Section 1

Number of questions from each code range:

Surgery, integumentary system (nine questions)

Musculoskeletal system (10 questions)
Respiratory system (10 questions)
Digestive system (10 questions)
Urinary system, male and female genital system (11 questions)
Nervous system, eye and ocular adnexa, and auditory system (10
questions)

1. James suffered a severe crushing injury to his left upper leg. Two days after surgery, Dr. Barnes
completed a dressing change under general anesthesia. How would you report this service?
a. 16020-LT
b. 15852, 01232, J2060
c. 01232-P6
d. 15852-LT

2. Dr. Jess removed a 4.5 cm (excised diameter) cystic lesion from Amy’s forehead. The ulcerated
lesion was anesthetized with 20 mg of 1% Lidocaine and then elliptically excised. The wound was
closed with a layered suture technique and a sterile dressing applied. The wound closure, according to
Dr. Jess’s documentation, was 5.3 cm. How would you report this procedure?
a. 11446, 12053-51
b. 11646, 12013-51
c. 11446, J2001 x 2, 12013-59
d. 11313, 12053-59

3. Martha has a non-healing wound on the tip of her nose. After an evaluation by Dr. Martino, a
dermatologist, Martha is scheduled for a procedure the following week. Dr. Martino documented an
autologous split thickness skin graft to the tip of Martha’s nose. A simple debridement of granulated
tissues is completed prior to the placement. Using a dermatome, a split thickness skin graft was
harvested from the left thigh. The graft is placed onto the nose defect and secured with sutures. The
donor site is examined, which confirms good hemostasis. How would you report this procedure?
a. 99213-25, 15050
b. 15050, 15004, 15005-59
c. 15335, 11041-59
d. 15120

4. A patient had a chest wall tumor excised. The procedure involved the ribs with plastic reconstruction
and mediastinal lymphadenectomy. How would you report this procedure?
a. 19272, 32503-59
b. 19272
c. 32503, 19271-59, 21632-59
d. 32422, 19260-51

5. Dr. Alexis completed Mohs surgery on Ralph’s left arm. She reported routine stains on all slides,
mapping, and color coding of specimens. The procedure was accomplished in three stages with a total
of seven blocks in the second stage. How would you report Dr. Alexis’ services?
a. 17313, 17314-58, 17315-59, 88314-59
b. 17311, 17312 x 7
c. 17313, 17314 x 2, 17315 x 2
d. 17311, 88302, 17314 x 3, 17312 x 7
6. How should you code an excision of a lesion when completed with an adjacent tissue transfer or
rearrangement?
a. The excision is always reported in addition to the adjacent tissue transfer or
rearrangement.
b. The excision is not separately reported with adjacent tissue transfer or
rearrangement codes.
c. Code only malignant lesions in addition to the adjacent tissue transfer or
rearrangement codes.
d. Code the lesion with a modifier -51 and code in addition to the adjacent
tissue transfer or rearrangement codes.

7. Tina fell from a step ladder while clearing drain gutters at her home. She suffered contusions and
multiple lacerations. At the emergency room she received sutures for lacerations to her arm, hand, and
foot. The doctor completed the following repairs: superficial repair to the arm of 12.8 cm, a single-
layered closure of 7.9 cm that required extensive cleaning and removal of glass from the hand, and a
simple repair to the foot of 9.6 cm How would you report the wound repairs?
a. 12034, 12036, 12046, 12007
b. 12006, 12034-59
c. 12044, 12006-51
d. 12005, 12004 x 2

8. Which modifier would you use if a re-excision procedure is performed during the postoperative
period of the primary excision of a malignant lesion?
a. 76
b. 59
c. 58
d. 79

9. James had a malignant lesion removed from his right arm (excised diameter 4.6 cm). During the
same visit the dermatologist noticed a new growth on James’ left arm. Dr. Terry took a biopsy of the
new lesion and sent it in for pathology. The biopsy site required a simple closure. How would Dr.
Terry report the biopsy procedure?
a. The biopsy is included in the primary procedure and not reported
b. 11100-59
c. 11406, 11100-59
d. 11100, 12001, 11406-51

10. Sally suffered a burst fracture to her lumbar spine during a skiing accident. Dr. Phyllis performed a
partial corpectomy to L2 by a transperitoneal approach followed by anterior arthrodesis of L1-L3. She
also positioned anterior instrumentation and placed a structural allograft to L1-L3. How would Dr.
Phyllis report this procedure?
a. 63090, 22558-51, 22585, 22845, 20931
b. 63085, 22533, 22585-51, 22808-59
c. 22612 x 2, 22808, 22840-51, 20931
d. 22558, 22858-51, 22845-51, 20931-59

11. A patient suffered a fracture of the femur head. He had an open treatment of the femoral head with
a replacement using a Medicon alloy femoral head and methylmethacrylate cement. How would you
report this procedure?
a. 27236
b. 27235
c. 27238
d. 27275, 27236-59
12. What modifier should you report when the same physician provided a rereduction of a fracture?
a. 76
b. 59
c. 77
d. 54

13. A patient suffered a penetrating knife wound to his back. A surgeon performed wound exploration
with enlargement of the site, debridement, and removal of gravel from the site. The surgeon decided a
laparotomy procedure was not necessary at this time. How would you report this procedure?
a. This procedure is bundled with the laparotomy
b. 49000, 97602-51, 20100-59
c. 49000, 20102-59
d. 20102

14. While playing at home, Riley dislocated his patella, when he fell from a tree. The surgeon
documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would
you report the treatment and diagnoses?
a. 27420, S83.003A
b. 27562, S83.006A, W14.XXXA, Y92.009
c. 27840, 27562-51, S83.003A, W14.XXXA
d. 27562, S83.006A

15. Sarah presented to her primary care physician with pain and swelling in the right elbow. After
careful examination he referred her to an orthopedic surgeon for a second opinion. Dr. Femur
diagnosed Sarah with acute osteomyelitis of the olecranon process and recommended surgery. Sarah
agreed to the surgery and underwent a sequestrectomy, through a posterior incision, with a loose
repair over drains ending the procedure. Dr. Femur sent a written report back to Sarah’s primary care
physician along with the operative report. How would you report the procedure?
a. 99244-57, 24138-RT
b. 99214, 99244-57
c. 24138-RT
d. 99214, 23172-59

16. How should you report a deep biopsy of soft tissue of the thigh or knee area?
a. 27323
b. 27324
c. 20206
d. 27328

17. Mike had a bicycle accident and suffered deep hematomas in both knees. He underwent a bilateral
incision and drainage. How would you report the procedure?
a. 27301-50
b. 10040
c. 27303
d. 27301-59

18. A patient had a unilateral percutaneous intradiscal annuloplasty on L3-L5 with magnetic resonance
guidance for needle placement. How would you report this professional service procedure?
a. 0062T, 0063T, 77021-26
b. 22526, 22527, 77002-26
c. 22899, 77003-51
d. 0062T-52, 0063T-59, 77021-26
19. What modifier is exempt from the following codes: 20974, 61107, 93602, 95900, 94610?
a. RT and LT
b. 63
c. 59
d. 51

20. Julie, a 28-year-old ESRD patient was seen by Dr. Jeri in an outpatient hospital facility for
treatment of an obstructed hemodialysis AV graft. Dr. Jeri provided moderate conscious sedation to
Julie for percutaneous transluminal balloon angioplasty of the venous portion of the graft. This
procedure lasted 45 minutes. Julie had an excellent result and was released to home after
recovery from the treatment. Dr. Jeri performed the professional radiological supervision and
interpretation with this procedure. What code(s) capture this service?
a. 35476, 75978-26
b. 35460, 75962-26
c. 36476, 92982, 75978-26
d. 36476, 99144, 99145, 75878-26

21. What code would you report for a cervical approach of a mediastinotomy with exploration,
drainage, removal of foreign body, or biopsy?
a. 39010
b. 39000
c. 39200
d. 39401

22. Roger had a rhinoplasty to correct damage caused by a broken nose. One year later he had a
secondary rhinoplasty with major revisions. At the end of the second surgery the incisions were closed
with a single layer technique. How would you report the second procedure?
a. 30450
b. 30450-78
c. 30420, 12014
d. 30430, 12014-59

23. A surgeon started with a diagnostic thoracoscopy. During the same surgical session she
completed a surgical thoracoscopy to control a hemorrhage. How would you report this procedure?
a. 32601
b. 32601, 32654-59
c. 32500
d. 32654

24. Dr. Sacra performed a CABG surgery on Fred five months ago. Today, Dr. Sacra completed
another coronary artery bypass using three venous grafts with harvesting of a femoropopliteal vein
segment. How would Dr.Sacra report her work for the current surgery?
a. 33512, 33530-51, 35572-51
b. 33535, 35500-51, 33519
c. 33512, 33530, 35572
d. 33535, 33519, 33530-51, 35500

25. What do the primary codes 33880 and 33881 include?

a. Placement of all distal extensions, if required in the distal thoracic aorta
b. Placement of all proximal extensions in the thoracic aorta
c. Repair of extensions in the thoracic aorta
d. Repositioning of all leads and extensions in the thoracic aorta
26. Mrs. Reyes had a temporary ventricular pacemaker placed at the start a procedure. This
temporary system was used as support during the procedure only. How would you report the
temporary system?
a. 33210
b. 33211
c. 33207
d. 33210, 33207-51, 33235-51

27. Mr. Azeri, a 68-year-old patient, has a dual-chamber pacemaker. The leads in this system were
recalled. The leads were extracted via transvenous technique, the generator was left in place, and new
leads were inserted via transvenous technique. How would you report this procedure?
a. 33214, 33215-51, 33208-51, 33218-51
b. 33215, 33210-51, 33216-51
c. 33208, 33235-51, 33217-51
d. 33235, 33217-51

28. A 35-year-old female patient with a venous catheter requires a blood sample for hematology
testing. The sample is collected via her PICC catheter. How would you report this procedure?
a. 36415
b. 36592
c. 36591
d. 37799

29. A patient underwent a secondary percutaneous transluminal thrombectomy for retrieval of a short
segment of embolus evident during another percutaneous intervention procedure. How would you
report this secondary procedure?
a. 37184, 37186
b. 37186 in addition to the primary procedure
c. 37185, 76000
d. 37187

30. Lynn has a family history of colon cancer and is scheduled for a screening colonoscopy. During the
procedure, three polyps were discovered and removed via hot biopsy forceps technique. The polyps
were reported as benign. What diagnoses and procedure(s) codes capture these services?
a. Z12.11, Z80.0, 45315, 45331
b. Z12.11, D12.6, Z80.0, 45384
c. 45378
d. D12.6, 45378, 45384

31. Dr. Blue performs a secondary closure of the abdominal wall for evisceration (outside the
postoperative period). He opens the former incision and removes the remaining sutures; necrotic
fascia is debrided down to viable tissue. The abdominal wall is then closed with sutures. How would
you report the closure?
a. 11043
b. This is a bundled procedure and not reported
c. 39541
d. 49900

32. Heather lost her teeth following a motorcycle accident. She underwent a posterior, bilateral
vestibuloplasty, which allows her to wear complete dentures. How would you report this procedure?
a. 40845,15002
b. 40843-50
c. 40844
d. 40843

33. Dr. Erin is treating a 58-year-old male patient with a history of chewing tobacco. Dr. Erin finds a 3.4
cm tumor at the base of his tongue. She places needles under fluoroscopic guidance for sub-
sequential interstitial radioelement application. How would you report the professional services?
a. 41019, 77002-26
b. 41019
, 77012-26, 77021-26
c. 61770, 41019-59
d. 77002

34. An 88-year-old male patient suffering from dementia accidentally pulled out his gastrostomy tube
during the night. Dr. Keys, an interventional radiologist, takes him into an angiography suite,
administers moderate sedation (an independent observer was present during the procedure),probes
the site with a catheter and injects contrast medium for assessment and tube placement. Dr. Keys
finds that the entry site remains open and replaced the tube into the proper position. The intra-service
time for the procedure took 45 minutes. How would Dr. Keys report his services?
a. 49440, 99156, 99157
b. 49440, 49450-59
c. 49450, 99152, 99153
d. 49450

35. Katherine had a hernioplasty to repair a recurrent ventral incarcerated hernia with implantation of
mesh for closure. The surgeon completed debridement for necrotizing soft tissue due to infection. How
would you report this procedure?
a. 49566, 11005-51, 49568
b. 49565, 11005-51, 49568
c. 49565
d. 49525, 11006, 49568-51

36. A 28-year-old patient underwent a proctosigmoidoscopy with ablation of five tumors under
moderate sedation. The same provider performed the procedure and the sedation. The intra-service
time for the procedure was 30 minutes. How would you report this procedure?
a. 45320-P1
b. 45320 x 5
c. 45320
d. 45320, 99152,99153

37. Harry had a sphincterotomy and an ERCP with a stent placed into the bile duct. How would you
report this procedure?
a. 43268, 43262
b. 43262
c. 43260, 43268
d. 43264

38. Incidental appendectomy during an intra-abdominal surgery does not usually warrant a separate
identification. If it is necessary to report a separate identification, what modifier should you add?
a. 52
b. 59
c. 51
d. 57
39. Sharon had a laparoscopic cholecystectomy with cholangiography. How would you report this
procedure?
a. 47605, 47570-59
b. 47605
c. 47563
d. 47579

40. A patient had a renal auto-transplantation extracorporeal surgery, reimplantation of a kidney, and a
partial nephrectomy. How would you report this procedure?
a. 50340, 50380, 50240-51
b. 50543, 50370-52
c. 50380, 50240-51
d. 50380, 50240-59

41. Bill, a 52-year-old male patient, was admitted to the hospital and treated for prostatic malignancy.
His doctor dictated a detailed history, detailed exam, and straightforward medical decision-making for
admission. He was treated with interstitial transperineal prostate brachytherapy, including implantation
of 51 iodine-125 seeds. His doctor visited him the day after the procedure. How would you report the
professional service by the therapeutic radiologist who did both the implantation and brachytherapy?
a. 99222, 55876, 77763 x 51
b. 55875, 77778
c. 99221, 58715, 77783
d. 58346, 77799 x 125

42. Harry had a couple of stones in both kidneys. He was taken into the lithotripsy unit and placed on
the lithotripsy table in a supine position with the induction of anesthesia. The stones were well
visualized and the patient received a total of 3,500 shocks with a maximum power setting of 3.0. The
treatment was successful. How would you report this procedure?
a. 50590
b. 50561
c. 50060
d. 50080

43. Tom was placed under general anesthesia (by an anesthesiologist) for an excision of a local lesion
of the epididymis. How would you report the surgeon’s services?
a. 54861-50
b. 54860-47
c. 54830, 00920-51
d. 54830

44. Alex suffered several injuries to his upper leg muscles and penis when he fell onto the bar of his
touring bicycle. The day of the accident, Dr. Green completed muscle repair surgery to Alex’s upper
legs. Today, three days after the leg surgeries, Dr. Green took Alex back to the operating suite to
complete an unrelated repair to the penis. Dr. Green completed a plastic repair to correct the penal
injury. What code(s) would capture today’s procedure?
a. 54440-79
b. 27385, 54440-59
c. 27393, 54620-79
d. 54440-26

45. Heather had a bilateral laparoscopic occlusion of her fallopian tubes using a Falope ring. How
would you report this procedure?
a. 58615
b. 58671
c. 58671-50
d. 58679-50

46. A 65-year-old male patient has an indwelling nephroureteral double-J stent tube replaced to treat a
ureteral obstruction caused by a stricture from postoperative scarring. His stent tube is exchanged
every two months to prevent occlusion in the stent, UTI, and loss of kidney function. Dr. Mott did this
procedure via a transurethral approach under conscious sedation and provided the radiological
supervision and interpretation. How would you report this procedure?
a. 50605, 50382
b. 50385, 52283, 99151
c. 50385
d. 0084T

47. Dr. Blue provided interpretation and results for a needle electromyography for anal sphincter
function. How would you report this service?
a. 51784
b. 51784, 51785-51
c. 55875
d. 51785-26

48. A 48-year-old patient with BPH has his prostate removed via a laser enucleation. During this
procedure he also has a vasectomy. What code(s) would report this procedure?
a. 52648
b. 52649
c. 52649, 55250-51
d. 52647

49. What code series would you refer to for patients who have had a previous cesarean delivery and
now present with the expectation of a vaginal delivery?
a. 59400–59141
b. 59618–59622
c. 59610–59614
d. 59610–59622

50. How would you report a bilateral cadaver donor nephrectomy with cold preservation?
a. 50300-50
b. 50320-50
c. 50234
d. 50300

51. An infant born at 33 weeks underwent five photocoagulation treatments to both eyes due to
retinopathy of prematurity at six months of age. The physician used an operating microscope during
these procedures. These treatments occurred once per day for a defined treatment period of five days.
How would you report all of these services?
a. 67229 -50
b. 67229 x 5
c. 67229, 69990
d. 67229

52. Todd had a tumor removed from his left temporal bone. How would you report this service?
a. 61563
b. 61500
c. 69979, 69990-51
d. 69970

53. Jennifer was admitted to the hospital for an aspiration of two thyroid cysts. Her physician
completed this procedure with CT guidance of the needle including interpretation and report. How
would you report the professional services?
a. 60300-26, 76942-26
b. 60300 x 2, 77012-26
c. 10021, 60300-51, 77012-26
d. 60300

54. Baby Smith was diagnosed with meningitis. His physician placed a needle through the fontanel at
the suture line to obtain a spinal fluid sample on Monday. The needle was withdrawn and the area
bandaged. The baby required another subdural tap bilaterally on Wednesday. How would you
report Wednesday’s service?
a. 61001 b. 61000, 61001 c. 61070 d. 61001-50

55. Max had a bilateral revision fenestration operation. How would you report this procedure?
a. 69840 b. 69840-50 c. 69820 d. Both a and c

56. Dr. Martin performed an excision at the middle cranial fossa for a vascular lesion. This procedure
was completed in an intradural fashion with dural repair and graft. His partner, Dr. Sutter, performed
an infratemporal approach with decompression of the auditory canal. How should Dr. Martin report her
services?
a. 61590, 61606-51 b. 61606-62 c. 61606 d. 61601

57. After a snow skiing accident, Barry had a cervical laminoplasty to four vertebral segments. How
should you report this procedure?
a. 63050 x 4
b. 22600, 63051-51
c. 22842, 63045, 63050
d. 63050

58. How is a neuroplasty procedure described in the CPT Professional Edition?

a. The decompression or freeing of intact nerve from scar tissue, including external neurolysis and/or
transposition
b. The surgical repair of nerves using only microscopic techniques
c. The position of nerves tested one or more anatomic digits
d. The decompression or freeing of an intact vein from scar tissue, including external neurolysis and/or
transposition

59. Phyllis fell down on the ice and fractured her leg. The fall also caused severe injury to the muscles
and tore several nerves. Her physician completed suturing of two major peripheral nerves in her leg
without transposition and shortened the bone. After the surgery she was seen by a physical therapist
for ongoing treatment and gait training. How would you report the surgical procedure?
a. 64857, 64859-51, 64876-51
b. 64856, 64857
c. 64857, 64859, 64876
d. 64858, 64857, 64859, 64876

60. John was hospitalized for a repair of a laceration to his left conjunctiva by mobilization and
rearrangement. How should you report this procedure?
a. 65273-LT b. 67930 c. 65272 d. 67930-LT