maryland next gen nclex test bank project case stu
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Maryland Next Gen NCLEX Test Bank Project Case Study Topic: (&
standalone trend) Compartment Syndrome
Question 1 1.2 out of 1.2 points
OPERATIVE REPORT: PREOPERATIVE DIAGNOSIS: Compound fracture, left humerus, with possible loss of left radial pulse.
PROCEDURE PERFORMED: Open reduction internal fixation, left compound humerus fracture. PROCEDURE: While under a general
anesthetic, the patient's left arm was prepped with Betadine and draped in sterile fashion. We then created a longitudinal incision
over the anterolateral aspect of his left arm and carried the dissection through the subcutaneous tissue. We attempted to identify
the lateral intermuscular septum and progressed to the fracture site, which was actually fairly easy to do because there was some
significant tearing and rupturing of the biceps and brachialis muscles. These were partial ruptures, but the bone was relatively
easy to expose through this. We then identified the fracture site and thoroughly irrigated it with several liters of saline. We also
noted that the radial nerve was easily visible, crossing along the posterolateral aspect of the fracture site. It was intact. We
carefully detected it throughout the remainder of the procedure. We then were able to strip the periosteum away from the lateral
side of the shaft of the humerus both proximally and distally from the fracture site. We did this just enough to apply a 6-hole
plate, which we eventually held in place with six cortical screws. We did attempt to compress the fracture site. Due to some
comminution, the fracture was not quite anatomically aligned, but certainly it was felt to be very acceptable. Once we had applied
the plate, we then checked the radial pulse with a Doppler. We found that the radial pulse was present using the Doppler, but not
with palpation. We then applied Xeroform dressings to the wounds and the incision. After padding the arm thoroughly, we applied
a long-arm splint with the elbow flexed about 75 degrees. He tolerated the procedure well, and the radial pulse was again present
on Doppler examination at the end of the procedure.
Selected Answer:24515-LT, 812.31, E887
Answer Feedback: 24515-LT. Open treatment of humeral shaft fracture with plates/screws with LT to indicate the left side; 812.31,
open fracture of the shaft of the humerus. You know this is an open fracture by the statement "compound," which is identified as
an open fracture in the Note box located in the Index of the ICD-9-CM. The following statement from the operative report
confirms that the fracture is of the humeral shaft: "We then were able to strip the periosteum away from the lateral side of the
shaft of the humerus both proximally and distally from the fracture site." E887 fracture, cause not specified in report.
Question 2 1.2 out of 1.2 points
Cryotherapy of the prostate is performed for prostate cancer. What CPT® and ICD-9-CM codes are reported for this service?
Selected Answer: 55873, 185
Answer Feedback:There is no mention that the prostate cancer is “in situ”, thus “C” cannot be considered for reporting. Also, the
diagnosis does not state that the prostate cancer is “secondary”, so “B” can also be excluded. As CPT® 55875 is used to report
transperineal placement of needles or catheters into the prostate, “D” can also be excluded. Cancer of the prostate is one of the
few three-digit ICD-9-CM codes and CPT® 55873 stated cryosurgical ablation of the prostate. Ultrasonic guidance and monitoring
is not reported separately.
Question 3 1.2 out of 1.2 points
OPERATIVE REPORT: DIAGNOSIS: Acute renal insufficiency. PROCEDURE: Renal biopsy. The patient was taken to the operating
room for a needle biopsy of the right and left kidneys.
Selected Answer:50200-50, 593.9
Answer Feedback: 50200-50, 593.9 – Coder would start in the CPT index with Biopsy and sub term Kidney. Coder is led to 50200-
20205. The coder would review the codes in the tabular and choose 50200 because it is performed percutaneous by trocar or
needle. Coder would append modifier 50 because this procedure was performed on both the right and left kidneys.
,Maryland Next Gen NCLEX Test Bank Project Case Study Topic: (&
standalone trend) Compartment Syndrome
Question 4 1.2 out of 1.2 points
The pediatric physician takes this newborn male to the nursery to perform a clamp circumcision.
Selected Answer: 54150, V50.2
Answer Feedback: 54150 identifies the clamp circumcision. V50.2 is the diagnosis code for a routine circumcision of a newborn.
Question 5 0 out of 1.2 points
What CPT and ICD-9-CM codes report a percutaneous insertion of a dual-lead pacemaker by means of the subclavian vein? The
diagnosis is sick sinus syndrome, tachy-brady.
, Maryland Next Gen NCLEX Test Bank Project Case Study Topic: (&
standalone trend) Compartment Syndrome
Selected Answer: 33249, 427.0, 427.81
Answer Feedback: 33249 is for insertion of the electrode lead(s) for a single- or dual-lead(s) pacing cardioverter-defibrillator and
the insertion of a pulse generator, not insertion of a pacemaker and electrodes. Code 427.0 reports a cardiac dysrhythmia,
specifically a paroxysmal supraventricular tachycardia; however, the report indicated sick sinus syndrome, reported with 427.81.
Only 427.81 needs to be reported because the tachy-brady is included in this code.
Question 6 1.2 out of 1.2 points
Dr Ale requests an office consultation from an obstetrician for a 23 year old female with first trimester bleeding.?The patient
presents with a history of brownish discharge and occasional pinkish discharge. During the history, the patient relates that she has
had suprapubic pain in the past week and cramping. She states her pain is 8/10. She has felt nausea and has vomited on three
occasions. On one occasion, the nausea was accompanied by dizziness and vertigo. All other systems are negative at this time and
included: Constitutional factors, ophthalmologic, otolaryngologic, cardiovascular, respiratory, musculoskeletal, integumentary,
neurologic, psychiatric, endocrine, hematologic, lymphatic, allergic, and immunologic. The PFSH included patient history of
tonsillectomy with family history of breast cancer on her mother?s side. The patient does not smoke or drink. The physician
conducts a comprehensive examination focused on the chief complaint and related systems. The uterus is found to be soft and
involuted. There is cervical motion tenderness and significant abdominal tenderness on palpation. A left pelvic mass is palpated in
the left quadrant. The physician orders a pelvic ultrasound, a complete CBC, and differential. Considering the range of possible
diagnoses, the medical decision making complexity is high.
Selected Answer: 99245, 640.93, 789.34
Question 7 0 out of 1.2 points
A 58-year-old patient has a PICC line with a port placed for chemotherapy infusion. Fluoroscopic guidance was used to gain access
and check placement. The patient is diagnosed with pancreatic cancer with mets to the lung and lower lobe of the liver. All are
being treated.
Selected Answer: 36556, 77001, 157.9, 155.2, 162.5
Question 8 1.2 out of 1.2 points
Left ureteral stent placement and ESWL are performed. What CPT® code(s) is/are reported for this service?
Selected Answer: 50590, 52332
Answer Feedback: CPT® 52353 describes laser lithotripsy, not extracorporeal shock wave laser lithotripsy and therefore you would
be incorrect in reporting this code. CPT® 52332 describes the stent placement, but does not include the ESWL, as with 50590
describing the ESWL but not the placement of the stent. CPT® 50590 and 52332 describes both procedures performed. Other
than adding a LT modifier to the procedures, no other modifiers would be added.
Question 9 1.2 out of 1.2 points
Patient is status post radical retropubic prostatectomy with erectile dysfunction, presenting for penile implant. An inflatable
penile prosthesis is inserted. What CPT® code(s) is/are reported for this service?
Selected Answer: 54405
Answer Feedback:Penile prosthesis insertion codes are described as either “semi-rigid” or “inflatable”; however, the group of
codes include removal, repair and removal and replacement. Descriptions should be read carefully before a code is chosen.
Semi-rigid prosthesis are reported with CPT® 54400, Multi-component prosthesis are reported with CPT® 54405. CPT® 54406 and
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