age you can narrow down your options to A or C
(because of the qualifying circumstance code 99100 depicts extreme age, which is
patients under the age of 1 and over the age of 70). Qualifying circumstance codes
can also be located in either the Anesthesia coding guidelines and/or in the medicine
chapter. Knowing your medical terminology will also help you eliminate options here.
Option A describes a ten-otomy, the term “-otomy” means to cut into, or to make an
incision. Option B describes a teno-desis, the suffix –esis means to remove fluid. In
our question a repair was being done though. Code 01714 uses the term tenoplasty,
and the suffix – plasty means to repair. Option C and D provide the same code, but D
does not list the qualifying circumstance code 99100. Also the P modifier for severe
asthma would be P3.

56. B – The answer to this question is found in the bottom half of paragraph two in the
Anesthesia coding guidelines.

57. C – The full CPT code has both components, technical and professional, and if the
physician did not perform both components he cannot be reimbursed for them both.
The TC modifier is used to depict the technical component, which is what the
radiologist often utilizes. Modifier 26 is the professional component, which is what
the physician should append to his CPT code. Modifier 52 is used when a physician
must terminate a procedure or attempts an entire procedure but has unsuccessful
results. A full description of modifiers 26 and 52 can be found in appendix A. Modifier
TC in a HCPCS modifier and should be referenced in the HCPCS book.

58. A – According to the chart provided above code 74176, the guidelines above that, and
the notation beneath code 74178, code 74178 is a standalone code. Guidelines state
“do not report more than one CT of the abdomen or CT of the pelvis for any single
session”. Using the chart the last box across the top should be selected (in bold)
“74170 CT of the Abdomen without contrast followed by with contrast (abbreviated
WO//W Contrast)”, and the top box on the side should be selected, “72192, CT of the
Pelvis without contrast (abbreviated WO Contrast)”. Following both selections to the
point where they meet you end up in the last box in the first (non-bold) column,
which contains code “74178”. Notations beneath this code state, “Do not report
74176 – 74178 in conjunction with 72192 – 72194, 74150– 74170

59. A – The “Aorta and Arteries” coding guidelines (above code 75600) state that a
diagnostic angiography may be reported with an interventional procedure when
performed together under specific circumstances. One such circumstance is when a
 prior report is recorded in the medical record but states there is inadequate
visualization of the anatomy. These guidelines also state modifier 59 would need to
be appended to the diagnostic radiological supervision and interpretation. To find this
information you would use the alphabetic index and look up the term
“angiography”. The index would direct you to “see aortography”. Looking up the term
“Aorta, aortography” would lead you to code 75600, and the guidelines above it.

60. B – For the bone biopsy, code 20225 accurately describes a percutaneous, deep bone,
biopsy. Code 20245 describes the same thing; only open instead of percutaneous
(requiring an incision instead of a needle). Code 38221 is a biopsy of the bone marrow
(not the actual bone). Beneath code 20225 the notations state to use either code
77002, 77012, or 77021 for radiological supervision and interpretation. Code 77012
accurately depicts the CAT scan (computed tomography). Code 76998 describes the
use of an ultrasound instead of a CAT scan, and code 73700 is used when a diagnostic
CAT scan is being taken, not a procedural one
.
61. A – There is little difference between codes 78451 and 78453. Code 78451 is done by
SPECT and includes attenuation correction and code 78453 is a planar type image. In
our scenario code 78451 is correct. This rules out options B and D. According to the
Radiology Cardiovascular System coding guidelines, (above code 78414), when a
myocardial perfusion study using codes 78451-78454 or 78472-78492 is performed in
conjunction with a stress test, then the stress test should be coded in addition to the
study using codes 93015 – 93018. In our scenario code 93016 is correct because the
physician did not provide the interpretation and report (the cardiologist did).

62. C – The fluid at the back of the fetuses’ neck is also known as the nuchal fold or the
nuchal translucency. When this is too thick it is an indication the fetus may have
Down syndrome. Option A describes an ultrasound for both the fetuses and the
mother. In our scenario only the fetuses are being evaluated though, so this
eliminates option A. Option B also includes a maternal evaluation, so this too is
incorrect. Option C correctly describes the first trimester, fetus evaluation only, is
specific to the nuchal translucency, and includes a transabdominal approach. Add-on
code 76814 is also correct when reporting multiple gestations, (per. notations
beneath code 76814, it should be used in conjunction with code 76813 when
reporting multiple gestations). Option D describes a re-evaluation to confirm a prior
finding. In our scenario there is no mention of a prior screening.

63. C – When coding a panel every test in that panel must be performed or that panel
cannot be coded. Every code listed in our scenario is listed beneath code 80053
except the TSH (which is coded using code 84443). Code 80053 also has an additional
test for Albumin listed. Since an Albumin level was not ordered we cannot use code
 80053, even with a 52 modifier. This eliminates option A. Option B lists total calcium
levels being ordered instead of ionized calcium levels, so this is incorrect. Option C is
correct because every test listed beneath code 80047 was ordered. In addition to
80047, the lab tests not listed are accurately coded individually. Option D seems like a
good option because it does accurately capture each test listed in our scenario,
however, code 80047 captures a larger number of tests while still being correct and
utilizes fewer codes overall which makes this the better option. When given the
option between choosing a panel or listing each test individually, you should select
the panel.

64. A – Only a gross examination was performed here. There is no mention of a

microscopic examination, so even though an ovary is not specifically listed beneath
code 88300, it is the only code that does not include the microscopic examination.

65. B – Appendix “A” has a full description of each modifier and how it should or
should not be used. Modifier 99 should be used when a single CPT code has two or
more modifiers appended to it. Modifier 99 could be used in place of the multiple
modifiers and the specific modifiers could then be listed elsewhere on a claim form.
Modifier 76 is meant to be used on a service and/or procedure code, not laboratory
codes. The use of modifier 76 eliminates option A. Modifier 91 is meant to be used on
laboratory codes, and is used when a test is purposely ran more than once on the
same day. Modifier 91 should only be appended to the second test and beyond
though, and not to the first test performed (like in option C). Option B is correct
because it lists each test once without a modifier and then the second and third time
each of those tests were ran modifier 91 was appended, indicating that it was
actually performed multiple times in one day. If option D was billed, the insurance
company would pay each test only once and then deny the second and third time the
test was run as a “duplicate charge”, this is because the 91 modifier was not
appended to indicate they were not duplicates.

66. B – Code 81005 is used for an analysis of the urine for things like protein, glucose, and
bacteria. This is often performed by way of a dipstick and may be accompanied by a
microscopic examination. This is not what is described in our scenario, and eliminates
options A and D. Code 81025 accurately describes a urine test that provides a positive
or negative result, in this case, pregnancy. Code 84702 and 84703 are both used
when testing for the growth hormone hCG. Code 84703 is a qualitative test and tests
if hCG is present or not. Code 84702 is a quantitative test, usually run to confirm a
pregnancy, and provides a specific level of the hormone, such as 12500 mIU/ml.

67. B – Code 89255 is used to describe a fertilized egg being prepared for implantation
into a woman’s uterus. Code 89258 is the code used when taking an embryo and
 preserving it by freezing, (the medical prefix cryo- means cold). This is what the
technician did in our scenario. Code 89268 describes the egg (oocyte) being fertilized
with the sperm to form a zygote. And code 89342 is a code that is used when an
embryo is already frozen and is simply being stored.

68. D – A glucose tolerance test (GTT) requires the patient to have a blood draw prior to
the glucose, they then receive glucose in some form, and then have their blood drawn
at intervals to determine how their body metabolizes the glucose. Code 82951 is the
correct code for this test and includes the pre-glucose blood draw, the glucose dose,
and the three blood draws following the ingestion. Code 82946 is also a tolerance
test, but it is for glucagon and not glucose. Code 82950 is a glucose test that is very
similar to the GTT, but does not require a blood draw prior to the glucose and is
usually only checked once, 2 hours after the glucose dose is received. According to
appendix “A” modifier 91 should not be used when a test is re-run due to a testing
problem. Because the issue was caused by the laboratory the patient’s insurance
should not be charged for two tests.

69. A – The physician did not perform the actual EKG but ordered another individual to
run it, so the physician cannot charge code 93000 which includes reimbursement for
performing the test. In this scenario code 93010 would accurately describe the report
and interpretation. This eliminates options B and D. Normal saline (NS) was also
infused for 1 hour and 45 minutes. According to the hydration coding guidelines
(above code 96360), normal saline is included in the 96360 and 96361 codes and can
be charged by a physician who is supervising, but not actually performing, the
hydration. Code 96360 may only be reported once for the initial hour and each
increment of time beyond that must utilize the add-on code 96361. Although the
96361 code description says it is for each additional hour, a notation beneath the
code states that code 96361 may be used for time increments of 30 minutes or
greater if the total infusion time is at least 1 hour and 30 minutes (or longer).

70. D – Reading the “End-Stage Renal Disease Services” coding guidelines (above code
90951) is the key to selecting this code. According to these guidelines code 90960 is
used when providing these services in an out-patient setting (like a physician’s office),
not for home dialysis. This eliminates option A. Code 90966 is for home dialysis and
correctly describes our patient’s age bracket (20 and older), however, according to
the coding guidelines these codes cannot be used for patients receiving services for
less than a full month (30 days). This eliminates option B. Code 90970 is the correct
code, but per. the description of this code, and per. the coding guidelines, this code
should be reported for each day of service outside any inpatient setting. This
eliminates option C and makes option D correct. The physician performed dialysis on
 the 15th – 18th (4 days), and then resumed dialysis on the 25th – 31st (7 days). For
the month the physician should charge 11 days

71. B – The simplest way to code this would be to code for one day and then just multiply
that for the number of visits in the month. When coding for a single day you would
use code 99601 as the initial peritoneal infusion code and code 99602 for the
additional hour. These codes would be used on all three days the nurse visits and
code 99509 would be added on once each week for the additional services performed
on Fridays. Code 90966 would not be correct because this code is only for physician
use (not nurses). Code 99512 is also incorrect because this code is for hemodialysis
and not peritoneal dialysis. Beneath this code there is even a notation stating that if
coding for home infusion of peritoneal dialysis to use codes 99601 and 99602. The
number of Mondays, Wednesdays, and Fridays in the month add up to 13. It would be
incorrect to code one initial infusion code (99601) and the rest of the visits as code
(99602 x25), because code 99601 states that it should be used “per visit”. This means
that code 99601 should be used for each individual date of service with the add-on
code 99602 for each date of service. (99601 x13 and 99602 x13). In a month there
were also 4 Fridays and so code 99509 would be coded as 99509 x4.

72. D –Code 93923 includes what is described in our scenario, but also has additional
studies as well (ex. 3 levels instead of 2 levels of plethysmography volume were
taken, 3 or more oxygen tension measurements were taken instead of 2. Etc.) This
eliminates options A and B. Code 93922 accurately describes what is performed in our
scenario. Requirements for using this code are also given in the coding guidelines
(above code 93880), under the heading “Noninvasive Vascular Diagnostic Studies'', in
the 5th paragraph titled, “Limited studies for lower extremity”. These guidelines
stipulations include items stated in our questions, such as “ ABI’s (ankle/brachial
indices) being taken at the posterior (back) and anterior (front) lower aspects of the
tibial and tibial/dorsalis pedis arteries; Plethysmography levels; Oxygen tension
reading, etc. The notation beneath code 93922 also states that if a single extremity,
(instead of both), are being studied to append modifier 52 to the procedure code.
73. B – Code 91010 is a manometric study, but it is of the esophagus (throat) and/or
where the stomach and esophagus meet (gastroesophageal junction; gastro meaning
stomach and esophageal meaning the esophagus). Code 91020, (Gastric motility), is
also a manometric study, and accurately describes our scenario. The term “gastric”
(or gastro), means the stomach and the word “motility” is a biological term referring
to the ability to move. In this case it is referring to the ability of food to move through
the stomach. Code 91022 is similar to code 91020, except the anatomical location is
different, it is studying the duodenum. The duodenum is the first portion of the small
intestine, and code 91022 is the study of movement through this. Code 0240T is a
category III code located between category II codes and Appendix A in the back of the
 CPT book. Code 0240T is also a motility study but this particular code is for study of
just the esophagus and/or gastroesophageal junction, and does not include the
stomach and gastric outlet into the small intestine.

74. A – To the left of each code are listed any coding conventions. Conventions each have
their own meaning which can be found with a short description at the bottom of each
page or in their full description at the front of the CPT book. The coding convention
that looks like a lightning bolt means “FDA approval pending”. Codes 90666, 90667,
and 90668 each have this convention listed beside them. Code 90664 does not have
this coding convention listed beside it, hence we know it has FDA approval

75. B – Cutting into is the term “otomy”; surgical removal is the “ectomy”; a permanent
opening is the term “ostomy”; surgical repair is the term “plasty”. Some CPT books
have common medical terms like these listed in the first few pages of the book.

76. C – In your CPT book turn to the index and look up the word vaccination. Indented
beneath vaccination look for the abbreviation MMRV or the word Measles. You will
see the full description “Measles, Mumps, Rubella, and Varicella” and beneath it you
will see the abbreviation MMRV.

77. D – Each term listed can be looked up in the CPT book’s index (if they do not exist in
the index move to the next one). Beside the term magnetic resonance imaging you
will see the abbreviation MRI.

78. A – Knowing some medical terminology is useful here. The term “salp” means tube,
the term “ooph” refers to the ovary, and the suffix “ectomy” means to surgically
remove. Some CPT books have common medical terms like these listed in the first
few pages of the book.

79. B – The answer to this question can be found the same two ways as the explanation
above describes

80. C – Some CPT books will have a few diagrams located in the front of the CPT book.
These diagrams describe body planes, regions, quadrants, and directional terms (Ex.
Posterior). If your book does not contain these diagrams try looking up the term
“femur, fracture, and then each term (distal, etc.)” in the index. The terms that do
not exist in the index should indicate they are not the correct answer. Flip to the
code provided for the terms that are in the index and look at any anatomical
diagrams. Ex. Femur, fracture, distal gives codes 27508, 27510, and 27514. If a
diagram is not provided remember that CPT codes are sequenced from the top of
 the body down, so code 27508 is closer to the hip (top of the body) and code 27514
is closer to the knee.

81. D – Again, look for an anatomical diagram first. Either in the front of the CPT or in the
guidelines of the digestive system. If no diagrams are provided in your book then try
looking up the term “abdominal” in your CPT or ICD-10 book and search for diagrams
or wording to help you.

82. B – This is another occasion that either you will find the answer in the diagrams in the
front of your CPT book, or your book does not provide them. If you do not have these
diagrams then this question would need to be an educated guess. Knowing medical
terminology could also assist here. In this case the term mid means middle

83. D – The correct open wound code is S51.829A because the wound has a foreign body.
In the alphabetic index under the term “open, wound” there is a box that describes
when to use the “complicated” option (this includes foreign bodies and infections). By
selecting code S51.829A, your choices are narrowed down to option B or D. Option B has a
second code describing a fall resulting in striking a sharp object. This is incorrect because she
struck the stove top (which was not sharp until it was broken by her fall). Option D’s second
code describes falling and striking an object and W45.8XXA describes being cut by broken
glass.

84. B

85. C – The patient does not have macular edema.

86. A – This is true according to the ICD-10-CM coding guidelines, Signs and symptoms
that are associated routinely with a disease process should not be assigned as
additional codes, unless otherwise instructed by the classification.

87. C – The coding guidelines, (found at the beginning of the ICD-10-CM manual), specify
the HIV coding rules , these guidelines state that Z21 should be coded for

asymptomatic HIV that has no documented symptoms, and may include the terms
“HIV positive”, “known HIV”, and “HIV test positive”.

88. C – Options A and D can be eliminated when comparing codes A6204 and A6252.
Code A6204 states composite dressing is used and code A6252 states special
absorptive sterile dressing is used (which is correct). When choosing between options
 B and C code A6219 meets the correct size requirements and also has an adhesive
border.

89. D – Option A is a plaster cast so it is incorrect. Option B is for a pediatric cast and it
states beneath the code that a pediatric cast is considered 0-10 years old, since the
patient is 12 this code would be incorrect. Option C meets most of the description but
it is for a splint and not a cast.

90. C – The correct answer is C for J9070. Neosar directs you to Cyclophosphamide 100
mg, which is a Chemotherapy drug used intravenously.
Answer A for J9100 is for Cytarabine 100 mg, which is not the correct medication.
Answer B for J7502 is for Cyclosporine oral medication, which is an
immunosuppressive drug.
Answer D is J8999 and is a prescription oral chemotherapeutic drug and our patient is
getting IV infusion.

91. A
92. B
93. A
94. C
95. D
96. C
97. A
98. D
99. A
100. A