46 year-old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn out and a 15 blade scalpel was used for full excision of an 8 cm lesion. Layered closure was performed after the removal. The specimen was sent for ...
46 year old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck a 05 cm margin was drawn out
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CPC Practice Exam 1
46 year-old female had a previous biopsy that indicated positive malignant margins
anteriorly on the right side of her neck. A 0.5 cm margin was drawn out and a 15 blade
scalpel was used for full excision of an 8 cm lesion. Layered closure was performed
after the removal. The specimen was sent for permanent histopathologic examination.
What are the CPT® code(s) for this procedure?
A. 11626
B. 11626, 12004-51
C. 11626, 12044-51
D. 11626, 13132-51, 13133 - Answer According to CPT® guidelines "Repair of an
excision of a malignant lesion requiring intermediate or complex closure should be
reported separately". The intermediate repair code is reported because it was a layered
closure. Answer C
30 year-old female is having 15 sq cm debridement performed on an infected ulcer with
eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to
down to the bone of the foot. The bone had to be minimally trimmed because of a sharp
point at the end of the metatarsal. After debriding the area, there was minimal bleeding
because of very poor circulation of the foot. It seems that the toes next to the ulcer may
have some involvement and cultures were taken. The area was dressed with sterile
saline and dressings and then wrapped. What CPT® code should be reported?
A. 11043
B. 11012
C. 11044
D. 11042 - Answer Debridement is not being performed on an open fracture/open
dislocation eliminating multiple choice answer B. The ulcer was debrided all the way to
the bone of the foot, making multiple choice answer C, the correct procedure. Answer C
64 year-old female who has multiple sclerosis fell from her walker and landed on a glass
table. She lacerated her forehead, cheek and chin and the total length of these
lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each
extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED
physician repaired the lacerations as follows: The forehead, cheek, and chin had
debridement and cleaning of glass debris with the lacerations being closed with one
layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure,
6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot
were closed with adhesive strips. Select the appropriate procedure codes for this visit.
A. 99283-25, 12014, 12034-59, 12002-59, 11042-51
B. 99283-25, 12053, 12034-59, 12002-59
C. 99283-25, 12014, 12034-59, 11042-51
D. 99283-25, 12053, 12034-59 - Answer To start narrowing your choices down, the
hand and foot were closed with adhesive strips. The Section Guidelines in the CPT®
manual for Repair (Closure) states: "Wound closure utilizing adhesive strips as the sole
repair material should be coded using the appropriate E/M code." Eliminating multiple
choice answers A and B. The lacerations on the face are intermediate repairs, because
debridement and glass debris was removed. The guidelines in the CPT® codebook for
Repair (Closure) states: "Single-layer closure of heavily contaminated wounds that have
,CPC Practice Exam 1
required extensive cleaning or removal of particulate matter also constitutes
intermediate repair." Eliminating multiple choice answer C. The intermediate repair of
the lacerations to the face totaled 6 cm (12053). The right arm and left leg had cuts
measuring 5 cm each which totaled 10 cm requiring intermediate repair (12034).
Answer D
52 year-old female has a mass growing on her right flank for several years. It has finally
gotten significantly larger and is beginning to bother her. She is brought to the
Operating Room for definitive excision. An incision was made directly overlying the
mass. The mass was down into the subcutaneous tissue and the surgeon encountered
a well encapsulated lipoma approximately 4 centimeters. This was excised primarily
bluntly with a few attachments divided with electrocautery. What CPT® and ICD-10-CM
codes are reported?
A. 21932, D17.39
B. 21935, D17.1
C. 21931, D17.1
D. 21925, D17.9 - Answer The mass growing turned out to be a lipoma found in the
subcutaneous tissue of the flank. In the ICD-10-CM Alphabetic Index, look for
Lipoma/subcutaneous/trunk. You are referred to code D17.1, eliminating multiple choice
answers A and D. Because the 4 cm tumor was found in the subcutaneous tissue code
21931 is the correct CPT® code to report. Answer C
PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open
reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF
PROCEDURE: The patient was brought to the operating room; anesthesia having been
administered. The right upper extremity was prepped and draped in a sterile manner.
The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated.
An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were
elevated. Cutaneous nerve branches were identified and very gently retracted. The
interval between the second and third dorsal compartment tendons was identified and
entered. The respective tendons were retracted. A dorsal capsulotomy incision was
made, and the fracture was visualized. There did not appear to be any type of
significant defect at the fracture site. A 0.045 Kirschner wire was then used as a
guidewire, extending from the proximal pole of the scaphoid distal ward. The guidewire
was positioned appropriately and then measured. A 25-mm Acutrak® drill bit was drilled
to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was
accomplished in this fashion. This was visualized under the OEC imaging device in
multiple projections. The wound was irrigated and closed in layers. Sterile dressings
were then applied. The patient tolerated the procedure well and left the operating room
in stable condition. What CPT® code is reported for this procedure?
A. 25628-RT
B. 25624-RT
C. 25645-RT
D. 25651-RT - Answer Patient had an open reduction, meaning an incision was made to
get to the fracture, eliminating multiple choice answer B. The fracture site was the
scaphoid of the wrist (carpal), eliminating multiple choices C and D. Answer A
, CPC Practice Exam 1
An infant with genu valgum is brought to the operating room to have a bilateral medial
distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize
the growth plate. With the growth plate localized, an incision was made medially on both
sides. This was taken down to the fascia, which was opened. The periosteum was not
opened. The Orthofix® figure-of-eight plate was placed and checked with X-ray. We
then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed
with 2-0 Vicryl and 3-0 Monocryl®. What procedure code is reported?
A. 27470-50
B. 27475-50
C. 27477-50
D. 27485-50 - Answer Your keywords in the scenario to narrow your choices down to
code 27485 are: "distal femur,""genu valgum," and "hemiepiphysiodesis." Answer D
The patient is a 67 year-old gentleman with metastatic colon cancer recently operated
on for a brain metastasis, now for placement of an Infuse-A-Port for continued
chemotherapy. The left subclavian vein was located with a needle and a guide wire
placed. This was confirmed to be in the proper position fluoroscopically. A transverse
incision was made just inferior to this and a subcutaneous pocket created just inferior to
this. After tunneling, the introducer was placed over the guide wire and the power port
line was placed with the introducer and the introducer was peeled away. The tip was
placed in the appropriate position under fluoroscopic guidance and the catheter trimmed
to the appropriate length and secured to the power port device. The locking mechanism
was fully engaged. The port was placed in the subcutaneous pocket and everything sat
very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk
stitch. What CPT® code(s) is (are) reported for this procedure?
A. 36556, 77001-26
B. 36558
C. 36561, 77001-26
D. 36571 - Answer Patient is having an Infuse-A-Port put in his chest to receive
chemotherapy. The subclavian vein (central venous) is being tunneled for the access
device, eliminating multiple choices A and D. The patient had a subcutaneous pocket
created to insert the power port, eliminating multiple choice answer B. Code 77001
reports fluoroscopic guidance for a central venous access device. Modifier 26 denotes
the professional service. Answer C
A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This
was estimated to be 800 cc in size and had an appearance of fluid on the CT Scan. A
needle is used to puncture through the chest tissues and enter the pleural cavity to
insert a guidewire under ultrasound guidance. A pigtail catheter is then inserted at the
length of the guidewire and secured by stitches. The catheter will remain in the chest
and is connected to drainage system to drain the accumulated fluid. The CPT® code is:
A. 32557
B. 32555
C. 32556
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