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Practice CPC Exam

Note: All answers have options of A-D answers. Please be sure to check the following page if all options
are not printed on one page due to a page break. Unless otherwise stated, assume that all information
provided was documented by a physician. No outside materials may be used on this exam other than
the CPT, ICD-9-CM and HCPCS Level II manuals.
Integumentary 9 Questions

1.

Patient presents with a stage III pressure ulcer of the sacrum and a stage III pressure ulcer of the
upper back. Physician performs an 18 sq.cm. debridement of the sacrum down to and including
the muscle. During the same session the physician also performed a 6 sq. cm. debridement of the
back down to and including the muscle. How should these services be reported?
a.
b.
c.
d.

11011, 11011-59
11043, 97597-59
11043, 11046
11043, 11043-59

c Per CPT Coding Guidelines for debridement you may combine sums of wounds that are the
same depth.

2.

Patient presents with ulcers of the ischium, left heel and upper back. The physician performs a 12
sq. cm. full thickness debridement of the ischium down to and including the muscle fascia. During
the same operative session the physician also performs a 10 sq. cm. debridement of the upper
back down to the muscle. The 4 sq cm heel ulcer was debrided down to the bone. How should
these services be reported?
a.
b.
c.
d.

11043, 11043-59, 11044-59


11043, 11046, 11044-59
11043, 11044-59
11043, 11046

b Per CPT Coding Guidelines for debridement in multiple wounds, sum the surface area of those
wounds that are the same depth, but do not combine the sums for different depths.

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American Medical Association.

3.

The physician excised a 5mm excised diameter benign blue nevus from the patients arm and
performed a simple closure for a patient for which the physician reported CPT 11400. A month
later (outside the postoperative period), the same patient as in the above question returned to
her surgeons office with a 2 cm malignant lesion on her arm. In order to ensure that the entire
malignancy was removed, the surgeon excised the 2 cm lesion and 2 cm skin margin (1 cm above
the lesion and 1 cm below the lesion). This was the narrowest clinical margin required to
adequately excise the lesion. How should this be reported?
a.
b.
c.
d.

11404
11602
11604
11604-58

c Based on CPT guidelines, the reporting of the excision of a lesion is based on the greatest
clinical diameter of the lesion plus the narrowest margins required for complete excision. See
guidelines preceding the Excision of Benign Lesions (11400-11471) and Excision of Malignant
Lesions (11600-11646) codes. Answer d is incorrect because the question stated that the service
was provided outside the postoperative period.

4.

A surgeon excised a benign 5 cm lesion from a patients back. An adjacent tissue transfer was
performed to repair the defect resulting from the lesion excision. The defect repaired
encompassed 11 sq. cm (including both the primary and secondary defects). What are the correct
code(s) for these services?
a.
b.
c.
d.

14001
11406, 14001-51
14000
11406, 14000-51

a The excision of the lesion is bundled into the adjacent tissue transfer codes per the Guidelines.
The procedure is reported based on the total size of the defect, not the size of the lesion.

5.

A patient presents with an infected 3 cm sebaceous cyst on her right anterior lower leg. The
surgeon decides to excise the cyst. Based on the operative report, the cyst was involving the nonmuscle fascia. After excising the cyst the physician had to close the non-muscle fascia as well as
the skin and subcutaneous tissues. What are the correct codes to be reported?
a.
b.
c.
d.

11423, 12002-51
11403, 12032-59
11404, 12042-51
11403, 12032-51

d A sebaceous cyst is a cyst on the epidermis or in a hair follicle. The guidelines for excision of
benign lesions note that a cystic lesion is a type of benign lesion. The best way to locate the code
in the index is to look up lesion, skin, excision, benign. The closure is reported separately because

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American Medical Association.

it required an intermediate repair (see guidelines for lesion excision). The modifier 51 is used
because multiple procedures are being reported.

6.

A patient presents for destruction of premalignant lesions. The patient had five lesions. What are
the correct code(s) for these services?
a.
b.
c.
d.

17000, 17003 x 4
17000, 17003
11200
17000 x 5

a The destruction of these premalignant lesions is reported based on the number of lesions
destroyed. Code 17000 describes the destruction of the first lesion and 17003 x 4 describes the
destruction of the remaining four lesions.

7.

A patient presents for destruction of three lesions. The pathologist confirmed that the lesions
were dermatofibrosarcomas. Cryosurgery was used to destroy a 1.2 cm back lesion, a 2.1 cm neck
lesion, and a 1.2 cm foot lesion. What are the correct code(s) for these services?
a.
b.
c.
d.

216.5, 216.4, 216.7, 17000, 17003


173.59, 173.49, 173.79, 17273, 17272-59, 17262-59,
173.59, 173.49, 173.79, 11602, 11602-59, 11623-59
173.89, 17262 x 3

b Dermatofibrosarcomas are defined in the ICD-9 manual as malignant neoplasms of the skin.
Malignant lesion destruction is reported based on the site and size of the lesions. Code 17273 is
reported for the destruction of the 2.1 cm malignant neck lesion. 17272-59 is reported for the
destruction of the 1.2 cm malignant back lesion. 17262-59 is reported for the destruction of the
1.2 cm malignant foot lesion.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

8.

History: 21 year old cook at a local Waffle House was admitted to the burn center after suffering
third degree burns from scalding grease involving the left shoulder and chest. The total body
surface area with a third degree burn is 10%. Procedure: The patient was brought to the operating
room and placed in a supine position. After the induction of general anesthesia, the subcutaneous
tissue beneath the full-thickness burn is infiltrated with crystalloid solution containing epinephrine
to minimize blood loss during the procedure. The eschar involving the left shoulder and anterior
chest area is excised down to clean bloody bed of viable subcutaneous tissue. A total area of 100
sq cm (40 sq cm on the arm and 60 sq cm on the chest) is excised and readied for a staged graft
procedure to be performed at a later date. Hemostasis is obtained with electrocautery,
epinephrine soaked pads and topical thrombin. The patient tolerated the procedure well and was
discharged to recovery in good condition. Estimated blood loss was 100ccs. Report the physician
services.
a.
b.
c.
d.

942.32, 943.35, 948.11, E924.0, E849.6, E015.2, E000.0, 15002


946.3, 948.11, E924.0, E849.6, E015.2, E000.0, 15002, 15220-51, 15221, 15200-51, 15201 x2
948.11, E924.2, E849.6, E015.2, E000.0, 15002, 15200-51, 15200 X 5
942.32, 943.35, 948.10, E924.0, E849.6, E015.2, E000.0, 15002

a This is a surgical preparation of a burn site. Per the Op note, 100 sq cm is excised and readied
for a staged graft procedure . 15002 is reported for preparation of specific sites involving the
trunk, arms, legs 1st 100sq cm. Answer B is incorrect because per the Official Guidelines for
burns code 946 should only be used if the location of the burns is not documented. Also, the graft
procedure was not done during this encounter per the Op note. Answer C is incorrect because
per the Official Guidelines category 948 may only be used as the first listed diagnosis when the
burn sites are not specified. Answer D is incorrect because the fifth digit of 0 for category 948
is reported when the TBSA contains less than 10% of third degree burns. Per the Op note, the
TBSA was listed as 10%.

9.

A patient presented for a percutaneous needle core biopsy of a lesion in her left breast. The
procedure was performed without imaging guidance. What is the correct code for the biopsy
procedure?
a.
b.
c.
d.

19102
11100
19100
19101

c Code 19102 would not be reported unless the procedure was performed under imaging
guidance. Code 11100 is not reported for breast biopsies. Code 19101 is not reported unless the
biopsy was performed using an open (i.e., non-percutaneous) technique.

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American Medical Association.

Musculoskeletal 10 Questions

10.

A 25 year-old construction worker presents to the emergency department with a penetrating and
traumatic open wound to his left arm. He has fallen from a ladder and a small piece of wood has
become lodged in his arm. The physician performs an exploration and enlargement of the
penetrating wound and removes the foreign body. How should these services be reported?
a.
b.
c.
d.

959.2, 20102
884.1, 20103, 24200-51
884.1, 20103
959.2, 10120

c The wound is reported as complicated due to the foreign body. See Note in the ICD-9
guidelines preceding the Open Wound codes (870-897). The removal of the foreign body is
bundled into the exploration of the wound.

11.

A driver suffered a closed LeFort fracture in a motor vehicle accident from striking a guardrail (on
a highway). The patient now presents for a midface reconstruction. The physician uses a LeFort III
technique involving a complete separation of the midfacial bones. The procedure requires bone
grafts, but is performed without LeFort I. How should these services be reported?
a.
b.
c.
d.

802.4, E815.0, E849.5, 21155


802.4, E815.0, E849.5, 21154
802.4, E816.0, E849.5, 21141
802.5, E829.8, E849.5, 21150

b A LeFort fracture is of the maxilla. The description for 21154 indicates that the bone grafts
are bundled.

12.

A physician performs an anterior interbody arthrodesis on C5-C7 including discectomy and


decompression of the spinal cord. How should the physicians services be reported?
a.
b.
c.
d.

22551, 22552, 63075-51, 63076


22551, 22552, 63075-59, 63076
22551, 22552
22554, 22585, 63075-51, 63076

c Per CPT Coding Guidelines, codes 22551 and 22552 include discectomy and decompression.
Based off the parenthetical notes under CPT codes 22554, 22585 the instruction is to assign 22551
(and 22552, if applicable) when both discectomy and fusion are performed at the same level.
Codes 63075-63076 cannot be reported separately even if performed by separate providers.

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American Medical Association.

13.

History: A 30 year old female fell while rollerblading (leisure). She suffered a closed fracture of the
distal radius of her right arm as documented on plain films in the emergency room. Procedure: She
is brought to the operating room in stable condition. She is placed in a supine position on the
operating table. After induction of general anesthesia, site is cleaned and prepped. The distal
radius is manipulated and the fracture fragments are visualized using fluoroscopic imaging. It was
determined with fluoroscopic imaging that the fracture did not require reduction prior to placing
the wires. The optimal site for wire placement is determined and a small incision was made. Tissue
protector was placed over the wire and the wire and tissue protector were passed through the
incision. The wire is drilled into position at the fracture site. After insuring correct placement, the
wire is then drilled into the second site completing the fixation process. Two more wires are
placed in similar fashion for stabilization. The patient was moved to recovery in excellent
condition. Report the physician services for this procedure.
a.
b.
c.
d.

813.52, E885.1; E006.0, E000.8, 25606, fluoroscopy included


813.42, E885.1; E006.0, E000.8, 25606, 77002-26
813.42, E885.1; E006.0, E000.8, 25600, 77002-26
813.43, E885.1; E006.0, E000.8, 25574

b 813.42, 25606 and 77002; Per the Musculoskeletal guidelines, percutaneous skeletal fixation
is where the fracture fragments are not visualized but fixation is placed via radiologic guidance.
Since fluoroscopy is not inclusive of 25606, it is appropriate to report an additional code for
fluoroscopic imaging when performed. Per the Op note, closed reduction was not performed
therefore c is incorrect. There is no mention of the ulna being involved therefore d is
incorrect. The fracture is described as a closed fracture therefore a is incorrect.

14.

In the morning, Dr. Jones attempted to treat a humeral shaft fracture with manipulation. The
procedure appeared to be successful. However, later that evening, the patient developed
additional problems relating to the fracture. Dr. Williams re-manipulated the fracture. The repeat
procedure was a success. What modifier should be appended to the code for the procedure
performed by Dr. Williams?
a.
b.
c.
d.

-77
-76
-62
-22

a This was a repeat procedure by a different physician.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

15.

A patient with scoliosis was scheduled for major surgery to repair the shape of his spine. The
physician determined that 10 vertebral segments required surgical repair. She performs posterior
arthrodesis followed by posterior segmental instrumentation. How should these services be
reported?
a.
b.
c.
d.

737.30, 22802, 22843


754.2, 22802, segmental instrumentation is bundled
737.30, 22802, 22843-51
754.2, 22812, 22847

a The scoliosis without further description is reported as acquired rather than congenital.
Acquired is a non-essential modifier.

16.

A patient presents for an excision of a benign bone tumor of the right clavicle with autograft. How
should these services be reported?
a.
b.
c.
d.

23145-RT
23140-RT; 20936-51
23150-RT
23155-RT

a Code 23145 includes the autograft and therefore it would be inappropriate to report 23140
and 20936. Code(s) 23150 and 23155 are for the proximal humerus.

17.

A general surgeon performed a deep biopsy of a soft tissue lesion in the area of the patients right
shoulder. The procedure was not a needle biopsy. While the patient is in the operating room, the
surgeon also excised a small 1 cm benign mass from the patients right hand. How should these
services be reported?
a.
b.
c.
d.

23066, 11401-59
23066, 11421-59
23076, 11421-59
23076, 11401-59

b Code 23066 is reported rather than 23076 because this case involved a soft tissue biopsy of
the shoulder area rather than the excision of soft tissue lesion in the shoulder area. The -59 is
appended to 11421 because this case involved separate sites.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

18.

A patient injured his elbow in a motorcycle accident. The physician had to excise the radial head
and replace it with an implant. How should these services be reported?
a.
b.
c.
d.

24130
24999
24365
24366

d According to the parenthetical note following 24130, when the radial head is replaced with an
implant, 24366 is reported.

19.

Dr. Jackson and Dr. Barber, two orthopedic surgeons, performed an anterior interbody arthrodesis
of L2-L3. Dr. Barber then proceeded to insert a morselized allograft and apply anterior
instrumentation across L2-L3. How should each physician report their services?
Dr. Jackson
a. 22558-62, 20930-62, 22845-62
b. 22558-62, 22585-62
c. 22558-62
d. 22558-62, 22585-62

Dr. Barber
22558-62, 20930-62, 22845-62
22554-62, 22585-62, 20930, 22845
22558-62, 20930, 22845
20930, 22845-51

c Dr Jackson was not considered a co-surgeon for the bone grafting and instrumentation. In the
guidelines, it states that modifier -62 should not be appended to the bone grafting and
instrumentation codes. L2-L3 involves only one interspace therefore 22585 would not be
appropriate. Modifier-51 cannot be appended to 22845 because it is an add-on code.
Respiratory and Cardiovascular 10 Questions

20.

A patient has nasal polyps removed from both sides of her nose. A total of 3 polyps were
removed. How should the physicians services be reported?
a.
b.
c.
d.

30110 x 3
30115-50
30110 x 2
30110-50

d In the absence of documentation that this was an extensive procedure, the coder must
assume it was simple. Per the note following 30110, the bilateral excision of simple nasal polyps
is reported using 30110-50. The number of nasal polyps excised does not affect reporting because
the code description refers to polyp(s).

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

21.

Mrs. Johnson underwent outpatient surgery for repair of a fractured left turbinate. The surgeon
ended up having to completely remove the left inferior turbinate using a surgical drill to sever it
from the lateral nasal wall. The procedure involved only mucousal nasal tissue and did not extend
into the submucousal tissue. How should the physicians services be reported?
a.
b.
c.
d.

30130-LT
30140-LT
30130-22-LT
30140-52-LT

a This was excision of a turbinate. Code 30130 is reported for the excision of a turbinate,
regardless of whether the procedure was partial or complete. It would not be appropriate to
report -22 based on the information provided because doing so would require the coder to
conclude that the use of the surgical drill made the procedure unusually complicated. In fact, it
may be that a surgical drill would always be used for this procedure. As a general rule, do not
report the -22 unless the documentation clearly indicates that there was something about this
particular case that made the procedure unusually complicated. Also, the fact that the physician
started out to do a repair and ended up doing an excision does not necessarily mean that the
excision in this case was unusually complicated as compared to other turbinate excision
procedures.

22.

A patient presented to the emergency room with an acute pneumothorax. The ER physician
performed a thoracentesis with insertion of a tube under CT guidance. The hospital owned the CT
machine. How should the physician report for these surgical services?
a.
b.
c.
d.

512.0, 32551, 77012-26


512.8, 32422, 77012-26
512.0, 32422, 75989-26
512.8, 32551, 75989-26

b Although this procedure is labeled a separate procedure it should be reported since it was
not performed as a component of a more comprehensive service. CPT code 32551 is for a tube
thoracostomy. An ostomy is a surgically created opening. In this question the patient
underwent thoracentesis which is a puncture of a cavity to remove fluid.

23.

Clara has had trouble breathing for two days. Her primary care physician referred her to an ENT.
The ENT performed a diagnostic maxillary sinusoscopy. How should the sinusoscopy be reported?
a.
b.
c.
d.

31237
31231-50
31233
31256-RT

c This was a diagnostic procedure that involved the insertion of an endoscope into a maxillary
sinus. In the absence of further documentation, the coder must assume that this was a unilateral
procedure.
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American Medical Association.

24.

Beverly had been hoarse for two weeks. Her surgeon scheduled a direct laryngoscopy with
injection of her vocal cords. During the surgery it became necessary for the surgeon to use an
operating microscope. How should the physicians services be reported?
a.
b.
c.
d.

31571
31570, 69990
31513-50
31541-50

a This was a direct procedure. Because 31571 specifically references the use of an operating
microscope, the operating microscope code (69990) is not reported with 31571.

25.

Mr. Baker was talking with his friends when he suddenly collapsed. He was admitted to the
hospital and scheduled for replacement of his dual chamber permanent pacemaker system. The
old pulse generator was replaced, and new atrial and ventricular electrodes were placed
transvenously. The skin pocket holding the pulse generator also required revision. How should
the physicians services be reported?
a.
b.
c.
d.

33214, 33222-51
33228, 33235-51, 33217-51, 33222-51
33235, 33208-51, 33222-51, 33233-51
33235, 33208-51, 33233-51

c The term system refers to both the pulse generator and electrode(s). The removal of the
old pulse generator, the removal of the old leads and the skin pocket revision are all separately
reported. A single code 33208 is reported for the reinsertion of the new system (See
parenthetical reference under code 33229). The upgrade code (33214) would not be appropriate
because that code is only used when a single chamber system is converted to a dual chamber
system.

26.

A physician replaced a dual chamber pacing cardioverter-defibrillator system. The electrodes


were removed and replaced transvenously. How should the physicians services be reported?
a.
b.
c.
d.

33223, 33243-51, 33249-51


33241, 33244-51, 33249-51
33244, 33249-51
33218, 33243-51

b Because the electrodes were removed and replaced transvenously, no thoracotomy would
have been necessary.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

27.

History: 77 year old male with chronic renal failure is seen for VAD placement.
Procedure: Ultrasound was used to reveal a patent right subclavian vein. Permanent images were
recorded. The region was anesthetized and access to the right subclavian vein was gained under
direct ultrasound guidance with a 19 gauge needle. A guidewire was advanced into the venous
system. The subcutaneous tunnel was anesthetized with Lidocaine with epinephrine. Incisions
were made at the venotomy and the chest wall exit site. A 24cm 14-FR Ashsplit catheter was
advanced from the chest wall exit site to the venotomy site with the supplied tunneling device.
Serial fascial dilation was then performed over a previously placed guidewire with final placement
of a 15-FR peel-away sheath into the subclavian vein. The dilator and wire were removed followed
by placement of the Ashsplit catheter into the venous system. The catheter was positioned at the
cavatorial junction under fluoroscopy. The peel-away sheath was removed. The venotomy was
closed with a single 3.0 Vicryl suture followed by Dermabond tissue. Assuming the procedure is
done at the facility and the ultrasound equipment is owned by the facility; report the physician
services for the procedure.
a.
b.
c.
d.

585.9; 36556, 77001-26, 76937-26


V56.0; 36569, 76937-26
V58.81; 36558, 77001-26
V58.81, 585.9; 36558; 77001-26 and 76937-26

d Both fluoroscopy and ultrasound were used during the procedure. Permanent recorded
ultrasound images were obtained during the procedure. Per CPT code 76937, ultrasonic guidance
may be reported separately when permanent image documentation is present. Use of ultrasound
without permanently recorded documentation may not be separately reported. Correct
assignment for the imaging services is also stated in the Central Venous Access Procedures
guidelines. The catheter was placed directly into the subclavian vein (centrally placed) and
tunneled to the chest wall site.

28.

Mr. Davis had a single coronary artery bypass graft in 1998 using a venous graft. Unfortunately,
the 1998 graft later became occluded and additional blockages developed. Today, the surgeon regrafted the 1998 graft using a venous graft and performed two additional grafts one venous and
one arterial. Due to Mr. Daviss peripheral vascular disease, the surgeon had to harvest a radial
artery from the patients left arm for use in doing the arterial graft. The saphenous vein was used
for the venous grafts. How should the surgeons services be reported?
a.
b.
c.
d.

33533, 33530, 35600, 33512


33533, 33530, 35600-51, 33518-51
33533, 33530, 35600, 33518
33533, 33530, 33518

c This was combined arterial-venous grafting using one arterial graft and two venous grafts.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

29.

A patient presents with a previously placed permanent biventricular pacemaker system (both
pulse generator and transvenous electrodes) in the right and left ventricles. During this encounter
the physician repositioned the pacemaker electrode in the patients left ventricle. How should the
physicians services be reported?
a.
b.
c.
d.

33215
33216
33207-76
33226

d The electrode was in the left ventricle, therefore answer a code 33215 would be incorrect.
Digestive 10 Questions

30.

A physician performs a diagnostic colonoscopy through a stoma. During the colonoscopy the
physician removes a foreign body from the colon through the scope. How would these services be
reported?
a.
b.
c.
d.

45379
44390
45378, 45378-51
44388, 44390-51

b A diagnostic colonoscopy is not reported separately when it is followed by a surgical


colonoscopy during the same surgical session. 45379 would not be appropriate because the
colonoscopy was inserted through a stoma not through the rectum.

31.

Two surgeons working together perform a partial esophagectomy with cervical esophagostomy,
without reconstruction. How would these services be reported?
a.
b.
c.
d.

43124, 43124-51
43124
43124-62 for one surgeon, 43124-62 for the second surgeon
43122-62 for one surgeon, 43122-62 for the second surgeon

c The modifier 62 is appended to report that these procedures were performed by co-surgeons.

32.

A surgeon biopsies four lesions during a rigid esophagoscopy. How would these services be
reported?
a.
b.
c.
d.

43200, 43202-51
43202 x 4
43202
43215

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

c The description of 43202 states single or multiple. Consequently the code is only reported
once even though multiple lesions were biopsied.

33.

The physician removed a foreign body during a flexible esophagoscopy under radiological
supervision and interpretation (the same physician provided both the surgical and radiological
services). The procedure was performed in a hospital. How would the physician report these
services?
a.
b.
c.
d.

43200, 74235-26
43215, radiological S&I is bundled
43216
43215, 74235-26

d Code 74235 is used to report the radiological S&I as stated in the parenthetical note under
code 43215. The modifier -26 is used to report that only the professional component of the
radiological S&I procedures was provided.

34.

A physician performed an esophagoscopy. Later that same day, the same physician performed a
colonoscopy on the same patient. What modifier is used to report the second procedure?
a.
b.
c.
d.

-51
-57
-58
-59

d Modifier -59 is appended to the secondary procedure to indicate that the procedure was
performed during a different operative session. Some students have suggested that -58 would be
a better answer. However, there was no indication in the problem that the second procedure was
planned or staged.

35.

How would a partial colectomy performed in conjunction with a take-down of the splenic
flexure be reported?
a.
b.
c.
d.

44140
44139
44140, 44139-51
44140, 44139

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

36.

A morbidly obese patient presents to the surgeon for laparoscopic insertion of gastric
neurostimulator electrodes into the lesser curvature of the stomach. How would the surgeon
report for his services?
a.
b.
c.
d.

43881
43647
43659
43647, 43659

c CPT code 43881 would not be appropriate because it was performed laparoscopically. CPT
code 43647 would be reported for implantation of gastric neurostimulator electrodes in the
antrum. The parenthetical remark under code 43648 directs the coder to use unlisted code 43659
for electrodes in the lesser curvature due to morbid obesity.

37.

When an appendectomy is performed for an indicated purpose at the time of another major
surgery, what additional code is reported for the appendectomy?
a.
b.
c.
d.

44950
This procedure is bundled within the primary procedure.
44955
44950-52

c This was an appendectomy for an indicated purpose, not an incidental appendectomy. Code
44955 would be reported as an add-on code with the code for the major surgery.

38.

A physician performs a flexible sigmoidoscopy with a biopsy of a lesion. During the same
sigmoidoscopy session, the physician removes the same lesion by bipolar cautery. How would
these services be reported?
a.
b.
c.
d.

45330, 45333-51
45331, 45333-51
45331
45333

d The biopsy of the lesion is bundled when the same lesion is biopsied and then removed
during the same endoscopic session. See Principles of CPT Coding.

39.

A general surgeon performs an initial femoral hernia repair on a 37 year-old patient, followed by
implantation of mesh. The hernia was incarcerated. How would these services be reported?
a.
b.
c.
d.

553.00, 49550
553.00, 49553, 49568
552.00, 49553, 49568
552.00, 49553

Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express
written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

d The hernia was incarcerated which is considered an obstructed hernia per the ICD-9
Alphabetic index. The implantation of mesh is bundled unless the hernia is incisional or ventral.
Although the notes for the hernia repair codes suggest that mesh implantation is only reported
separately with an incisional hernia repair, the description of 49568 clarifies that mesh
implantation is reported separately with both incisional and ventral hernia repairs.
Urinary, Genital & Obstetrics 11 Questions

40.

A patient presents with a renal abscess. The surgeon performs a percutaneous renal abscess
drainage. How should these services be reported?
a.
b.
c.
d.

50020
50021
50010
10060

41.

A single physician changed a patients nephrostomy tube using radiological guidance. The
procedure was performed in the hospital. How should these services be reported?
a.
b.
c.
d.

75984
50398, 75984
50398, the imaging is bundled
50398, 75984-26

42.

A surgeon performs a diagnostic laparoscopy followed by a laparoscopic nephrectomy (including


partial ureterectomy) during the same surgical session. How should the physicians services be
reported?
a.
b.
c.
d.

50546
49320, 50546-51
49320
50549

a The diagnostic laparoscopy is bundled into the surgical laparoscopy.

Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express
written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

43.

A physician performs an aspiration of a patients bladder. How should the physicians services be
reported?
a.
b.
c.
d.

51100
51101
51102
More information is needed

d To correctly code for the bladder aspiration, the physician must document whether this
procedure was performed by needle, trocar or intracatheter or via suprapubic catheter. The
unlisted code would, at this point, probably be inappropriate because we still do not have enough
information. In general, an unlisted code should be reported when we know what service was
provided but the service does not fit into any non-unlisted code.

44.

A patient presents with an abdominal mass and is diagnosed with a bladder tumor. The surgeon
performs a cystourethroscopy with fulguration and resects an 8 cm tumor. During this surgical
session, the physician also performs a cystourethroscopy with the insertion of an indwelling
urethral stent. How should these services be reported?
a.
b.
c.
d.

52240, the secondary procedure is bundled


52235, 52282-51
52240, 52283-51
52240, 52282-51

d Two distinct endoscopic procedures performed during the same session or performed on the
same day are separately reportable, according to Principles of CPT Coding. For the correct
reporting of the indwelling urethral stent, see the cystourethroscopy guidelines for the ureter and
pelvis.

45.

A physician performs a simple cystourethroscopy with the removal of a self-retaining indwelling


ureteral stent. This procedure is performed within the global period of a previous surgery. The
stent had been inserted during the previous surgery. How should these services be reported?
a.
b.
c.
d.

52310-78
52315-58
The stent removal is included into the post-op care and may not be reported separately.
52310-58

d The ureter and pelvis subsection guidelines in the CPT manual state that the
cystourethroscopic removal of an indwelling ureteral stent should be reported with either 52310
or 52315 with -58 appended. In this case, 52310 is reported because the procedure was simple.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

46.

A patient requires a vasovasostomy. The surgeon operates on the patient while utilizing an
operating microscope. How should these services be reported?
a.
b.
c.
d.

55300, 69990-51
55400,
55400, 69990-51
55400, 69990

d The note following 55400 indicates that the use of the operating microscope should be
separately reported.

47.

History: A 68 year old male with a PSA of 6.8 recently underwent transrectal ultrasound and
biopsy of his prostate. The biopsy was positive for adenocarcinoma of his prostate. After
discussion of various treatment modalities available; the patient has opted for intensity
modulated radiation therapy. The patient is being seen today for placement of fiducial markers for
radiation therapy guidance. Procedure: The patient is brought into the treatment room and
positioned on his left side. A digital rectal exam is performed and the anus is dilated. A transrectal
ultrasound probe is inserted into the rectum and the prostate is visualized in the transverse and
sagittal planes. Local anesthetic injection is performed at the base and at the apex of the prostate
gland for adequate peripheral nerve block, and at the perineum to allow a cutaneous block for
needle introduction. Utilizing ultrasonic needle guidance, four preloaded gold fiducial markers are
introduced and implanted bilaterally at the base and apex of the prostate. The positions of the
seeds are confirmed; the transrectal probe is removed and transrectal pressure is applied to
achieve hemostasis. The patient is discharged from the procedure room in good condition. Report
for the physicians professional services regarding procedure and imaging services performed. Do
not report for the supply item of the fiducial markers.
a.
b.
c.
d.

55875, 76965-26
55876, 77002-26
55876, 76942-26
77418-26, 76942-26

c 55876 and 76942-26; since ultrasound imaging was performed for the placement report also
for the ultrasound guidance. See parenthetical note below CPT code 55876. 55876 should be
reported once regardless of number of devices placed per the code description single or
multiple. Look up, Prostate, placement, fiducial marker.

48.

A gynecologist performs a loop electrode conization and an endocervical curettage of the cervix
via colposcopy (including upper/adjacent vagina) during the same surgical session. How should
these services be reported?
a.
b.
c.
d.

57461, 57456-51
57461, 57505-51
57522, 57505-51
57461

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

d The note following 57461 states that it is not appropriate to report 57456 in addition to
57461, therefore answer a would be incorrect. Answer b and c would be inappropriate
because the endocervical curettage was performed via a colposcope.

49.

A gynecologist performs a radical vulvectomy on a patient. The physician removes 60% of the
vulvar area. How should these services be reported?
a.
b.
c.
d.

56620
56625
56630
56633

c A partial vulvectomy is defined as a vulvectomy involving the removal of less than 80% of the
vulvar area.

50.

Rita, a patient of Dr. Smith, is pregnant for the second time. Rita delivered her first baby via
cesearean. Dr. Smith informed her that there was a very good chance for a successful vaginal
delivery this time. However, the patient elected to deliver her second baby via cesarean. Dr.
Smith provided all normal antepartum and postpartum care. How should these services be
reported?
a.
b.
c.
d.

59510
59514
59899
59620

a The subsection guidelines for delivery after previous cesarean delivery section state that an
elective cesarean delivery should be reported with code 59510, 59514 or 59515. In this case,
59510 is appropriate because the physician provided the antepartum care in addition to the
delivery and postpartum care.
Nervous, Eye and Auditory 10 Questions

51.

A patient presents with a large mass on the left side of the neck. The patient is diagnosed with a
thyroid goiter. The surgeon performs a left total thyroid lobectomy. How should the surgeons
professional services be reported?
a.
b.
c.
d.

60240-LT
60220-LT
60220
60240

b Although arguably unnecessary, the use of the -LT modifier would be the preferred method of
reporting because it provides more precise information. Note that the thyroid is a bilateral
structure.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

52.

Using an intradural approach, a physician excised an intradural lesion at the base of the anterior
cranial fossa. How should the physicians services be reported?
a.
b.
c.
d.

61583, 61601
61583, 61601-51
61581, 61608-51
61583, 61601-59

b The -51 modifier is used because both the approach and the definitive procedure were
performed at the same time at the same site.

53.

A physician percutaneously placed a spinal neurostimulator electrode catheter array into the
epidural area of the lumbar spine and subcutaneously placed a spinal neurostimulator receiver
with inductive coupling. How should the physicians services be reported?
a.
b.
c.
d.

63650, 63685-51
63650, 63685
63655, 63650-51, 63685-51
63655, 63685-59

a Code 63655 is for placement of electrods, plate/paddle via laminectomy. Modifier -51
should be appended to either 63650 or 63685 identifying multiple procedure as this requires
two codes to place the system.

54.

A patient who suffers from osteoarthritis of L3-4 and L4-5 is scheduled for paravertebral facet
joint injections of Solu-Cortef and Marcaine 2%. A facet joint is injected at L3-L4 and another
injection is performed at L4-L5. The physician utilizes fluoroscopic guidance for accurate needle
placement. The services were performed in the hospital outpatient department. How would you
report for the physicians professional service?
a.
b.
c.
d.

721.42, 64483 and 64484


721.3, 64493, 64494
721.3, 64493, 64494, 77003-26
721.90, 64490, 64491

b In the Alphabetic Index, reference Injection, paravertebral facet joint nerve. L3-L4
constitutes one level and L4-L5 constitutes a second level. Per the instructional notes prior to CPT
code 64490; Imaging guidance is an inclusive component to CPT 64490-64495. Answer a is
incorrect because the patient is not stated to have myelopathy and the injection site is not
identified as transforaminal. Answer c is incorrect because fluoroscopic guidance cannot be
reported separately. Answer d is incorrect because the location was identified as lumbar not
cervical and the ICD-9-CM code identified osteoarthritis of the lumbar region.

Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express
written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

55.

A physician performs an enucleation of Mrs. Millers right eye with placement of an implant. The
muscles were attached to the implant during the same operative session. Also during the same
operative session, the physician performed a surgical repair of the conjunctiva with conjunctival
graft. How should the physicians services be reported?
a.
b.
c.
d.

65103-RT, 68320-51-RT
65105-RT
65105-RT, 68320-51-RT
68320-RT

c The parenthetical remark following code 65105 directs the coder to use 68320 for
conjunctivoplasty after enucleation.

56.

Mr. Roberts was hit in the eye by a staple from an electric staple gun. A piece of the staple lodged
in the posterior segment of the eye. The piece of the staple was removed with a magnet via an
anterior route. How should the physicians services be reported?
a.
b.
c.
d.

65265-RT
65920
65260
67120-RT

57.

A physician performed a mechanical vitrectomy using a pars plana approach with removal of
preretinal cellular membrane via ophthalmic endoscope. During the same operative session, the
physician removed a splinter from the posterior segment using nonmagnetic extraction. How
should the physicians services be reported?
a.
b.
c.
d.

67041, 66990-51, 65265-51


67036, 67041-51, 65260-51
67041, 65265-51
67041, 66990, 65265-51

d The ophthalmic endoscope is separately reported per the notes under CPT code 67043.
Modifier-51 would not be appended to 66990 because it is an add-on code.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

58.

A physician performed a complex extracapsular cataract extraction with simultaneous insertions


of intraocular lens. The patient was diagnosed with cataracts due to type I diabetes mellitus. How
should the physicians services be reported?
a.
b.
c.
d.

250.51, 366.41, 66982


366.41, 250.41, 66984
250.51, 366.41, 66984
366.9, 250.01, 66982

59.

A physician corrected a problem with misalignment of the eye by performing strabismus surgery
on a patients lateral rectus, medial rectus and superior oblique eye muscles. Both horizontal
muscles were transposed during the procedure. How should the physicians services be reported?
a.
b.
c.
d.

67312, 67314-51, 67320


67312, 67318-51, 67320
67312, 67314-51
67312, 67318-51

b The transposition procedure is reported separately, using the add-on code 67320.

60.

A physician performed a radical tympanoplasty with mastoidectomy and reconstruction of the


ossicular chain. An oval window fistula was repaired during the same operative session. How
should the physicians services be reported?
a.
b.
c.
d.

69641, 69667-51
69636, 69666-59
69646, 69666-51
69633, 69667-59

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

c
Evaluation and Management 10 questions
Note: Answers are based off of national coding guidelines not based off any particular third party
payer (e.g., Medicare)

61.

A 59-year old male presented to the ED for treatment of trauma to the left kidney following an
auto accident. The ED physician took a history and examined the patient. The ED physician then
called in a urologist to consult on the case. Neither the urologist nor any other member of her
group has seen the patient before. The urologist saw the patient in the ED. She took a
comprehensive history and performed a comprehensive exam. Medical decision making was of
high complexity. During the course of this work-up, the urologist decided to schedule the patient
for outpatient surgery the next day. The urologist then properly documented the consult
(including the request for the consult) and communicated her opinion back the ED physician in
writing (the consultants report was filed in the patients medical record). The patient was then
released to home and instructed to return the next day for the outpatient surgical procedure.
How should the urologists E&M services be reported?
a.
b.
c.
d.

99205-57
99245-57
99245-25
99285-57

b This encounter met the criteria necessary to qualify as a consult. The -57 indicates decision
for surgery. For Medicare purposes this visit would be reported as d 99285-57.

62.

Dr. Lynn, a rheumatologist, had been treating Betty for severe rheumatoid arthritis for years.
Betty was recently in a bad car accident and was admitted into the hospital by Dr. Marty, an
orthopaedic surgeon, for treatment of a distal supracondylar fracture of the right femur. Dr.
Marty asked Dr. Lynn to manage Bettys rheumatoid arthritis while she was in the hospital,
however, he did not request a consult. Dr. Lynn saw Betty in the hospital. She took a detailed
history and performed a detailed exam. Medical decision making of moderate complexity,
including reviewing recent lab test results regarding Bettys qualitative rheumatoid factor. How
should Dr. Lynns inpatient encounter with Betty be reported?
a.
b.
c.
d.

821.23, 99253
821.23, 99221
714.0, 99233
714.0, 99233, 86430

c Per the Initial Hospital Care guidelines, only the admitting physician may report an initial
hospital care code. In this case, Dr. Lynn was neither the admitting physician, nor a consultant.
Consequently, she should report a subsequent hospital care code. Dr. Lynn was following the
patient specifically for the rheumatoid arthritis. The review of the lab test would be considered
part of the E & M service. For Medicare purposes, Dr. Lynn would report CPT code 99221 and Dr.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

Marty would report the appropriate Initial Hospital Care code (CPT 992221-99223) with modifier
AI (principal physician of record).

63.

An ED physician provided 2.5 hours of uninterrupted critical care services in the ED for a critically
ill 35 year-old established patient. A comprehensive exam was performed as a part of the critical
care services. Medical decision making was of high complexity.
a.
b.
c.
d.

99285
99291; 99292 x 3
99285-25, 99291; 99292 x 3
99285-22

b These were critical care services provided for a critically ill patient and may be reported using
the critical care codes even though the services were provided in the ED. From a coding
standpoint, the key components are not relevant in this case.

64.

Ms. Jones was seen by her primary care physician for her annual checkup one year ago. She now
presents to the same physician on her 40th birthday for another annual checkup. The physician
performed a comprehensive preventive medicine reevaluation including an age and gender
appropriate history and exam. During the preventive medicine examination, the physician
discovered that Ms. Jones had an arrhythmia. After completing the preventive medicine service,
the physician decided to take additional history and perform an additional examination to
determine whether Ms. Jones was developing atrial fibrillation. The additional history consisted
of a brief history of present illness and a problem pertinent system review. The additional exam
consisted of a complete examination of the cardiovascular system. Medical decision making
related to this follow-up work was of moderate complexity. How should this encounter be
reported?
a.
b.
c.
d.

99396, 99214-25
99396
99214
99396, 99213-25

a Based on the information provided the problem oriented visit consisted of an expanded
problem focused history, a comprehensive exam (per the E & M Services Guidelines a complete
exam of an organ system qualifies as a comprehensive exam) and medical decision making of
moderate complexity. Because she was an established patient (which only requires 2 of the 3 key
components) the problem-oriented services are reported as a level 4 established patient office
visit.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

65.

George suffers from chronic hypertension. He has been a patient of Dr. Callahans for 15 years.
George last saw Dr. Callahan regarding his hypertension 3 days ago where he provided E & M
services. During that encounter Dr. Callahan changed Georges antihypertensive medication from
Lopressor to Cozaar. Today, George calls Dr. Callahan to discuss the fact that his new medication
makes him extremely dizzy. The call lasted 14 minutes. Dr. Callahan arranges to see George the
following day in the office to address his adverse effects of the Cozaar. How should Dr. Callahans
services for today be reported?
a.
b.
c.
d.

99442
98967
99441
Not reported separately

d Per the guidelines, the telephone services codes may not be reported if the decision is made
to see the patient within the next 24 hours. Also since the patient was seen within the previous 7
days the telephone services would be considered part of the E & M provided on the previous
encounter.

66.

Sandy saw Dr. Baker, her cardiologist, for a follow-up visit relating to her coronary artery disease.
She last saw Dr. Baker two months ago. At the time of her visit with Dr. Baker, Sandy had been
experiencing shortness of breath for three days. Dr. Baker took a detailed history and performed
a problem focused exam. Medical decision making was of moderate complexity. Dr. Baker had
some concerns about Sandys shortness of breath. The following day, he asked Dr. Ross, one of
his partners to evaluate Sandys breathing problems. Dr. Ross is also a cardiologist, however, he
has a lot of experience working with cardiac patients who also have respiratory problems. Dr.
Ross documented Dr. Bakers request in Sandys chart. He took a comprehensive history and
performed a comprehensive exam. Medical decision-making was of moderate complexity. Dr.
Ross submitted a report back to Dr. Baker (which was filed in the patients medical record) listing
the services he had performed/ordered and providing his opinion on Sandys breathing problems.
What E&M codes would be used to report these services?

a.
b.
c.
d.

Dr. Baker
99213
99214
99213
99214

Dr. Ross
99244
99244
99215
99215

b Neither the fact that Dr. Ross practiced with Dr. Baker nor the fact that they are both
cardiologists preclude Dr. Ross from reporting a consult code. See Principles of CPT Coding. In this
case, Dr. Ross was asked to and did provide his opinion. He also properly documented the
consult. Determining whether the patient is new or established is not a contributing factor for
office/outpatient consultation codes (CPT 99241-99245). For Medicare purposes, answer d
would be correct. Dr. Ross would report office visit code CPT 99215 since Sandy is an established
patient to the practice.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

67.

Mr. Davis was awakened at 2 am by crushing chest pain. He called his primary care physician, Dr.
Henry, who asked him to go to the hospital emergency department immediately and wait for him.
Both Mr. Davis and Dr. Henry arrived at the ED at the same time. Dr. Henry took a comprehensive
history and performed a comprehensive exam. Medical decision making was of high complexity.
Dr. Henry then admitted Mr. Davis with a diagnosis of an acute myocardial infarction. No ED
physician was involved in the case. Because of the comprehensive nature of the services provided
in the emergency department, no additional history, exam or medical decision making was
necessary to complete the admission. What E&M code(s) would be used to report Dr. Henrys
services?
a.
b.
c.
d.

99285
99285, 99223-25
99223
99223, 99285-25

c If a patient is admitted as an inpatient in the course of an ED visit, only the inpatient


admission is reported. However, the work performed in the ED is counted for purposes of
selecting the appropriate level code for the inpatient admission. See the Initial Hospital Care
guidelines.

68.

Mr. George gets regular allergy injections, however, he had not seen his allergist, Dr. Green, for
almost a year. He presented today to Dr. Greens office complaining of mild asthma. Dr. Green
took a comprehensive history and performed a detailed exam. Medical decision making was of
moderate complexity. While Mr. George was in the office, Dr. Green gave Mr. George his regular
weekly allergy shot. How should the physician services provided during this encounter be
reported?
a.
b.
c.
d.

95115, 99203-25
95115, 99214-25
99214, 95115-25
99214

b The -25 is necessary to report that significantly separately identifiable E&M services were
provided in addition to the allergy shot.

Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express
written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

69.

Dr. Jane saw Ralph, a 30-year old HIV patient, in the office for treatment of thrush relating to his
HIV disease. Dr. Jane had not seen Ralph for over six months. Dr. Jane performed a
comprehensive history and a comprehensive exam. Medical decision making was of moderate
complexity. The total encounter lasted 90 minutes. Of the 90 minutes, 50 minutes were spent
counseling Ralph on various aspects of managing his disease and coordinating Ralphs care. Ralph
was present in the office with Dr. Jane for the entire 90 minutes. How should Dr. Jane report this
encounter?
a.
b.
c.
d.

042, 112.0, 99215, 99354


112.0, V08, 99214
112.0, V08, 99214, 99354
042, 112.0, 99215, 99354-25

a Established patient office visits only require two of the three key components. Because the
history and exam were both comprehensive, this encounter qualified as a 99215. It would also be
appropriate to report 99354 for the additional 50 minutes of prolonged services. The -25 is not
reported because 99354 is an add-on code. Per the Official Guidelines, if a patient is admitted
for an HIV-related condition, the first listed diagnosis should be 042, followed by additional
diagnosis codes for all reported HIV-related conditions.

70.

Mr. Johnson is in the intensive care unit of the hospital. Mr. Johnson sustained a massive
hemorrhage in his brain two weeks ago. Mr. Johnson is no longer considered critically ill but
remains in the intensive care unit. The attending physician, Dr. Sampson sees Mr. Johnson today.
He performs a problem-focused history, a detailed exam and medical decision making of
moderate complexity. The total encounter time was 40 minutes. How should Dr. Sampson report
this encounter?
a.
b.
c.
d.

99232
99291
99251
99252

a Answer b would be incorrect because Mr. Johnson was not critically ill during this
encounter. See the guidelines for the critical care codes services for a patient who is not critically
ill but happens to be in a critical care unit are reported using other E & M codes. This encounter
was not a consult since Dr. Sampson was the attending physician.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

Anesthesia 6 Questions

71.

An otherwise healthy ten-month old infant is administered a general anesthetic by an


anesthesiologist for a lower abdominal hernia repair. The infant was born full term. The
anesthesiologist was not involved in any other cases. What code(s) should be used to report the
anesthesia services?
a.
b.
c.
d.

00836-AA-P1
00834-AA-P1
00834-AA-P1, 99100
49495-47

b Although the qualifying circumstance add on code seems appropriate the note under CPT
code 00834 states it should not be assigned in conjunction with 00834. The baby was a full term
infant therefore CPT code 00836 would not be appropriate.

72.

A 76 year-old male with mild hypertension presents to the hospital for a scheduled surgical
bronchoscopy with bronchial alveolar lavage. Moderate sedation is administered by the surgeon
who completes the procedure. The procedure intra-service time is 30 minutes. What code(s)
should be used to report the anesthesia services?
a.
b.
c.
d.

00520-AA-P2, 99100
31624, 99100, 99144
31624-P2, 99144
31624

d CPT code 31624 is a designated procedure. When a procedure is performed in a facility


setting by the same physician performing the procedure the moderate sedation is considered an
inherent part of the procedure. The add-on code 99100 would not be reported since CPT code
31624 is not an Anesthesia code.

73.

In a rural area, an otherwise healthy female patient presents to the local 25 bed hospital with
extreme upper abdominal pain. It is 2:30 in the morning and the surgeon on call decides that she
needs an emergency splenectomy. There is no anesthesiologist present. The surgeon decides
that there is no time to waste and he performs a total splenectomy using an open technique. He
personally administered general anesthesia. How should this encounter be reported?
a.
b.
c.
d.

00790-AA-P1, 99140
38100-47, 99140
38100-47
38100-47, 00790-AA-P1, 99140

c When the surgeon performs the anesthesia, modifier 47 is appended to the surgical code. No
qualifying circumstances code should be reported. Although not entirely clear from the CPT
Manual, the AMA intends for the qualifying circumstances codes to be used only with anesthesia

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codes. See Principles of CPT Coding (stating that the qualify circumstances codes are to be used
only with anesthesia codes are not appropriate for other procedures in the CPT code set).

74.

Ms. Jones, an otherwise healthy 29 year-old, arrives at the hospital in an ambulance because she
has unexpectedly gone into labor. The CRNA quickly administers an epidural under the direction
of an anesthesiologist. Although Ms. Jones had planned to deliver vaginally, after several hours of
continued labor and minor complications, it becomes apparent that vaginal delivery was too risky.
The obstetrician performs a cesarean delivery. The CRNA also provided the anesthesia for the
cesarean delivery. What code(s) should be used to report the CRNAs anesthesia services?
a.
b.
c.
d.

01967-QX-P1, 01968-QX-P1
01967-QX-P1
01961-QX-P1
01968-QX-P1

a Code 01967 should be reported whenever an epidural is administered for a planned vaginal
delivery. If the vaginal delivery is unsuccessful, and a cesarean delivery is necessary, the add-on
code 01968 should be reported in addition to 01967. Although not entirely clear, it appears that
01961 should be reported if an epidural is administered for a planned cesarean delivery (as
opposed to a cesarean performed after a failed attempt at a vaginal delivery).

75.

Dr. Roberts, a vascular surgeon, administers a digital block to anesthetize a healthy 41 year-old
patients finger prior to performing surgery to repair a damaged blood vessel in the finger. What
code should be used to report the anesthesia services?
a.
b.
c.
d.

01850-AA-P1
35207-23
35207-47
None The anesthesia services are not separately reported.

d The digital block is bundled with the surgical procedure.

76.

A surgeon administers general anesthesia on a 70 year old male prior to performing an emergency
partial hepatectomy to control hemorrhage. How should the surgeons services be reported?
a. 47120-47-AA
b. 47120-47
c. 47120, 00792-AA-P1, 99100, 99140
d. 47120, 99100, 99140
b Regional or general anesthesia provided by a surgeon may be reported by adding modifier 47
to the procedural service. Anesthesia codes are not reported by the surgeon. Qualifying
circumstances are add-on codes intended for use with anesthesia codes. They are not reported
with surgery codes.

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American Medical Association.

77.

An anesthesiologist personally performs monitored anesthesia care for a 73 year old patient with
type II diabetes. The surgeon performs a complex craniectomy for evacuation of a deep subdural
hematoma. How should the anesthesiologists services be reported?
a.
b.
c.
d.

00210-AA-P2
00211-AA-QS-P2
00210-AA-P2, 99100
00211-AA-G8-P2, 99100

d CPT code 00211 is specific to the evacuation of a hematoma by craniectomy or craniotomy.


Patient has type II diabetes, a mild systemic disease. The modifier G8 would be appropriate
because the procedure was considered a complex surgical procedure.

78.

Mr. Bear is a 72 year-old champion golfer. Other than mild hypertension, which he has had for
years, he enjoys good health. However, his cardiologist recently determined that he had some
blockage in one of his coronary arteries. The blockage was successfully treated by an
interventional radiologist who performed percutaneous transluminal coronary balloon angioplasty
of the artery. Dr. Sue, an anesthesiologist, administered general anesthesia for the procedure
while medically directing 2 other procedures. How should Dr. Sues services be reported?
a.
b.
c.
d.

01925-AD-P2
01925-AD
01925-QK-P2, 99100
01925-QK-P2, 99100-51

c Even though the patient is relatively healthy, the extreme age qualifying circumstances code
should be used because he is over 70.
Radiology 9 Questions

79.

A physician interpreted a CT study of cervical spine (C2-C4 area) with IV contrast. How should the
physicians professional services be reported?
a.
b.
c.
d.

70491-26
70492-26
72126-26
72126-26, 62284

c Code 72126 is used to report CT studies of the cervical spine with contrast. It is not clear
whether the physician in this case injected the contrast, however, even if she did, the injection
procedure would not be separately reported because the note preceding 72125 states that IV
injection of contrast material is part of the CT procedure.

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American Medical Association.

80.

A physician interpreted a CT of the abdomen and pelvis with contrast. The films were taken by the
physicians staff in his office using x-ray equipment owned by the practice. How should these
radiology services be reported?
a.
b.
c.
d.

74177-26
74160, 72193, 74177
74177 x 2
74177

d Code 74177 identifies the performance of both studies. Per the instructional note, this code
should not be used in conjunction with 72192-72194, 74150-74170 and can only be reported once
per examination. The -26 modifier should not be reported because, in this case, the physician
provided both the technical and professional components.

81.

A 27 year-old female was seen by her OB-GYN for an annual checkup. Although the patient had
never experienced any problems with her breasts, as a part of the checkup, her OB-GYN referred
her to a local freestanding (i.e., not hospital affiliated) womens imaging center for her bi-annual
mammogram. Two views were taken of each breast. After the patient left, the radiologist on duty
at the imaging center interpreted the films. The images were then digitized and analyzed by
computer. The physician then interpreted the digitized images and computerized analysis. The
radiologist found a small mass in the left breast and reported her findings back to the OB-GYN the
next day. The imaging center bills globally. How should the services provided by the imaging
center be reported?
a.
b.
c.
d.

77057, 77052
77057-26
77055, 77052
77055-26, 77057-26

a This mammogram should be reported as a screening mammogram because the patient was
asymptomatic at the time of the mammogram. The fact that a potential problem was found does
not affect how this mammogram should be reported (although any follow-up mammograms to
further explore the mass would be reported as diagnostic mammograms). The -26 is not reported
because the imaging center provided both the technical and professional components.

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American Medical Association.

82.

An interventional radiologist performed an arteriogram via the common femoral artery. The
physician guided the catheter into the arch of the aorta, contrast was injected and images were
interpreted. The radiologist then manipulated the catheter through the left subclavian artery
(first order, thoracic branch) and into the left vertebral artery (second order, thoracic branch in
the same family as the subclavian artery) where contrast was injected. Images of the left
vertebral artery in the neck were obtained and interpreted. How should this interventional
radiology session be reported?
a.
b.
c.
d.

36245, 36246-LT, 75650-26, 75685-26


36200, 36215-LT, 36216-LT, 75650-26, 75685-26
36215, 36216-LT, 75685-26
36216, 75650-26, 75685-26

d The introduction of the catheter into the left common femoral artery (i.e., the puncture site)
is not separately reported. Code 36200 would not be reported because once you have selectively
catheterized a vessel (through the same access site) then the non-selective catheter placement is
not reported. Code 36245 and 36246 are not appropriate because they are for selective
catheterizations of the abdominal, pelvic or lower extremity arteries. Code 36215 would not be
reported because all lesser families used in the approach are not separately reported.

83.

A physician performed a percutaneous needle core biopsy of a breast lesion using mammographic
guidance to place the needle. How should the physicians professional services be reported?
a.
b.
c.
d.

19100, 77032-26
19102, 77032-26
19102, 76942-26
19102, 77031-26

b As suggested by the note following 19103, the imaging guidance is reported separately in
addition to code for the biopsy.

84.

How would a radiation oncologist report the professional services required to develop a clinical
treatment plan involving three converging ports, two treatment areas and multiple blocks?
a.
b.
c.
d.

77285
77407
77262
77263

c This was intermediate clinical treatment planning.

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American Medical Association.

85.

A hospital inpatient underwent five different radiation therapy sessions. Each session involved a
single treatment area and parallel opposed ports. A total of 5 MeV of energy was delivered during
each of the treatment sessions. How should the hospital report the delivery of this radiation
treatment?
a.
b.
c.
d.

77402 x 5
77427
77407
77406

a Radiation treatment delivery is a technical component service. Each session is reported


separately based on complexity of the treatment and the total energy delivered during the
session.

86.

A patient underwent a complete course of radiation therapy involving a total of seven fractions
(i.e., treatment sessions) over a two-week period. Each fraction involved multiple treatment
areas. A total of 10 MeV of energy was delivered during each of the treatment sessions. How
should the radiation oncologist report the radiation treatment management services he provided
in connection with this course of therapy?
a.
b.
c.
d.

77427 x 7
77427
77427, 77431
77413 x 7

b The last two fractions at the end of the course of therapy are not separately reported.

87.

Mr. Mays was treated for prostate cancer five years ago. Mr. Mays is now presenting to the
hospital for a PET (positron emission tomography) scan for tumor imaging of his head for
detection of brain metastases. The physician concurrently performs a CT of the head without
contrast to localize the anatomic location to be studied. During the same encounter, the same
physician also performs a CT of the chest without contrast to determine the cause of Mr. Mays
severe chest pain he has been experiencing over the past few months. How should the physicians
professional services be reported?
a.
b.
c.
d.

78814-26, 70450-26-59, 71250-26-59


78815-26
78814-26, 71250-26-59
78814, 71250-59

c The use of CT for localization of the anatomic location is included in the code description
therefore would not be separately reported. However, per the note under CPT code 78816, a
code should be assigned with a -59 modifier for CTs performed other than for localization.

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American Medical Association.

Laboratory & Pathology 10 Questions

88.

A physician ordered an electrolyte panel from a local laboratory company. The order form
supplied by this company indicates the following tests are always included whenever an
electrolyte panel is ordered: carbon dioxide, chloride, glucose, potassium and sodium. The lab
company performed all of these tests. How should the lab company report these services?
a.
b.
c.
d.

82374, 82435, 84132, 84295, 82947


80051, 82374, 82435, 84132, 84295, 82947
80051
80051, 82947

d This panel included the entire electrolyte panel as defined by CPT plus a glucose test. The
panel code must be reported for the electrolyte panel. The glucose test may be separately
reported in addition to the panel.

89.

Multiple drug class chromatographic drug testing was performed to determine whether a patient
had amphetamines and opiates in his system. A single stationary phase was run to test for both
drug classes. However, two separate mobile phases were required to complete the testing. How
should these lab services be reported?
a.
b.
c.
d.

80100 x 2
80101 x 2
80100, 80101
80100

a Multiple drug class chromatographic drug testing is reported using 80100 once for each
procedure performed. Each combination of a stationary and mobile phase is considered to
constitute one procedure. In this case, 80100 is reported twice, once for each combination of the
shared stationary phase and separate mobile phases. Note that this example is very similar to the
example contained in the drug testing subsection guidelines.

90.

A lab performed a calcitonin stimulation panel consisting of three separate calcitonin tests. How
should these lab services be reported?
a.
b.
c.
d.

80410, 82308 x 3
82308 x 3
80410
82308, 82308-91 x 3

c The single code 80410 is used to report the fact that the calcitonin test was run three times.

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American Medical Association.

91.

A pathologist was asked to consult on the results of a quantitative urine alkaloid test taken in a
primary care physicians office. The pathologist reviewed the test results but did not review the
patients records or personally examine the patient. A written report was produced by the
pathologist rendering his opinion and sent back to the primary care physicians office. How should
the pathologists services be reported?
a. The pathologists professional services should not be separately reported they are a part of
the labs overhead.
b. 80500
c. 82101, 80500
d. 82101
b This was a clinical pathology consult, which is separately reportable. However, it would not
be appropriate for the pathologist to also report the performance of the lab test (82101) because
the lab test was not done by the pathologist. Rather, the pathologist may only report the
professional services necessary to render advice to the attending physician regarding the
interpretation of the lab test.

92.

A six-year old child was taken to the hospital emergency department after swallowing a lead toy
soldier. A lead toxicity test was performed immediately and the patient was started on IV infusion
of a detoxification agent. Three hours later, a lead test was run again to determine whether the IV
infusion was reducing the level of lead in the patients blood. How should these lab services
performed in connection with this encounter be reported?
a.
b.
c.
d.

83655
83655 x 2
83655-91
83655, 83655-91

d Although the CPT manual is not entirely clear, it appears that the AMA intends the first lab
test be reported without the -91 modifier. The repeated test (for clinical reasons) on the same day
should be reported with a -91 modifier.

93.

A physician aspirated a sample of bone marrow and then interpreted a smear from the sample.
How should the physicians professional services be reported?
a.
b.
c.
d.

38220, 85097
38220, 88305-26
38221, 85097
85097

a The service of obtaining the sample is separately reportable from the smear interpretation.

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American Medical Association.

94.

A quantitative colony count bacterial culture of the urine was performed with isolation and
presumptive identification of isolates. How should these lab services be reported?
a.
b.
c.
d.

87040
87070
87075
87088

d is the right answer. Code 87040 is for culture of blood specimen. Code 87070 is by any
other source except urine, blood or stool. Code 87075 is anaerobic.

95.

Cytopathology slides prepared from a vaginal specimen were manually screened with computerassisted rescreening using cell selection with the Bethesda system of reporting. This service was
performed by lab personnel under physician supervision. The initial results were positive. The
pathologist then reviewed the initial test results and rendered an interpretation. How should
these lab services (including the physician interpretation) be reported?
a.
b.
c.
d.

88154
88167, 88141
88154, 88141
88142, 88141

b 88141 is reported when a physician interprets the test results. Code 88167 is reported
because there is documentation that the test results were reported using the Bethesda System.

96.

A patient who had developed a tumor on his tonsils underwent surgery for resection of the
tonsils. After the tonsils had been removed and the patient was sent to the recovery room, the
tonsils were sent (as a single specimen) to the pathologist for gross and microscopic evaluation.
How should the pathologists services be reported?
a.
b.
c.
d.

88305-26
88304-26
88309-26
88399-26

c is the right answer. Code 88309 identifies Tongue/tonsil-resection of tumor. Code 88305
would be reported if a biopsy were performed.

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American Medical Association.

97.

A patient presented for a colonoscopy. The gastroenterologist biopsied three polyps from the
colon and sent each polyp as a separately identified specimen to pathology requesting a pathology
consult while the patient was still on the table. Tissue blocks and frozen sections were then
prepared and examined as follows:
Specimen 1:

First Tissue Block Three Frozen Sections


Second Tissue Block One Frozen Section

Specimen 2:

First Tissue Block Two Frozen Sections


Second Tissue Block Four Frozen Sections

Specimen 3:

Single Tissue Block Three Frozen Sections

How should the pathologists services be reported?


a.
b.
c.
d.

88331-26, 88332-26 x 5
88331-26 x 3, 88332-26 x 10
88331-26 x 8, 88332-26 x 5
88331-26 x 3, 88332-26 x 2

d The number of frozen sections examined is not relevant for coding purposes. Rather, code
assignment is based on the number of specimens and the number of tissue blocks examined.
Code 88331 is reported one time for the first tissue block from each specimen. Code 88332 is
report once for each additional tissue block from the same specimen.
Medicine 10 Questions
98.

A primary care physician administers DTP, live mumps and live measles vaccines at the same office
visit. All three vaccines were administered from separate vials. The DTP was administered by
intramuscular injection. The mumps and measles where administered by separate subcutaneous
injections. How should these injections be reported?
a.
b.
c.
d.

96372, 96374, 96375, 90701, 90704, 90705


90471, 90472 x 2, 90701, 90707
90471, 90472 x 2, 90701, 90704, 90705
90471, 90472, 90700, 90704, 90705

c CPT codes 96374 and 96375 are for IV push and therefore a would be incorrect. You will
notice that CPT codes 90471, 90472 are in three of the answers, and when analyzing answers for
the exam I would focus on these three. 90472 is one unit in answer d where as in answer b
and c it is 2 units. The physician administered three vaccine injections therefore d would be
incorrect. The difference between b and c is codes 90704, 90705, and 90707. Since these
were separate vaccines 90707 which is a combination of the measles and mumps would be
incorrect.

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American Medical Association.

99.

A primary care physician administered 100 mg of RSV immune globulin by intramuscular


injection. How should these services be reported?
a.
b.
c.
d.

96372, 90378 x 2
96372, 90378
96372 x 2, 90378 x 2
99211-25, 90378 x 2

a CPT code 99211 is for an established office visit therefore d is incorrect. Since the code
description for 90378 is for 50 mg, it requires 2 units to identify the correct dosage. This was
administered in a single injection therefore only one administration code is required.
100. A psychiatrist saw his patient at a residential care facility. The psychiatrist provided 50 minutes of
face-to-face individual psychotherapy relating to the patients schizophrenia. The purpose of the
treatment was to attempt to help the patient modify his behavior to better manage his disease.
How should the physicians services be reported?
a.
b.
c.
d.

90826
90806
90818
90819

c This was behavior modifying therapy provided to a residential (inpatient) care facility patient.
Code selection is based on time and whether any medical evaluation and management services
were provided. 90826 is psychotherapy involving play equipment, physical devices, language
interpretor, or mechanisms of non-verbal communication which is not documented in the
question, therefore a is incorrect. 90806 is for office or other outpatient facility therefore b is
incorrect. 90819 involves medical evaluation and management on top of the psychotherapy
which is not documented in the question, therefore d is incorrect.
101. An ophthalmologist performed an intermediate medical examination and evaluation on an
established patient. He determined that the patient needed contact lenses. The ophthalmologist
prescribed and fitted one pair of contact lenses. The supply of the contact lenses was considered
included in the fitting service. This patient does not have aphakia. How should these services,
including the supply of the contact lens, be reported?
a.
b.
c.
d.

92002, 92314-51
92012, 92310-51
92012, 92314-51
92002, 92310-51

b The supply of the contact lens is included in 92310 and therefore is not separately reported.
Patient is an established patient, therefore a and d are incorrect as 92002 is for a
new patient. 92314 is for fitting being performed by an independent technician.

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American Medical Association.

102. Dr. Fredericks performed a cardiac catheterization on Mrs. Dillon last week to determine the
extent of her coronary artery disease. She was subsequently admitted to the hospital for surgery.
The surgeon performed a PTCA on the left anterior descending coronary artery and placed a stent
in the left circumflex coronary artery. All of these services were performed during the same
operative session. How should this surgical session be reported?
a.
b.
c.
d.

92980, 92982-51
92982, 92984
92980, 92984
92980

c When PTCA is performed at the same time and in the same vessel as a stent placement, the
PTCA is bundled. CPT codes 92980 and 92982 are mutually exclusive and can never be reported
together during same session therefore a is incorrect. Answer b is incorrect because that is
indicating angioplasty procedures in 2 different coronary vessels and fails to take into account our
stenting procedure. Answer d is wrong because it does not report the angioplasty which
occurred in a different vessel than the stent placement making c the right answer.
103. Mr. Tyler was admitted to the hospital and had a combined right and left heart catheterization.
The operative session included injection procedures for a left ventriculography and aortography.
Imaging supervision, interpretation, and generation of a report were also performed. A single
physician provided all of these services. How should the physicians professional services be
reported?
a.
b.
c.
d.

93460-26, 93567, 93563


93453-26, 93567
93451-26, 93542-26, 93567-51
93453-26, 93567-51

b A single code (93453) is used to report the right and left heart catheterization. It also includes
the injection procedure for the ventriculography. The injection procedure for the aortography is
reported separately with the add-on code of 93567. Since it is an add-on code, the 51 modifier is
not appropriate. The imaging and supervision is included with the catheterization code.
104. Dr. May and Dr. Lynn teamed up to perform a real time image with 2 dimensional M-mode
recording for a transesophageal echocardiography study for Mr. Thompson, an 81 year-old male
with a history of coronary artery disease. Dr. May placed the transesophageal probe and Dr. Lynn
acquired the images and produced a written interpretation. How should these physician services
be reported?

a.
b.
c.
d.

Dr. Lynn
93312-26
93314-62
93317-26
93314-26

Dr. May
Not separately reportable his services are bundled
93313-629331693313

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American Medical Association.

d CPT provides separate codes for use when different physicians perform the probe placement
and acquisition/interpretation. The -62 is not used unless two physicians work together on a
single reportable procedure. In this case, there are separate CPT codes for the services provided
by each physician. Therefore a is incorrect as it says Dr. May would not report separately for his
service. 93312 is for the procedure being done all by one physician. 93317 is for a
transesophageal echocardiography for congenital cardiac anomalies, therefore c is incorrect.
105. Judy went to see her allergist for follow-up allergy testing. She was last seen by the same
physician one month ago. Because Judy had recently recovered from the flu, the allergist took a
brief interval history (five minutes) prior to administering the tests. She then administered three
intradermal tests with allergenic extracts (delayed type reaction) and interpreted the test results.
How should these services be reported?
a.
b.
c.
d.

95028 x 3, 99211-25
95024 x 3, 99211-25
95028 x 3
95028, 99211-25

a In this case, separately identifiable E&M services were provided and therefore should be
reported. Also, 95028 is reported once for each test performed. 95024 is for immediate type
reaction therefore b is incorrect. Since the physician also performed a separately identifiable
E&M service code c is incorrect.
106. A physical therapist placed a hot pack on Janes right shoulder and left the hot pack in place for 15
minutes while he attended to other patients. When the therapist returned, he provided 15
minutes of ultrasound treatment on Janes same shoulder. The therapist then provided 15
minutes of therapeutic exercise to the same shoulder. How should the physical therapist services
be reported?
a.
b.
c.
d.

97035-51, 97110
97010, 97035, 97110
97010, 97028, 97110
97010, 97035-51, 97110-51

b Each procedure is separately reportable therefore a would be incorrect as it does not report
for the hot pack. 97028 is for ultraviolet therapy, not ultrasound therapy making c incorrect.
Per the guidelines, the 51 modifier is not to be reported with these codes which makes d
incorrect.

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American Medical Association.

107. Mr. West is recovering at home from a post-operative wound infection. A home health nurse
administered IV Cephalosporin (an antibiotic supplied by the patient). This IV administration and
home health visit lasted four hours. How should these services be reported?
a.
b.
c.
d.

96374, 99601-51, 99602


99601, 99243-25
99601, 99602 x 2
99243, 96374-51

c Since the IV infusion was provided in the patients home 96374 would not be correct making
a incorrect. 99243 is for an office consultation therefore b and d are incorrect.
Medical Terminology and Anatomy 22 Questions
108. Which term identifies the imaginary line that separates the body into upper and lower halves?
a.
b.
c.
d.

Coronal
Transverse
Sagittal
Dorsal

b See Illustrations Anatomical and Procedural Review Figure 1A. Coronal means to separate
the body into front and back sections. Sagittal means a vertical body plane dividing the body into
right and left sides. Dorsal refers to the back surface of the body.
109. Molluscum contagiosum is a condition best described as a:
a.
b.
c.
d.

A malignant skin lesion caused by a virus


A benign skin lesion
A benign skin lesion caused by a virus
A skin lesion

c The CPT index entry for this term directs the coder to 17110-17111 and 54050-54065.
Molluscum contagiosum is caused by a virus in the poxvirus family. Referencing this term in the
ICD-9-CM Alphabetic index is to code 078.0.
110. Which of the following is not a term that is typically used to describe a type of fracture?
a.
b.
c.
d.

Comminuted
Linear
Percutaneous
Greenstick

c The ICD-9-CM manual guidelines preceding code 800 provides some alternative descriptors of
the various types of fractures. The term percutaneous is typically used to indicate a way to treat
a fracture by inserted stabilization devices through the skin.

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written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the
American Medical Association.

111. Formation of new red blood cells takes place in the:


a.
b.
c.
d.

Liver
Bone marrow
Spleen
Lymph nodes

b This is an example of a question that probably cannot be answered from the manuals (at least
not in two minutes). With a question like this if you dont know the answer, you should make an
educated guess and move on dont burn up time.
112.

The ilium is:


a.
b.
c.
d.

A bone that is part of the pelvic girdle


The small intestine
The large intestine
A portion of the iliac artery

a See CPT Illustrations preceding the Musculoskeletal System (20000-29999). The ileum (with
an e) is a part of the small intestine.
113. A tenotomy is:
a.
b.
c.
d.

A procedure involving an incision into the eardrum


A procedure involving an incision into the tenomatic membrane
A procedure involving the surgical cutting of a tendon
A procedure involving the complete removal of one or more tendons

c Look at tenotomy in the CPT index. You will find that all of the codes involve procedures on
tendons.
114. According to CPT, which pair of organs are considered part of two separate body systems?
a.
b.
c.
d.

Thyroid and thymus


Ovary and testes
Gallbladder and jejunum
Epiglottis and larynx

b See CPT Illustrations ( Male Genital System (54000-55899/Female Genital System (5640558999 and Endocrine System). The ovaries and testes are considered part of the endocrine
system as well as the male/female genital systems. The thyroid and thymus are both part of the
Endocrine system. The gallbladder and jejunum are both part of the digestive system. The
epiglottis and larynx are both part of the respiratory system.

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American Medical Association.

115. Which of following statements best describes the function of the arteries?
a.
b.
c.
d.

They carry oxygen-loaded blood from the heart to other parts of the body
They return blood to the heart from throughout the body
They carry blood from the heart to other parts of the body
They are used to reroute blockages in and around the heart and coronary vessels

c This question probably cannot be answered from the coding manuals. However, this is an
important concept that students should commit to memory. Many students incorrectly answer
a for this question. While the usual function of the arteries is to carry oxygen-loaded blood from
the heart to other parts of the body, there is one circumstance (the pulmonary arteries) in which
arties actually carry oxygen-depleted blood. The pulmonary arteries carry oxygen-depleted blood
from the heart to the lungs, where the carbon dioxide in the blood is exchanged for oxygen. The
oxygen-loaded blood is then returned to the heart through the pulmonary veins. Consequently
c is a more accurate answer than a because c is always a correct statement while a is not
always correct (because the pulmonary arteries carry oxygen-depleted blood, rather than oxygenloaded blood).
116. A xenograft is a graft:
a.
b.
c.
d.

From another species


From the same body
From another human being
From a cadaver

a A graft from the same body is an autograft. A graft from another human being, including a
cadaver, is an allograft. See guidelines preceding code 15002 under Skin Graft Substitutes
identifying a xenograft is a non-human skin substitute.
117. Which of the following terms is used to describe a vertebral segment?
a. A single complete vertebral bone only
b. The non-bony compartment between two adjacent vertebral bodies and the associated
articular processes and laminae
c. The non-bony compartment between two adjacent vertebral bodies
d. A single complete vertebral bone with its associated articular processes and laminae
d See the arthrodesis guidelines above CPT code 22590.
118. The term adenosine refers to:
a.
b.
c.
d.

A sine wave examination of the adenoids


A diagnostic study of the adenoids
A drug
A device used to treat the adenoids

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American Medical Association.

c This answer may be located by looking up Adenosine in the HCPCS Level II Table of Drugs or
the ICD-9-CM Table of Drugs and Chemicals.
119. The vestibule of the mouth includes:
a.
b.
c.
d.

Lips, tongue, cheek


Tongue, cheek
Mucosal and submucosal tissue of lips and cheeks
Lips, cheeks, pharynx

c This question can be answered by reading the subsection guidelines for Vestibule of the
Mouth at the beginning of the Digestive System subsection.
120. TURP is an acronym for:
a.
b.
c.
d.

Transurethral Renal Pyelotomy


Transurethral Resection of Prostate
Transurethral Renal Pelvectomy
Transurethral Repair of Prostate

b Start by looking up TURP in the index. It will lead you back to prostatectomy codes. The
TURP codes start at 52601.
121. The suffix orrhaphy means:
a.
b.
c.
d.

Resection
Suture/surgical repair
Grafting
Re-implantation

b See the Illustrated Anatomical and Procedural Review following the introduction in the
professional edition of the CPT manual.
122. Cryotherapy involves the use of:
a.
b.
c.
d.

Heat treatment
Artificial tears
A freezing probe
Laser treatment

c Cryo means cold. Therapy means treatment.

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American Medical Association.

123. Trichiasis is:


a.
b.
c.
d.

Fungal infection of eyelashes


Trichamonal infection of eyelashes
Lice infestation of eyelashes
Ingrown or misdirected eyelashes

d This term can be located in both the CPT and ICD-9-CM indices.
124. Which of the following conditions would be considered to be volvulus?
a.
b.
c.
d.

Infection of one of the cardiac valves


Obstruction of the intestine due to an overgrowth of volvular tissue
An inflammation of the external genital organs of a female
Strangulation of the intestine

d Look up volvulus in the ICD-9-CM alphabetic index. The index will direct you to 560.2,
which provides examples of volvulus, including strangulation of the intestine.
125. Dysphagia is:
a.
b.
c.
d.

Abnormal cell growth


Speech disturbance
Difficulty swallowing
Shortness of breath

c Look up dysphagia in the ICD-9-CM alphabetic index. The index will direct you to 787.2x,
which lists difficulty in swallowing as an example condition for dysphagia.
126. Which of the following lists only components of the digestive system?
a.
b.
c.
d.

Mouth, large intestine, liver, spleen


Trachea, stomach, large intestine, anus
Mouth, stomach, pancreas, colon
Stomach, liver, colon, spleen

c See CPT Illustrations Digestive System (40490-49999. The spleen is a large glandlike organ in
the upper part of the abdomen whose function is to disintegrate the red blood cells to release the
hemoglobin, which the liver converts to bilirubin. The trachea is part of the Respiratory System.

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American Medical Association.

127. Which of the following is not part of the endocrine system?


a.
b.
c.
d.

Pituitary
Pancreas
Ovaries
Lymph Nodes

d See the Endocrine system illustration preceding the Radiology section of the CPT manual.
128. What does the term acromegaly mean?
a.
b.
c.
d.

Fear of heights
Enlarged kidneys
Enlarged extremities
Fear of falling

c Acro means extremities or top and -megaly means enlarged or large. See the Illustrated
Anatomical and Procedural Review following the introduction in the professional edition of the
CPT manual. Also, can be found by looking up acromegaly in the ICD-9-CM manual.
129. What is another term for the bicuspid valve in the heart?
a.
b.
c.
d.

Mitral valve
Tricuspid valve
Pulmonary valve
Aortic valve

a Look up bicuspid valve in the CPT index which instructs, See Mitral Valve.
ICD-9-CM 11 Questions
130. Which of the following types of diagnosis codes should never be reported as the first listed
diagnosis code?
a.
b.
c.
d.

V-codes
Codes printed in italics in the tabular list
Poisoning codes
Codes for signs or symptoms

b Per ICD-9-CM Manual Conventions, codes printed in italics should not be used for describing
the primary diagnosis. Answer a is an incorrect answer because V codes can be reported as a
first diagnosis per the Official Guidelines as in such instances as admission for a screening
examination (e.g., Admission for a screening mammogram) or the a type V Codes. Also V codes
are reported as a first listed diagnosis when the encounter is for treatment or attention to a
current or resolving illness or injury (e.g., Admission for chemotherapy) or the b type V codes.

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American Medical Association.

131. Jimmy fell off his bicycle (leisure) and was taken to a local hospitals emergency department. The
emergency physician did an expanded problem focused history, an expanded problem focused
exam and performed medical decision making of moderate complexity. The exam reveals a 3cm
laceration to Jimmys forehead and a large contusion to his right knee. The knee x-rays were
negative. The physician did a simple repair of the laceration. Select the appropriate diagnosis
codes for this encounter.
a.
b.
c.
d.

873.42, 924.11, E826.1,E006.4, E000.8


873.42, 924.11, E885.2, E006.4, E000.8
873.52, 924.11,
873.42, 924.10, E826.1. E006.4, E000.8

a
132. Susie presented to the emergency department vomiting blood. The emergency physician
determined that the vomiting was due to esophageal varices resulting from liver cirrhosis. Select
the appropriate diagnosis codes for this encounter.
a.
b.
c.
d.

456.0, 571.5
456.20, 571.5
571.2, 456.21
571.5, 456.20

d The code 456.20 would never be reported as the first listed diagnosis because the note under
456.2, states code first underlying disease (also note that 456.20 is italicized). The vomiting of
the blood is not separately reported because, 456.20 is combination code that includes both the
varices and the bleeding.
133. Mr. Morgan reports to his physician feeling very dizzy. It is discovered that his blood pressure is
elevated (210/190). The physician documents a diagnosis of end stage renal failure due to
malignant hypertension. Select the appropriate diagnosis code(s) for this encounter.
a.
b.
c.
d.

403.01
403.01, 585.9
403.01, 585.6
404.02, 585.6

c Per the instructional note at category 403, an additional code is used to identify the stage of
chronic kidney disease. It would not be appropriate to report 585.9 because the documentation
specifically states end stage renal failure. 404.02 would be incorrect because there is no
documentation that this patient had heart disease. Hypertension, in and of itself, is not
considered to be heart disease.

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American Medical Association.

134. Mr. Barber reported to his primary care physician complaining of difficulty breathing. He is HIV
positive, but prior to today has never had any symptoms of HIV disease. The physician examined
Mr. Barber and documented that his breathing difficulty was due to pneumocystis carinii
pneumonia (PCP), a HIV related disease. Select the appropriate diagnosis code(s) for this
encounter.
a.
b.
c.
d.

136.3, V08
042, 136.3
042, 480.8, 079.89
136.3, 042

b According to the Official Guidelines Section (I) (C) (1) (a) (2) (f), 042 is reported as the first
listed code followed by the additional code(s) for the HIV related conditions. The Official
Guidelines use the term admissions/encounter, meaning this same concept should also apply in
a non-inpatient setting. In other words, if an outpatient presents for treatment of HIV-related
conditions, 042 would be reported first followed by the codes for the other conditions as
applicable. Answer c might appear to be correct. However, ICD-9-CM provides a specific code
for PCP (136.3). In addition, PCP is a fungal infection (commonly related to HIV disease). The
codes in answer c are for a viral infection. Answer a is also incorrect because this patient is no
longer asymptomatic.
135. Mr. Sawyer was adding water to his car battery when the battery exploded. (He reported to the
local burn center that tracks the mortality of burns.) After examining Mr. Sawyer, the emergency
physician documented a diagnosis of third degree burns to the right palm and a second degree
burn to his left cheek and forehead. The physician determined that the burns were caused by
contact with the battery acid. Total body surface burned was documented as less than 10%.
Select the appropriate diagnosis codes for this encounter.
a.
b.
c.
d.

944.35, 941.20, 948.00, E924.1


944.30, 941.24, 948.00, E923.2
944.35, 941.27, 948.10, E924.1
944.35, 941.27, 948.00, E924.1

d For facilities that track the mortality of burns, per the Official Guidelines it is advisable to
report a 948 code to indicate the extent of body surface burned. Answer c would not be correct
because the patient had less than 10% of the TBSA burned.

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American Medical Association.

136. Carrie reported to her physician with an acute sore throat. The physician diagnosed this as strep
throat, and gave her prescription for Ampicillin. After taking two doses as prescribed Carrie
developed a skin rash. She returned to the physician who determined that she was experiencing
dermatitis as a reaction to the Ampicillin. The physician discontinued the Ampicillin and called in a
prescription for another antibiotic. Select the correct diagnosis codes for this encounter.
a.
b.
c.
d.

960.0, 693.0, E930.0, 034.0


693.0, E856, 034.0
693.0, E930.0, 034.0
692.3, E930.0, 034.0

c This is an adverse effect, not a poisoning.


137.

Russell has been a Type I insulin dependent diabetic for twenty years without any complications.
Two days ago he began to experience episodes of blurred vision. During one of these episodes
Russell stubbed his left big toe. Today it is extremely inflamed, painful and has a small ulceration.
He saw his primary care physician who determined that Russell had a diabetic ulcer of the left big
toe. Select the correct diagnosis codes for this encounter.
a.
b.
c.
d.

250.83, 707.10, V58.67


250.81, 707.15
250.81, 707.19
250.83, 707.15, V58.67

b Given the optional answers, blurred vision is not specifically related to this encounter (i.e., did
not affect patient care or management), therefore a code would not be assigned. This is an
example of utilizing test taking strategies to choose the best answer of those listed rather than
focusing on non-pertinent information. Per the Official Guidelines, it is not necessary to report
V58.67 when a patient has type I diabetes mellitus since it is implied that the patient has had long
term use of insulin.
138. Vanessa saw her primary care physician three days ago. At that time, the physician diagnosed a
urinary tract infection and prescribed an antibiotic. Today, the culture and sensitivity from the
earlier encounter was returned from the lab. Based on the lab report, the physician concluded
that the UTI was due to E Coli. The physician decided to change Vanessas antibiotic. After
speaking with Vanessa on the phone, the physician called in a prescription for a new antibiotic.
Select the correct diagnosis code(s) for the original encounter assuming that the physician
reviewed the culture and sensitivity (and documented her findings) prior to billing for the
encounter.
a.
b.
c.
d.

041.49, 599.0
599.0
599.0, 041.49
041.49, 599.89

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American Medical Association.

c As stated in the note following 041, 041 is used as an additional code to identify the bacterial
agent in diseases classified elsewhere. Consequently, 041 would not be reported as the first
listed code. Answers a and d are incorrect because they both sequence 041 as the first listed
code. Answer b is incorrect because an additional code must be reported with 599.0 to identify
the organism causing the infection. See the guidelines following 599.0.
139. Mrs. Ashworth is two months post partial mastectomy for breast cancer. She is still undergoing
radiation therapy for the breast cancer. During the hospitalization for her mastectomy, she was
found to have another primary malignancy in her kidney. She presents to her oncologist today for
further work-up relating to the kidney cancer. While she is in the office, the physician also
examines her breast and determines that, unfortunately, the cancer is still present in the upper
outer portion of her left breast. Select the correct diagnosis codes for todays encounter.
a.
b.
c.
d.

174.4, 189.0
189.0, V10.3
189.0, 174.4
198.0, 174.4

c In this case, the patient has two primary malignancies (i.e., one is not due to cancer spreading
from the other). The kidney cancer is sequenced first because it was the primary reason for the
current encounter.
140. Mrs. Ashworth is five months pregnant and presents to her OB/GYN for management of her
gestational diabetes during the antepartum period. Select the correct diagnosis codes for todays
encounter.
a.
b.
c.
d.

648.03, 250.00
648.01
250.00, V22.2
648.83

d The patient had gestational diabetes meaning the patient developed diabetes during the
pregnancy. Answers a and b would be incorrect because they are for a patient with
established diabetes mellitus prior to the pregnancy. A 3 is used as a fifth digit because she did
not deliver during this admission. Answer c is incorrect because per the Guidelines, it is the
physicians responsibility to state that the condition being treated is not affecting the pregnancy.
HCPCS Level II 5 Questions
141. What HCPCS Level II supply code would be reported for a 2 mg oral administration of Tacrolimus?
a.
b.
c.
d.

J7525
J7507 x 2
J7599
J7507

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b J7507 is reported once for each 1 mg of drug supplied.


142. Jennifer is diabetic and must check her blood sugar regularly. Her primary care physician supplied
two boxes of Lancets to her for use in checking her blood sugar. Each box contained 100 Lancets.
What HCPCS Level II code would be reported for the supply of these Lancets?
a.
b.
c.
d.

A4259
A4258
A4259 x 2
A4258 x 2

c A4259 is reported once for each box of 100 Lancets


143. Mr. Thomas, a 72 year- old, goes to his primary care physician for a yearly physical. While there it
is determined that Mr. Thomas should undergo a screening flexible sigmoidoscopy for colorectal
cancer. What HCPCS Level II code would be used to report this encounter?
a.
b.
c.
d.

G0105
G0104
G0106
G0121

b This was a screening procedure. Without additional documentation that the patient was
considered high risk Answer a would not be appropriate. There was no supporting
documentation that the screening sigmoidoscopy utilized a barium enema so Answer c would
not be appropriate.
144. A physician administers 12 cc of IM gamma globulin immunization in his office. What HCPCS Level
II supply code(s) would be used in reporting this drug?
a.
b.
c.
d.

J1550, J1470
J1460 x 12
J1560
J1510 x 2

c J1560 is reported once if more than 10 cc of drug are supplied. Answer a would constitute
unbundling.

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American Medical Association.

145. Mr. Stewart was in a car accident and had to have both legs amputated. The local DME company
supplied him an amputee wheelchair with fixed full-length arms and swing-away, detachable
footrests. What HCPCS Level II code would be reported for supplying this wheelchair?
a.
b.
c.
d.

E1180
E1130
E1200
E1140

c
Coding Concepts 5 Questions
146. Which of the following is a key difference between add-on () codes and modifier -51 exempt
() codes?
a. The modifier -51 exempt codes are never reported with a modifier
b. The add-on codes may be reported in addition to other codes for services provided during the
same encounter
c. Add-on codes are never reported as stand alone codes
d. An add-on code is never reported if the service provided is a component of a more
comprehensive service provided during the same encounter
c Modifier -51 exempt codes, unlike add-on codes, may be reported as stand alone codes in
some circumstances
147. The phrase separate procedure when listed in parentheses at the end of a CPT code description
means that:
a. The code should always be reported separately whenever the service described by the code is
performed
b. The code should not be reported separately if the service described by the code was a
component of a more comprehensive service provided during the same encounter
c. The code should only be reported if the service described by the code was the only service
provided during the encounter
d. The code should only be reported when a separate physician performed the service described
by the code
b A definition of, Separate Procedure, can be found in the Surgery Guidelines of the CPT book.

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American Medical Association.

148. Which of the following is not an acceptable method of reporting the CPT code(s) for surgical
services when no single code accurately and fully describes the services performed during a
particular outpatient surgical session?
a. Report the code that most closely reflects the physician work involved even if the code does
not exactly describe the specific services performed
b. Report a combination of codes that, taken together, accurately and fully describe the services
performed
c. Report the code that most closely describes the services performed, modified by either a -22
or a -52 modifier as appropriate to reflect the differences between the description for the
code and the actual services performed
d. Report the unlisted code that best describes the services performed
a
149. Which of the following is not considered a part of the CPT surgical package?
a.
b.
c.
d.

All E&M encounters on the day prior to the surgery and the day of the surgery
Local anesthesia
Evaluation of the patient in the recovery area
Typical uncomplicated follow-up care

a Under the surgery guidelines only one related E&M encounter on the date immediately prior
to or on the date of the procedure is included in the surgical package.
150. Which symbol(s) is used in the CPT manual to indicate that the description of a particular CPT code
was revised for the current year?
a.
b.
c.
d.

c The symbol is used to indicate revisions to CPT descriptions. The symbol is used for
modifier 51 exempt codes. The symbols are used to indicate revisions to any other text.
Bonus Practice Management Questions 6 questions
151. What does the acronym CPT stand for?
a.
b.
c.
d.

Current Physician Treatment


Classified Patient Terms
Clinical Procedural Tactics
Current Procedural Terminology

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American Medical Association.

152. What does it mean when a procedure is assigned a Category I code from the CPT manual?
a.
b.
c.
d.

AMA endorses the procedure


The procedure is covered by all insurance companies
CMS recognizes these experimental procedures as covered procedures.
The procedure is consistent with contemporary medical practice and is performed by many
practitioners in clinical practice in multiple locations.

d
153. What does the acronym AMA stand for?
a.
b.
c.
d.

American Medical Authority


Association of Medical Assistants
American Medical Association
American Medical Applicants

c
154. What organization(s) are responsible for the development and update of the CPT code set?
a. Centers for Disease Control (CDC) oversee the code assignment and identifies which
procedures will receive a CPT code. The CDC then relays this information to the CPT Editorial
Panel of the AMA.
b. American Medical Association
c. American Medical Association (AMA) and Center for Medicare and Medicaid Services (CMS)
together develop and update CPT codes
d. Medical Specialty Societies identify what procedures need codes and American Medical
Association (AMA) assigns the codes based on the medical societys decision.
b
155. Who can use the CPT codes to report their services?
a.
b.
c.
d.

Physicians only
Physicians and their office staff
Physicians and outpatient facilities
Physicians, other qualified healthcare professionals and outpatient facilities

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American Medical Association.

156. What option (if any) does a physician practice have when a claim has been denied by Medicare?
a. Identify the reason for the denial and follow the appeals process set forth by Medicare when
applicable
b. Identify the reason for the denial and then change the codes to bypass the denial
c. Resubmit with different dates of service and always append modifier 59 to denied codes
d. There is no appeal process so the practice can choose to write off the service or bill the
patient directly for the unpaid services.
a

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