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Name:
Date:
Time: 4 Hours
Medical Terminology

1. The acronym MMRV stands for

a. Measles, Mumps, and Rubella vaccine
b. Measles, Mumps, and Rosella vaccine
c. Measles, Mumps, Rubella, and Varicella
d. Measles, Mumps, Rosella, and Varicella

2. The term “Salpingo-Oophorectomy” refers to

a. The removal of the fallopian tubes and ovaries
b. The surgical sampling or removal of a fertilized
egg
c. Cutting into the fallopian tubes and ovaries for surgical
purposes d. Cutting into a fertilized egg for surgical purposes

3. Which of the following describes the removal of fluid from a body

cavity? a. Arthrocentesis
b. Amniocentesis
c. Pericardiocentesis
d. Paracentesis

4. If a surgeon cuts into a patient’s stomach, he has performed a

a. Gastrectomy
b. Gastrotomy
c. Gastrostomy
d. Gastrorrhaphy

5. The Radius is the

a. Outer bone located in the forearm
b. Outer bone located in the lower leg
c. Inner bone located in the forearm
d. Inner bone located in the lower leg

6. The portion of the femur bone that helps makes up the knee cap isconsidered
what?
a. The posterior portion
b. The proximal portion
c. The distal portion
 d. The dorsal portion

7. The round window is located in the

a. Pericardium

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b. Anterior aqueous chamber of the eye
c. Inner ear
d. Middle ear
8. The cardia fundus is
a. Part of the heart wall that causes contractions
b. Where to esophagus joins the stomach
c. A fungal infection that attacks the heart
d. Part of the female reproductive systemCoding
Concepts

9. An ABN must be signed when?

a. Once the insurance company has denied payment
b. Before the service or procedure is provided to the
patient
c. After services are rendered, but before the claim is filed
d. Once the denied claim has been appealed at the highest level

10. Wound exploration codes include the following service (s)

: a. Exploration and repair
b. Exploration, including enlargement, removal of foreign body(ies),
repair c. Exploration, including enlargement, repair, and necessary
grafting d. Exploration, including enlargement, debridement, removal of
foreign body(ies), minor vessel ligation, and repair

11. The full description of CPT code 24925 is:

a. Secondary closure or scar revision
b. Amputation, secondary closure or scar revision
c. Amputation, arm through humerus; secondary closure or scar revision d.
Amputation, arm through humerus; with primary closure, secondaryclosure or
scar revision

12. Medical necessity means what?

a. Without treatment the patient will suffer permanent disability or
death b. The service requires medical treatment
c. The condition of the patient justifies the service provided
d. The care provided met quality standards

13. Which of the following statements is false?

a. External Causes of Morbidity Codes are in the range V01-
 Y99. b. You may assign as many external cause codes as
necessary. c. External cause codes are only used in the initial
encounter.
d. External cause codes can never be a principal diagnosis.

14. Which of the following codes allows the use of modifier 51?

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a. 20975
b. 93600
c. 35500
d. 45392

15. Which of the following statements is not true regarding Medicare Part
A a. It helps cover home health care charges
b. It helps cover skilled nursing facility charges
c. It helps cover hospice charges
d. It helps cover outpatient charges

16. Which of the following is not one of the three components of HIPAA that is
enforced by the office for civil rights?
a. Protecting the privacy of individually identifiable health information b.
Setting national standards for the security of electronic protected health
information
c. Protecting identifiable information being used to analyze patient safety
events and improve patient safety
d. Setting national standards regarding the transmission and use of
protected health information

17. Which criteria would support an initial

encounter 7th character?? a. Medication
b. Evaluation and coordination for a fracture
surgery
c. Checking surgical wound sutures
d. First physical therapy evaluation

18. As defined in Medicare’s National Physician

Fee
Schedule Relative Value File, there are
three RVU
categories that, when totaled, determine payment. Which if the following is NOT
one of those RVU categories?
 a. GPCI
b. Work
c. PE
d. MP

19. Lucy was standing on a chair in her apartment’s kitchen trying to change a light
bulb when she slipped and fell. She struck the glass top stove, which shattered.
She presents to the ER with a simple laceration to her left forearm that has
embedded glass particles.
a. S51.812A, W18.02XA, W25.XXXA, Y92.030
b. S51.822A, W18.02XA, W25.XXXA, Y92.030, Y93.E9
c. S51.812A, Y92.030, W07.XXXA, W25.XXXA
d. S51.822A, W07.XXXA, W25.XXXA, Y93.E9, Y92.030

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20. A 35-year-old woman who is pregnant in her 38th week with her first child is
admitted to the hospital. She experiences a prolonged labor during the first
stage and eventually births a healthy baby boy.
a. O63.0, O09.519, Z37.0
b. O80, Z37.0
c. O80, O63.0, O09.519, Z37.0
d. O63.0, O09.513, Z37.0

21. A 60-year-old male is admitted for detoxification and rehabilitation. He has

continuously abused amphetamines to the point that he cannot voluntarily stop
on his own and has become dependent upon them. He also has a long
documented history of alcohol abuse and alcoholism. He experiences high
levels of anxiety due to PTSD, which causes him to use and abuse substances.

a. F15.10, F15.20, F10.10, F10.20, F41.1, F43.10

b. F15.20, F10.20, F41.1, F43.10
c. F19.20, F10.10, F41.1, F43.
d. F15.10, F15.20, F10.10, F10.20, F41.1,
F43.10

22. A patient fell asleep on the beach and

comes in with
blistering on her back.She is diagnosed with
second
degree solar radiation burns.
a. L55.1
b. L56.8
c. T21.23XA
d. L58.9
23. A Patient presents for C1D1 (cycle one, day one) of chemotherapy for a
neoplasm of the stomach, specifically, at the gastro esophageal junction. How is
this coded?
a. C16.9
b. Z51.0, C16.0
c. C16.9, Z51.11
d. Z51.11, C16.0

24.A Patient is issued a 22-inches seat cushion for his

wheelchair.a. E2601
b. E0950
c. E0190
d. E2602

25. Which HCPC modifier indicates the great of the right foot?
a. T1
b. T3
c. T4

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d. T5
26.A patient presents for trimming of 10 dystrophic toenails.a.
G0127 X 2, L60.0
b. G0127 X 2, G0127 X 9, L60.0
c. G0127, L60.3
d. G0127 X 5, G0127 X 5, L60.9

27. A new patient is seen in the office with complaints of fever, chills, and difficulty
breathing. The patient states that he has not been well for several weeks now
and has progressively gotten weaker. He has not been able to work for the past
week and before that was frequently absent from work over the course of two
weeks. He is uncertain how long fever has been present but believes that it has
been approximately four days. He does not have a thermometer at home and
does not know what his temperature has been. He has been sleeping in a living
room recliner because when he lies down, he has increased difficulty breathing.
The detailed history and examination centered on the respiratory and
cardiovascular systems. The upper respiratory findings included conjunctival
injection, nasal discharge, and pharyngeal erythema.
A rapid test pack was used to diagnose the viral
infection. Chest x-ray showed patchy bilateral
infiltrated. The physician diagnosed the patient with
influenza A. The medical decision-making complexity
was low. How would you report this E&M service?
 a. 99203
b. 99213
c. 99205
d. 99215

28. A three-year-old child is brought into the ER after swallowing a penny. The child
is admitted to observation. A detailed history and exam are taken on the child
and medical decision making is of moderate complexity. After three hours the
patient is discharged home.
a. 99284
b. 99235
c. 99223
d. 99222

29. A 20-month-old child is admitted to the hospital with pneumonia and acute
respiratory distress. The physician spends 3 minutes intubating the child and
spends 90 minutes of Critical Care time stabilizing the patient.
a. 99291, 99292-25, 31500, J80, J18.9
b. 99471-25, 31500, R06.89, J18.9
c. 99291-25, 99292-25, 31500, R06.89, J18.9
d. 99471, J80, J18.9

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30. At the request of a physician who is delivering for a high risk pregnancy,Dr.
Smith, a pediatrician, is present in the delivery room to assist the infant if
needed. After thirty minutes the infant is born, but is not breathing. The
delivering physician hands the infant to Dr. Smith who provides chest
compressions and resuscitates the infant. The pediatrician then performsthe
initial evaluation and management and admits the healthy newborn to the
nursery. What codes should Dr. Smith submit
on a claim?

a. 99360, 99465
b. 99465, 99460
c. 99360, 99460
d. 99360, 99465, 99460

31. The GI physician’s note in the patient’s medical

record states, “Patient with-term established
colostomy presents complaining of redness and pus
at ostomy site. Reviewed history from Jan.21, 2021, visit and remarkable
changes include redness and yellowish secretions from the ostomy site, Vital
 signs stable; Ordered culture of colostomy secretions, cleaned and replaced
colostomy tube. I spent 25 minutes with the patient and discussed infection
management, ways to keep the ostomy site free from bacteria, and medication
management options.” If the total time spent on the day of the encounter is 34
minutes, but the only documents is wjat’s in the GI physician’s note above,
which code is reported?

a. 99202
b. 99203
c. 99213
d. 99214

32. E/M services reported with CPT® code 99211 must all meet of the following
requirements EXCEPT?
a. The services are rendered under the direct supervision of the physician or
NPP.
b. The patient has a new complaint that their physician has not addressed. c.
The services are furnished as an integral, although incidental, part of the
physician’s or NPP’s professional services in the course of the diagnosis or
treatment of an injury or illness.
d. When billing incident to the physician, the physician must initiate treatment
and see the patient at a frequency that reflects their active involvement in the
patient’s case.

33.A 72-year-old male with a history of severe asthma is placed underanesthesia to

have a long tendon in his upper arm repaired
a. 01712-P4, 99100
b. 01716-P3

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c. 01714-P3, 99100
d. 01714-P4

34. Which of the following procedures can be coded separately when performedby
the anesthesiologist?
a. Administration of blood
b. Monitoring of a central venous line
c. Capnography
d. Monitoring of an EKG

35.AA 75-year-old healthy male patient sustained a hip dislocation following a fall.
He is taken to the OR and plans to be placed under general anesthesia prior to
the hip reduction. The anesthesiologist begins preparing the patient at 8:15am.
AT 8:30am the patient is induced with anesthesia and the anesthesiologist is
 monitoring the patient’s vitals, ECG, pulse ox, and capnography. The surgeon
begins the reduction at 8:45am and completes the procedure at 9:15am. The
anesthesiologist monitors the patient until 9:30am
when he releases the patient to the nurse for
post-operative supervision. At 9:45am the patient is
fully alert and taken to recovery.
How many minutes of anesthesia time should the
anesthesiologist charge for?

a. 30 minutes
b. 45 minutes
c. 1 hour
d. 1 hour and 15 minutes

36. An 81-year-old female patient with a history of well controlled type 2 diabetes
and a mild history of asthma presents to the Emergency Room withan injured
forearm. After x-rays are taken, she is sent to the operating room for an open
reduction with internal fixation for a displaced fracture of the right distal radius.
The patient was laid in the supine position on the operating table. The right arm
was prepped and draped in the normal sterile fashion. Prior to the surgery the
patient was given 1g of cefazolin intravenously. A tourniquetwas place on the
upper arm and inflated to 250 mmHg. An incision was made along the dorsal
aspect of the forearm and subcutaneous tissue was dissected to reveal the
fractured radius. A curette was used to remove the splintered ends of the radius
on each side of the fracture and a K-wire was then introduced along the radius to
stabilize it. A guide pin was then placed down the central axis of the radius. A
20mm hole was then drilled and a screw was introduced. The K-wire was then
removed and the wound was thoroughly irrigated with normal saline. The fascia
layer was closed with absorbable sutures and the epidermis was closed with
Monocryl. The wound was dressed with Vaseline gauze, 4x4s, and sterile
Sof-Rol. A long arm

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Velcro splint was then placed over this and placed in a sling. The tourniquet was
deflated after a total time of 60 minutes. The
patient was awakened, placed in his hospital
bed, and taken to the recovery room in fair
condition.
Estimated blood loss was 15cc. Sponge and
needle counts were correct. Code for the
anesthesia procedure(s) and ICD-10-CM
diagnostic codes only.
 a. 01830-P2, 99100, S52.501A, E11.9, J45.909
b. 01830-P3, 99100, S52.501B, E11.9, J45.909
c. 01810-P2, 99100, S52.501A, Z86.39, Z87.09
d. 01820-P3, 99100, S52.501B, Z86.39, Z87.09

37. John was in a fight at the local bar and presents to the ER with multiple
lacerations. The physician evaluates John and determines that he has a 2.5 cm
gash to his left forearm and a 4cm gash on his right shoulder, bothwhich require
layered closure. He also has a simple 3cm laceration on his forehead that
requires simple closure. What are the correct codes for the laceration repairs?

a. 12032-RT, 12031-LT, 12013-59, S51.822A, S41.021A, S01.81XA

b. 12032, 12013-59, S51.802A, S41.001A, S01.81XA
c. 13121, 12052-59, S41.009A, S01.81XA
d. 12032-RT-LT, 12013-59, S51.802A, S41.001A, S01.81XA

38. A patient presents to her dermatologist’s office with three suspicious looking
lesions. The dermatologist evaluates them and determines that the 1.3cm lesion
of the scalp is benign and the 1.5cm lesion of the neck is premalignant. The 2.5
cm on the dorsal surface of the patient’s hand is also evaluated and is
determined to be malignant. The dermatologist chooses to ablate all three
lesions using electrosurgery.
a. 17273, 17003, 17110
b. 17273, 17000, 17003
c. 17273, 17000-59, 17110-59
d. 17273, 17003

39. An 18-year-old female presents with a cyst of her left breast and herphysician
performs a puncture aspiration.
a. 10160
b. 10060
c. 10021
d. 19000

40. OPERATIVE REPORT

Preoperative Diagnosis: Basal Cell Carcinoma
Postoperative Diagnosis: Basal Cell Carcinoma

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Location: Mid Parietal Scalp
Procedure:
Prior to each surgical stage, the surgical site was tested for anesthesia and re
anesthetized as needed, after which it was prepped and draped in a sterile fashion.
The clinically apparent tumor was carefully defined and de-bulked prior to the first
stage, determining the extent of the surgical excision. With each stage, a thin layer of
tumor-laden tissue was excised with a narrow margin of normal appearingskin, using
the Mohs fresh tissue technique. A map was prepared to correspond to the area of skin
from which it was excised. The tissue was prepared for the cryostat and sectioned.
Each section was coded, cut and stained for microscopic examination. The entire base
and margins of the excised piece of tissue were examined by the surgeon. Areas noted
to be positive on the previous stage (if applicable) were removed with the Mohs
technique and processed for analysis.
No tumor was identified after the final stage of microscopically controlled surgery. The
patient tolerated the procedure well without any complication. After discussion with the
patient regarding the various options, the best closure option for each defect was
selected for optimal functional and cosmetic results.
Preoperative Size: 1.5 x 2.9 cm
Postoperative Size: 2.7 x 2.9 cm
Closure: Simple Linear Closure, 3.5cm, scalp
Total # of Mohs Stages: 2
Stage Sections Positive

I61
II 2 0

a. 17311, 17315, 17312, 12002

b. 17311, 17312, 12002
c. 17311, 17315, 17312
d. 17311, 17312

41. A patient with a non-healing burn wound on her right cheek and is admitted tothe
OR for surgery. The physician had the patient prepped with a Betadine scrub and
draped in the normal sterile fashion. The cheek was anesthetized with 1%
Lidocaine with 1:800,000 epinephrine (6 cc), and SeptiCare was applied. A skin
graft of the epidermis and a small portion of the dermis was taken with a Goulian
Weck blade with a six-thousands-of-an–inch-thick shimon the blade. The 25 sq cm
graft was flipped and sewn to the adjacent defect with running 5-0 Vicryl. The
wound was then dressed with Xeroform and the patient was taken to recovery.
a. 14041
b. 15115
c. 15120
d. 15758

42. The size of an excision of a benign lesion is determined by:

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a. Adding together the lesion diameter and the widest margins necessary to
adequately excise the lesion.
 b. Adding together the lesion diameter and the narrowest margins
(Minimal) necessary to adequately excise the lesion.
c. The diameter of the lesion only, excluding any margins excised with
it. d. The depth of the lesion plus the full diameter of the lesion.

43. Medical and lateral meniscus repair performed

arthroscopically.a. 27447
b. 29868
c. 29882
d. 29883

44. A patient comes into the emergency department complaining of sever wrist pain
after falling onto her out stretched hands. The physician evaluates the patient
taking a detailed history, a detailed exam, and medical decision making of
moderate complexity. Upon examination the physician notes that there is a small
portion of bone protruding through the skin. After ordering x-rays of the forearm
and wrist the patient is diagnosed with an open distal radius fracture of the right
arm. The physician provides an IV drip of morphine to the patient for pain and
reduces the fracture. 5- 0 absorbable sutures were use to close the
subcutaneous layer above the fracture and the surface was closed with 6-0
nylon interrupted sutures. Wound length was measured at 2.5 cm. It was then
dressed with sterile gauze and the wrist was stabilized with a Spica fiberglass
cast. The physician provided thepatient with a prescription for Percocet for pain
and instructions for her to follow up with her orthopedist in 7 days.

a. 99284-25, 25574-RT, S52.501B

b. 99284-57-25, 25605-54-RT, 12031,
S52.501B
c. 99284-57, 25574-54, S52.501B
d. 99284-25, 25605-RT, 12031, S52.501B

45.A A Scapulopexy is found under what

heading
a. Incision
b. Excision
c. Introduction
d. Repair, Revision, and/or Reconstruction

46.OPERATIVE NOTE
PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at
C4- C5 and C5-C6.
POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations
at C4- C5 and C5-C6.
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PROCEDURE PERFORMED:
1. Anterior discectomy, C5-C6.
2. Arthrodesis, C5-C6.
3. Partial corpectomy, C5.
4. Machine bone allograft, C5-C6.
5. Placement of anterior plate with a Zephyr C6.

ANESTHESIA: General. ESTIMATED

BLOOD LOSS: 60 mL.
COMPLICATIONS: None.
INDICATIONS: This is a patient who presents with progressive weakness in the left
upper extremity as well as imbalance. He has a very large disc herniation that came
behind the body at C5 as well and as well as a large disc herniation at C5- C6. Risks
and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion,
progressive spondylosis, and lack of improvement were all discussed. He understood
and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating roomand
placed in the supine position. Preoperative antibiotics were given. The patient was
placed in the supine position with all pressure points noted and well padded. The
patient was prepped and draped in standard fashion. An incision was made
approximately above the level of the cricoid. Blunt dissection was used to expose the
anterior portion of the spine with carotid moved laterally and trachea and esophagus
moved medially. I then placed needle into the disc spaces and wasfound to be at
C5-C6. Distracting pins were placed in the body of C6. The disc was then completely
removed at C5-C6. There was very significant compression of the cord. This was
carefully removed to avoid any type of pressure on the cord. This was very severe and
multiple free fragments noted. This was taken down to the level of ligamentum. Both
foramen were then also opened. Part of the body of C5 was taken down to assure that
all fragments were removed and that there was no additional constriction. The nerve
root was then widely decompressed. Machine bone allograft was placed into C5-C6
and then a Zephyr plate was placed in the body C6 with a metal pin placed into the
body at C5. Excellent purchase was obtained. Fluoroscopy showed good
placement and meticulous hemostasis were obtained.
Fascia was closed with 3-0 Vicryl, subcuticular 3-0
Dermabond for skin. The patient tolerated the procedure well
and went to recovery in good condition.
a. 22551, 63081, 20931, 22845
b. 22554, 63081, 20931, 22840
c. 22551, 63081, 63082, 20931, 22845
d. 22554, 63081, 20931, 22840
 47. A patient is brought into the OR for a diagnostic arthroscopy of the shoulder.
The patient has been complaining of pain since his surgery 4 months ago. The
surgeon explores the shoulder and discovers a metal clamp

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which had been left in from the prior surgery. The surgeon removed the
clamp and closed the patient up.
a. 29805, 23333
b. 29805, 29819
c. 29819-78
d. 29819

48. If a provider performs a level 3 new patient encounter coded based on medical
decision making as well as a separately
identifiable tendon sheath injection for trigger
diagnosed during the encounter, how would you
report the services?
a. 99203 only
b. 20550 ony
c. 99203,20550
d. 99203-25, 20550

49. Operative Note

PREOPERATIVE DIAGNOSIS: Angina and coronary artery disease.
POSTOPERATIVE DIAGNOSIS: Angina and coronary artery disease. PROCEDURE
DETAILS: The patient was brought to the operating room andplaced in the supine
position upon the table. After adequate general anesthesia,the patient was prepped
with Betadine soap and solution in the usual sterilemanner. Elbows were protected to
avoid ulnar neuropathy and phrenic nerveprotectors were used to protect the phrenic
nerve. All were removed at the end ofthe case.
A midline sternal skin incision was made and carried down through the sternum which
was divided with the saw. Pericardial and thymus fat pad was divided. The left internal
mammary artery was harvested and spatulated for anastomosis. Heparin was given.
The Femoropopliteal vein was resected from the thigh, side branches secured using 4-
0 silk and Hemoclips. The thigh was closed multilayer Vicryl and Dexon technique. A
Pulsavac wash was done, drain was placed. The leftinternal mammary artery is sewn
to the left anterior descending using 7-0 runningProlene technique with the Medtronic
off-pump retractors. After this was done, thepatient was fully heparinized, cannulated
with a 6.5 atrial cannula and a 2-stage venous catheter and begun on cardiopulmonary
bypass and maintained normothermia. Medtronic retractors used to expose the
circumflex. Prior to going on pump, we stapled the vein graft in place to the aorta.
Then, on pump, we did the distal anastomosis with a 7-0 running Prolene technique.
The right side graft was brought to the posterior descending artery using running 7-0
Prolene technique. Deairing procedure was carried out. The bulldog clamps were
removed. The patient maintained good normal sinus rhythm with good mean perfusion.
The patient was weaned from cardiopulmonary bypass. The arterial and venous lines
were removed and doubly secured. Protamine was delivered. Meticulous hemostasis
was present. Platelets were given for

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coagulopathy. Chest tube was placed and meticulous hemostasis was present. The
anatomy and the flow in the grafts was excellent. Closure was begun. The sternum
was closed with wire, followed by linea alba and pectus fascia closure with running 6-0
Vicryl sutures in double-layer technique. The skin was closed with subcuticular 4-0
Dexon suture technique. The patient tolerated the procedurewell and was transferred
to the intensive care unit in stable condition.

a. 35600, 35572, 33533, 33517, 32551, 36825, 33926

b. 33533, 33517, 35572
c. 33510, 33533, 35572, 32551, 36821
d. 33510, 33533, 33572

50.A patient with chronic emphysema has surgery

to remove both lobes of theleft lung
(pneumonectomy).
a. 32440
b. 32482
c. 32663x2
d. 32310

51. A thoracic surgeon makes an incision under the

sternal notch at the base of the throat, introduces the scope into the mediastinal
space and takes two biopsies of the mediastinal mass. He then retracts the
scope and closes the small incision.
a. 39401
b. 32606
c. 39000
d. 32408
52. A patient has endoscopic surgery done to remove his anterior and posterior
ethmoid sinuses. The surgeon dilated the maxillary sinus with a balloon using a
transnasal approach, explored the frontal sinuses, remove two polyps from the
maxillary sinus, and then performed the tissue removal.
 a. 31255, 31295, 31237
b. 31201, 31295, 31237
c. 31255, 31267
d. 31255, 31295, 31267

53. Operative Note

Approach: Left cephalic vein.
Leads Implanted:
Medtronic model 5076-45 in the right atrium, serial number
PJN983322V. Medtronic 5076-52 in the right ventricle, serial number
PJN961008V.

Device Implanted: Pacemaker, Dual Chamber, Medtronic EnRhythm, modelP1501VR,

serial number PNP422256H.

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Lead Performance: Atrial threshold less than 1.3 volts at 0.5 milliseconds. P wave
3.3 millivolts. Impedance 572 ohms. Right ventricle threshold 0.9 volts at 0.5
milliseconds. R wave 10.3. Impedance 855.

Procedure: The patient was brought to the electrophysiology laboratory in afasting

state and intravenous sedation was provided as needed with Versed andfentanyl. The
left neck and chest were prepped and draped in the usual mannerand the skin and
subcutaneous tissues below the left clavicle were infiltrated with1% lidocaine for local
anesthesia. A 2-1/2-inch incision was made below the leftclavicle and electrocautery
was used for hemostasis. Dissection was carried out to the level of the pectoralis
fascia and extended caudally to create a pocket for thepulse generator. The
deltopectoral groove was explored and a medium-sizedcephalic vein was identified.
The distal end of the vein was ligated and a venotomywas performed. Two guide wires
were advanced to the superior vena cava andpeel-away introducer sheaths were used
to insert the two pacing leads. The venouspressures were elevated and there was a
fair amount of back-bleeding from thevein, so a 3-0 Monocryl figure-of-eight stitch was
placed around the tissuesurrounding the vein for hemostasis. The right ventricular lead
was placed in thehigh RV septum and the right atrial lead was placed in the right atrial
appendage.The leads were tested with a pacing systems analyzer and the results are
notedabove. The leads were then anchored in place with #0-silk around their
suturesleeve and connected to the pulse generator. The pacemaker was noted to
functionappropriately. The pocket was then irrigated with antibiotic solution and
thepacemaker system was placed in the pocket. The
incision was closed with twolayers of 3-0 Monocryl and a
subcuticular closure of 4-0 Monocryl. The incision
wasdressed with Steri-Strips and a sterile bandage and
the patient was returned toher room in good condition.
 a. 33240, 33225, 33202
b. 33208, 33225, 33202
c. 33213, 33217
d. 33208

54. A cardiologist manipulates a catheter through the patient’s atrial system,

starting in the femoral artery and manipulating to the third order, using
intravascular ultrasound. The cardiologist performs radiological supervisionand
interpretation. a. 36217, 37252
b. 36217, 37252, 37253
c. 36247, 37252, 37253 X2
d. 36247, 37252, 37253

55. A patient was taken into the operating room where after induction of appropriate
anesthesia, her left chest, neck, axilla, and arm were prepped

Page 14
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with Betadine solution and draped in a sterile fashion. An incision was made at
the hairline and carried down by sharp dissection through the clavipectoral
fascia. The lymph node was palpitated in the armpit andgrasped with a figure-of
eight 2-0 silk suture and by sharp dissection, was carried to hemoclip all
attached structures. The lymph node was excised in its entirety. The wound was
irrigated. The lymph node was sent to pathology.
The wound was then closed. Hemostasis was
assured and the patient was taken to recovery
room in stable condition.

a. 38308
b. 38500
c. 38510
d. 38525

56. The patient was scheduled for an

esophagogastroduodenoscopy(EGD). Upon arrival they were placed under
conscious sedation and instructed to swallowa small flexible camera. The
camera was then manipulated into the esophagus, and through the entire length
of the esophagus. The esophagus appeared to be slightly inflamed, but there
was no sign of erosion or flame hemorrhage. A small 2cm tissue sample was
taken to look for gastroesophageal reflux disease. There was no stricture or
Barrett mucosa. The bony and the antrum of the stomach were normal without
any acute peptic lesions. Retroflexion of the tip of the endoscope in the body of
the stomach revealed an abnormal cardia. There were no acute lesions and no
 evidence of ulcer, tumor, or polyp. The pylorus was easily entered, and the first,
second, and third portions of the duodenum were normal.

a. 43202
b. 43206
c. 43235
d. 43239

57. After informed consent was obtained, the patient was placed in the left lateral
decubitus position and sedated. The Olympus video colonoscope was inserted
through the anus and was advanced in retrograde fashion through the sigmoid
colon, descending colon, and to the splenic flexure. There was a large amount
of stool at the flexure which appeared to be impacted. The physician decided not
to advance to the cecum due to the impaction and the scope was pulled back
into the descending colon and then slowly withdrawn. The mucosa was
examined in detail along the way and was entirely normal. Upon reaching the
rectum, retroflex examination of the rectum was normal. The scope was then
straightened out, the air removed, and the scope withdrawn. The patient
tolerated the procedure well.

a. 45330-53

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b. 45330
c. 45378-53
d. 45378

58. Operative Note

The 45-year-old male patient was taken to the operative suite, placed on the table in the supine
position, and given a spinal anesthetic. The right inguinal region was shaved, prepped, and
draped in a routine sterile fashion. The patient received 1 gm of Ancef IV push. A transverse
incision was made in the intraabdominal crease and carried through the skin and subcutaneous
tissue. The external oblique fascia was exposed and incised down to, and through, the external
inguinal ring. The spermatic cord and hernia sac were dissected bluntly off the undersurface of
the external oblique fascia exposing the attenuated floor of the inguinal canal. The cord was
surrounded with a Penrose drain. The sac was separated from the cord structures. The floor of
the inguinal canal, which consisted of attenuated transversalis fascia, was imbricated upon itself
with a running locked suture of 2-0 Prolene. Marlex patch 1x 4 in dimension was trimmed to an
appropriate shape with a defect to accommodate the cord. It was placed around the cord and
sutured to itself with 2-0 Prolene. The patch was then sutured medially to the pubic tubercle,
inferiorly to Cooper’s ligament and inguinal ligaments, and superiorly to conjoined tendon using
2-0 Prolene. The area was irrigated with saline solution, and 0.5% Marcaine with epinephrine
was injected to provide prolonged postoperative pain relief. The cord was returned to its
position. External oblique fascia was closed with a running 2-0
PDS, subcu with 2-0 Vicryl, and skin with running subdermal 4-0 Vicryl and Steri-Strips.
Sponge and needle counts were correct. Sterile dressing was applied.
a. 49505
b. 49505, 54520
c. 49505, 49568
d. 49505, 54520, 49568

59.A 13-year-old child has his tonsils and adenoids removed due acutetonsillitis
and chronic tonsilitis and adenoiditis.
a. 42826, 42831, J36, J35.0
b. 42826, 42836, J03.90, J35.03
c. 42821, J03.90, J35.03
d. 42821-50, J03.90, J35.0

60. Operative Note

Preoperative Diagnosis: Protein-calorie malnutrition Postoperative
Diagnosis: Protein-calorie malnutrition.

Anesthesia: Conscious sedation per Anesthesia..

Complications: None

EGD: Dr. Brown

PEG Placement: Dr. Smith

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History: The patient is a 73-year-old male who was admitted to the hospital with some
mentation changes. He was unable to sustain enough caloric intake and had markedly
decreased albumin stores. After discussion with the patient and his son they agreed to
place a PEG tube for nutritional supplementation.
Procedure: After informed consent was obtained the patient was brought to the
endoscopy suite. He was placed in the supine position and was given IV sedationby
the Anesthesia Department. An EGD was performed from above by Dr. Brown who has
dictated his finding separately. The stomach was transilluminated and anoptimal
position for the PEG tube was identified using the single poke method. The skin was
infiltrated with local and the needle and sheath were insertedthrough the abdomen into
the stomach under direct visualization. The needle was removed and a guidewire was
inserted through the sheath. The guidewire was grasped from above with a snare by
Dr. Brown. It was removed completely and thePonsky PEG tube was secured to the
guidewire. The guidewire and PEG tube were then pulled through the mouth and
esophagus and snug to the abdominal wall. There was no evidence of bleeding.
Photos were taken. The Bolster was placed on the PEG site. A complete dictation for
the EGD will be done separately by Dr. Brown. The patient tolerated the procedure well
and was transferred to recovery room in stable
condition. He will be started on tube feedings in 6 hours with
aspiration and dietary precautions to determine his nutritional goal.
What code(s) should Dr. Smith charge?
a. 43246-62
b. 49440
c. 43752
d. 43653

61. An 18-year-old female was found with a suicide note and an empty bottle of
Tylenol. She was rushed into the emergency department where she had a
large-bore gastric lavage tube inserted into her stomach and the contents were
evacuated.
a. 43756
b. 43752
c. 43753
d. 43754

62. Operative Note

History of Present Illness: Ms. Moore is status post lap band placement, the band was
placed just over a year ago and she is here for a LAP BAND ADJUSTMENT. She has a
history of problems previously with her adjustments. She has beenunder a lot of stress
recently due to a car accident she was in a couple of weeksago. Since the accident
she has been experiencing problems of “not feel full”. She states that she is not really
hungry but she does not feel full either. She also states that when she is hungry at
night she is having difficulty waiting until the morning

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to eat. She also mentioned that she had a candy bar and that seemed to make her feel
better.

Physical Examination: On exam, her temperature is 98, pulse 76, weight 197.7
pounds, blood pressure 102/72, BMI is 38.5, she has lost 3.8 pounds since her last
visit. She was alert and oriented in no apparent distress.

Procedure: I was able to access her port. She does have an AP standard low profile.I
aspirated 6 mL, I did add 1 mL, so she has got approximately 7 mL in her restrictive
device, she did tolerate water post procedure.

Assessment: The patient’s status post lap band

adjustments; doing well, has a total of 7 mL within her lap
band, tolerated water pos procedure. She will come back in
two weeks for another adjustment as needed.

a. 43771
b. 43886
 c. 43842
d. 43848

63. A patient was brought to the OR and sedated. She was then placed in the
supine position on a water filled cushion. The C-Arm image intensifier was
positioned in the correct anatomical location above the left renal and a total of
2500 high energy shock waves were applied from the outside of the body.
Energy levels were slowly started and O2 increased up to 7. Gradually the
2.5cm stone was broken into smaller pieces as the number of shocks went up.
The shocks were started at 60 per minute and slowly increased up to 90 per
minute. The patient's heart rate and blood pressure were stable throughout the
entire procedure. She was transported to recovery in good condition.
a. 50081, 74425
b. 50130, 76770
c. 50060
d. 50590

64. A patient recently underwent a total hysterectomy due to ovarian cancer, which
has metastasized. She is now having cylinder rods placed for clinical
brachytherapy treatment. Treatment will consist of high dose rate (HDR)
brachytherapy once correct placement of the rods have been confirmed.
a. 57155
b. 57156
c. 57155-58
d. 57156-58

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65.Operative Note
Epidural anesthesia was administered in the holding area, after which the patient was
transferred into the operating room. General endotracheal anesthesia was
administered, after which the patient was positioned in the flank standard position. A
left flank incision was made over the area of the twelfth rib. The subcutaneous space
was opened by using the Bovie. The ribs were palpated clearly and the fascia overlying
the intercostal space between the eleventh and twelfth rib was opened by using the
Bovie. The fascial layer covering of the intercostal space was opened completely until
the retroperitoneum was entered. Once theretroperitoneum had been entered, the
incision was extended until the peritoneal envelope could be identified. The peritoneum
was swept medially. The Finochietto retractor was then placed for exposure. The
kidney was readily identified and was mobilized from outside Gerota’s fascia. The
ureter was dissected out easily andwas separated with a vessel loop. The superior
aspect of the kidney was mobilized from the superior attachment. THE PEDICLE OF
THE LEFT KIDNEY WAS COMPLETELY DISSECTED revealing the vein and the
artery. The artery was a single artery and was dissected easily by using a right-angle
clamp. A vessel loop was placed around the renal artery. The tumor could be easily
palpated in the lateral lower pole to mid pole of the left kidney. The Gerota’s fascia
overlying that portion of the kidney was opened in the area circumferential to the tumor.
Oncethe renal capsule had been identified, the capsule was scored using a Bovie
about
0.5 cm lateral to the border of the tumor. Bulldog clamp was then placed on the renal
artery. The tumor was then bluntly dissected off of the kidney with a thin rim of a normal
renal cortex. This was performed by using the blunted end of the scalpel. The tumor
was removed easily. The argon beam coagulation device was then utilized to coagulate
the base of the resection. The visible larger bleeding vessels were oversewn by using
4-0 Vicryl suture. The edges of the kidney were then reapproximated by using 2-0
Vicryl suture with pledgets at the ends of the sutures to prevent the sutures from pulling
through. Two horizontal mattress sutures were placed and were tied down. The
Gerota’s fascia was then also closed by using 2-0 Vicryl suture. The area of the kidney
at the base was covered with Surgicel prior to tying the sutures. The bulldog clamp was
removed and perfect hemostasis was evident. There was no evidence of violation into
the calycealsystem. A 19-French Blake drain was placed in the inferior aspect of the
kidney exiting the left flank inferior to the incision. The drain was anchored by using silk
sutures. The flank fascial layers were closed in three separate layers in the more
medial aspect. The lateral posterior aspect was closed in two separate layers using
Vicryl sutures. The skin was finally re-approximated by using metallic clips. The patient
tolerated the procedure well.
a. 50545
b. 50240
c. 50220
d. 50290

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66.A 26-year-old patient who is Gravida 2 Para 1 presents to the ER in her36th
week of pregnancy with twin gestations who are monochorionic and
monoamniotic. She is in active labor, 6 cm dilated, and her water is intact. Her
OBGYN, who provided 12 antepartum visits, admitted her to labor & delivery.
Although the patient had a previous cesarean during her first pregnancy the
physician allowed her to attempt a vaginal birth. After pushing for three hours
the patient was exhausted and taken to the OR fora cesarean delivery
with a transverse incision. Two healthy newborns were born 15 minutes later.
During the hospital stay and afterward the same
physician provided the postpartum care to the
mother.
 a. 59426, 59622, 59620, O75.81, O30.013, O60.14X2, Z38.4
b. 59618, 59620-51, O75.81, O30.013, O60.14X0, O66.41, O82, Z37.2,
Z3A.36
c. 59618, 59618-51, O30.013, O66.41, O82, Z37.2, Z3A.36
d. 59618-22, O82, O60.14X2, O030.013, Z38.4

67.Procedure: Hydrocelectomy
A scrotal incision was made and further extended with electrocautery. Once the
hydrocele sac was reached we then opened and delivered the testis which drained
clear fluid. There was moderate amount of scarring on the testis itself from the tunica
vaginalis. The hydrocele sac was completely removed. A drain was then placed in the
base of the scrotum and then the testis was placed back into the scrotum in the proper
orientation. The same procedure was performed on the left. The skin was then sutured
with a running interlocking suture of 3-0 Vicryl andthe drains were sutured to place with
3-0 Vicryl. Bacitracin dressing, ABD dressing, and jock strap were placed. The patient
was in stable condition upon transfer to recovery.
a. 55041
b. 54861
c. 55000-50
d. 55060

68. A urologist performs a cystometrogram with intra-abdominal voiding

pressure(51797) studies in a hospital using calibrated electronic equipment that
is provided for his use. He interprets the study and diagnosis the patient with
neurogenic bladder.
a. 51726, 51797
b. 51729-26, 51797-26
c. 51726-26, 51797-26
d. 51729, 51797

69. Transvaginal sonographically controlled retrieval of a 26-year-old female’s

eggs by piercing the ovarian follicle with a very fine needle.
a. 58976, 76948
b. 58672

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c. 58970, 76948
d. 58940, 76948

70. Operative Note

Pre-operative Diagnosis: Increased intracranial pressure and cerebral edema dueto
severe brain injury.
Post-operative Diagnosis: Increased intracranial pressure and cerebral edema dueto
severe brain injury.
Procedure: Scalp was clipped. Patient was prepped with ChloraPrep and Betadine.
Incisions are infiltrated with 1% Xylocaine with epinephrine 1:200000. Patient did
receive antibiotics post procedure and was draped in a sterile manner. The incision
made just to the right of the right mid-pupillary line 10 cm behind the nasion. A self
retaining retractor was placed. A hole was then drilled with the cranial twist drill and the
dura was punctured. A brain needle was used to localize the ventricle and it took 3
passes to localize the ventricle. The pressure was initially high. The CSF was clear and
colorless. The CSF drainage rapidly tapered off because of the brain swelling. With two
tries, the ventricular catheter was then able to be placed into the ventricle and then
brought out through a separate puncture site; thedepth of
catheter was 7 cm from the outer table of the skull. There
was intermittent drainage of CSF after that. The catheter
was secured to the scalpwith #2-0 silk sutures and the
incision was closed with Ethilon suture. The patient
tolerated the procedure well. No complications. Sponge and
needle counts were correct. Blood loss is minimal.
a. 61107, 62160
b. 61210
c. 61107
d. 61210, 62160

71. Using the posterior approach the surgeon made a midline incision above the
underlying vertebrae and dissected down to the paravertabral muscles and
retracted then. The ligamentum flavum, lamina, and fragments of a ruptured C3-
C4 intervertebral disc were all removed. The surgeon alsoremoved a portion of
the facet to relieve the compressed
nerve of the C4 vertebrae. He then placed a free-fat graft over the exposed
nerve and the paravertabral muscles were repositioned. The patient was then
closed using layered sutures and taken to recovery.

a. 63040
b. 63075
c. 63081
d. 63170

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72. A procedure in which corneal tissue from a donor is frozen, reshaped, and
implanted into the anterior corneal stroma of the recipient to modify refractive
error.
a. 65710
 b. 65760
c. 65765
d. 65770

73. Following a motor vehicle collision a 28 year old male was given a CT scanof
the brain which indicated an infratentorial hematoma in the cerebellum. The
patient was taken to the OR where the neurosurgeon, using the CT coordinates,
incised the scalp and drilled a burr hole into the cranium above the hematoma.
Under direct visualization he then evacuated the hematoma using suction and
irrigated with NS. Hemorrhaging was controlled
and the dura was closed. The skull piece was then
placed back into the drill hole andscrewed into place.
The scalp was closed and the patient was sent to
recovery.

a. 61154
b. 61253, 61315
c. 61315
d. 61154, 61315

74. An incision was made right in the mid palm area between the thenar and
hypothenar eminence. Meticulous hemostasis of any bleeders was done. The fat
was identified. The palmar aponeurosis was identified and cut and this was
traced down to the wrist. There was severe compression of the median nerve.
Additional removal of the aponeurosis was performed to allow for further
decompression. After this was all completed, the area was irrigated with saline
and bacitracin solution and closed as a single layer using Prolene 4-0 as
interrupted vertical mattress stitches. Dressing was applied. The patient was
brought to the recovery.
a. 64702
b. 64704
c. 64719
d. 64721

75. A postauricular incision is made on the right ear. With the use of anoperating
microscope the surgeon visualizes and reflects the skin flap and posterior
eardrum forward. A small leak from the middle ear into the round window is
noted. The surgeon then roughens up the surface of the window and packs it
with fat. Upon retraction the eardrum and skin flap are replaced and the canal is
packed. The surgeon then sutures the postauricular incision. He then repeats
the procedure on the left ear.

Page 22
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 a. 69666-50, 69990
b. 69667-50, 69990
c. 69666, 69990
d. 69667-50

76. Code 60512 should not be used:

a. In conjunction with code 60260
b. As a primary code
c. As an additional code following a total
thyroidectomy
d. After code 60500

77. Some radiology codes include two components. Often a radiologist will use the
radiology equipment, which is known as the technical component, and the
physician will provide the second half of the CPT code by supervising and
interpreting the study. When this occurs what should the physician report?

a. The full CPT code

b. The CPT code with a modifier TC
c. The CPT with a modifier 26
d. The CPT with a modifier 52

78. This 69-year-old female is in for a magnetic resonance examination of the brain
because of new seizure activity. After imaging without contrast, Contrast was
administered, and further sequences were performed. Examination results
indicated no apparent neoplasm or vascular malformation.
a. 70543-26, R56.00
b. 70543-26, R56.00
c. 70553-26, R56.00
d. 70553, G40.909

79.A physician performed a deep bone biopsy of the femur. The trocar was
visualized and guided using a CAT scan and interpretation was provided. a.
20245, 77012-26
b. 20225, 77012-26
c. 38221, 76998
d. 20225, 73700

80. EXAMINATION OF: Brain

CLINICAL FINDING: Headache.
COMPUTED TOMOGRAPHY OF THE BRIAN was performed withoutcontrast
material.
 Page 23
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FINDING: There is blood within the third
ventricle. The Lateral ventriclesshow mild
dilatation with small amounts of blood.
IMPRESSION: Acute subarachnoid
hemorrhagea. 70460-26,
R51.9
b. 70250, I60.9
c. 70450-26, I60.9
d. 70450,R51.9

81. Report both the technical and professional components of the followingservices:
This 68-year-old man is seen in Radiation Oncology Department for prostate
cancer. The oncologist performs a complex clinical treatment planning,
dosimetry calculation, complex isodose plan; treatment devices include blocks,
special shields, wedges, and treatment management. The patient had 5days of
radiation treatment for 2 weeks, a total of 10 dyas of treatment.
a. 77260, 77300, 77315, 77334, C61
b. 77263, 77307, 77334, 77427 x 2, C61
c. 77263, 77300, 77315, 77334, 77427 x 2, C61
d. 77263, 77427 x 2, C61

82. EXAMINATION OF: Cervical Spine.

CLINICAL SYMPTOMS: Herniated disc.
FINDINGS: A single fluoroscopic film from the operating room is submitted for
interpretation. The cervical spine is not well demonstrated above the level of the
inferior aspect of C6. There is a metallic surgical plate seen anterior to the
cervical spine. The cephalic portion of the plate is at the level of C6 at its
superior endplate. That extends in an inferior direction, presumably anterior to
C7; however, there is not adequate visualization of C7 to confirm location.
Density overlies the C6-7 intervertebral disc space, suggesting the presence of
a bone plug in this area; however, again visualization is not adequate in this
area. Further evaluation with plain radiographs is recommended.
a. 72100-26, M51.26
b. 72020-26, M50.20
c. 72100-52-26, M50.20
d. 72020-50-26, M51.24

83. This patient is suffering from primary lung cancer and is in for a follow-up CT
scan of the thorax with contrast material. Code the physician componentonly. a.
71250-26, C78.00
 b. 71260, C34.90
c. 71260-26, C34.90
d. 71270-26, D49.1

Page 24
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84. CLINICAL HISTORY: Boil, left groin.

SPECIMEN RECEIVED: Necrotic fascia left groin and leg (anterior and
posterior).
GROSS DESCRIPTION: The specimen is labeled with the patient’s name and
“fascia left groin and leg” and consists of multiple segments of skin and soft
tissue measuring up to 30 cm in greatest dimension. The skin is unremarkable,
with the soft tissue being hemorrhagic and soft tissue being hemorrhagic and
friable and foul smelling.
MICROPIC DESCRIPTION: Sections of skin and soft tissue show coagulative
necrosis with neutrophilic exudates.
DISGNOSIS: Skin and soft tissue, left groin,
and leg, anterior and posterior showing
coagulative necrosis and acute inflammation.
a. 88304.L02.92
b. 88305-26, L44.8
c. 88304-26, L44.8, L08.9
d. 88305, L02.224

85. Report the global service.

Clinical History: Mass, left atrium.
Specimen Received: Left atrium.

GROSS DESCRIPTION: The specimen is labeled with patient's name and "left
atrial myxoma" and consists of a 4x4 2-cm ovoid mass with a partially calcified
hemorrhagic white-tan tissue.

Intraoperative Frozen Section Diagnosis: Myxoma.

Microscopic Description: Sections show a well-circumscribed mass consisting of

fibro-myxoid tissue showing numerous vascular channels. Areas of superficial
ulceration and chronic inflammatory infiltrate are noted. Areas of calcification are
also present.
Diagnosis: Myxoma, benign, left atrium.

a. 88305, D49.89
b. 88307, 88331, D15.1
c. 88307, 88331-26, D15.1
d. 88305, D15.1

86. This patient is in for a kidney biopsy (50200) because a mass was identified by
ultrasound. The specimen is sent to pathology for gross and microscopic
examination. Report the technical and professional components for thisservice.
The results were inconclusive.
a. 88305-26, N28.89
b. 88307-26, N28.89

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c. 88307, N28.89
d. 88305, N28.89

87. This 69-year-old female presents to the laboratory after her physician ordered
quantitative and qualitative assays for troponin to assist in the diagnosis of her
chief complaint of acute onset of chest pain.
a. 84484, 80299, R07.2
b. 84512, 84484, 80299, R07.89
c. 84484, 84512, R07.9
d. 84484, 84512, R07.89

88. This patient presented to the laboratory

yesterday for a creatinine measurement. The
results came back at higher-than-normal
levels; therefore, the patient was asked to
return to the laboratory today for a repeat
creatinine test before the nephrologist is
consulted. Report the second day of test only.
a. 82540 x 2, R79.89
b. 82550, R79.89
c. 82550, R79.81
d. 82540, R79.89

89. What CPT code would you use to code a bilirubin, total (transcutaneous)?a.

82252
b. 82247
c. 82248
d. 88720

90. This 34-year-old established female patient is in for her yearly physical and lab.
The physician orders a comprehensive metabolic panel, hemogram automated
 and manual differential WBC count (CBC), and a thyroid- stimulating hormone.
Code the lab only.

a. 99395, 80050
b. 80050-52
c. 80069, 80050
d. 80050

91. A 5-year-old is brought into the ER after being attacked by a stray dog. The
stray was captured and tested positive for rabies. The patient has a 3cm
laceration on his right cheek that requires simple closure and a 1cm and 4cm
laceration on his upper left arm requiring layered repair. After discussing the
benefits and risks with the patient's parents they decide to have an IM rabies
vaccination administered by the physician, due to the patient's rabies exposure.

Page 26
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a. S41.109A, S01.411A, Z23, 12013-51, 12032-51, 96372-51,

90375 b. S41.112A, S01.411A, Z20.3, 12032, 12013-51,
90460-51, 90675
c. S41.112A, S01.411A, Z23, 12013-51, 90471-51, 90675-51
d. S41.112A, S01.411A, Z20.3, 12013-51, 90471-51, 90460-51, 90375

92. A 52-year-old male is in the emergency department complaining of

dizzinessand states he passed out prior to arrival. The physician evaluates him,
orders that a 12 lead EKG be performed, and has the nurse infuse 2 liters of NS
over a 1 hour and 45-minute time period under
his supervision. TheEKG results were reviewed
by the physician and were normal. A report was
written, and the patient was diagnosed with syncope
due to dehydration and released. In addition to the
EM service what should the physician code for?
a. 93010, 96360, 96361
b. 93000, 96360
c. 93010
d. 93000, 96360, 96361

93. A45-year-old patient with end stage renal disease has in home dialysis services
initiated on the 15th of the month. The physician provides dialysis every day. On
the 19th the patient was admitted to the hospital and discharged on the 24th.
The physician and patient began in-home dialysis again on the 25th and
continued day until the 31st.
a. 90960
 b. 90966
c. 90970
d. 90970 x 11

94. A patient with a dual lead implantable cardioverter-defibrillator has his physician
initiate remote monitoring of the ICD and of cardiovascular monitor functionality
(within the ICD), to help diagnosis the patient with what he suspects is left sided
heart failure. Over the course of 90 days the physician remotely analyzes
recorded data from the device, including left atrial pressure, ventricular pressure,
and the patient's blood pressure. He also remotely analyzes data from the
defibrillator, including the heart rhythms and pace. After analysis and review the
physician compiles reports on both During this time period there was also one
in-person interrogation of the ICM device and one in person encounter for
programming and adjusting the ICD device to ensure test functions and to
optimize programming.
a. 93297 x 3, 93295, 93290, 93283
b. 93297, 93295, 93290, 93283
c. 93297, 93295, 93283
d. 93297 x 3, 93295, 93283

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95. History: Past ocular surgery history is significant for neurovascular age- related
dry macular degeneration. Patient has had laser four times to the macula on the
right and two times to the left. Exam: Established 63-year- old female patient.
On examination, lids, surrounding tissues, and palpebral fissure are all
unremarkable. Conjunctiva, sclera, cornea, and iris were all assessed as well.
Palpitation of the orbital rim revealed nothing Visual acuity with correction
measured 20/400 Ou. Manifest refraction did not improve this. There was no
afferent pupillary defect. Visual fields were grossly full to hand motions.
Intraocular pressure measured 17 mm in each eye. Vertical prism bars were
used to measure ocular deviation and a full sensorimotor examination to
evaluate the function of the ocular motor system was performed. A slit-lamp
examination was significant for dear corneas OU. There was early nuclear
sclerosis in both eyes. There was a sheet like 1-2+ posterior subcapsular
cataract on the left. Dilated examination by way of cycloplegia showed choroidal
neovascularization with subretinal heme and blood in both eyes. Magnified
inspection was obtained with a Goldman 3-mirror lens and the retina, optic disc,
and retinal vasculature were visualized. Macular degeneration was present in
both the left and right retinas.

Assessment/Plan: Advanced neurovascular age-related macular degeneration

OU, this is ultimately visually limiting. Cataracts are present in both eyes. I doubt
 cataract removal will help increase visual acuity; however, I did discuss with the
patient, especially in the left, that cataract surgery will help us better visualize
the macula for future laser treatment so that
her current vision can be maintained. We
discussed her current regiments and
decided to continue with the high doses of
the vitamins A, C and E, and the minerals
zinc and copper to help slow her
degeneration. After consideration the
patient agreed to left cataract surgery which
we scheduled for two weeks from today.
a. 92012
b. 92014
c. 92014, 92060
d. 92012, 92060, 92081

96. A 73-year-old group home resident with end stage renal disease has a nurse
come in on Mondays, Wednesdays, and Fridays to perform peritoneal dialysis.
Each dialysis session lasts three hours. Once a week, (on Friday), the nurse
also assists the patient with his meals, cleaning, and grocery shopping. What
should the nurse charge for a month (30 days) of services if the 1st of the month
landed on a Monday?

a. 99601, 99602 x 25, 99509 x 4

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b. 99601 x 13, 99602 x 13, 99509 x 4
c. 90966, 99509 x 4
d. 99512 x 13, 99509 x 4

97. Due to a suspected gastric outlet obstruction a

manometric study is performed. Using nuclear
medicine, the physician monitors the time it
takesfor food to move through the patient's
stomach, the time it take the patient's stomach to
empty into the small intestine, and how fully it
empties. How would you report the CPT for this
encounter.
a. 91010
b. 91020
c. 91022
 d. 91010, 91013

98.A physician performs a complex repair of a 16 cm facial laceration to thechin.

Code this procedure.
a. 13131, 13132, +13133
b. 13152, +13153
c. 13132, +13133
d. 13132, +13133 x 2

99. In which of the following instances is it NOT appropriate to query aphysician?

a. Clinical indicators of a diagnosis are present without documentation ofthe
diagnosis.
b. Clinical evidence suggests a higher degree of specificity.
c. Clinical findings are insignificant
d. Treatment is documented without a diagnosis

100. Which of the following modifiers is NOT used for monitored anesthesia care?
a. QS
b. G8
c. G9
d. QW

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