Exam (elaborations)
AAPC CPC EXAM PRACTICE D, E, F.
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AAPC CPC EXAM PRACTICE D, E, F.
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AAPC CPC EXAM PRACTICE D, E, FCPC EXAM D Answer - 1. Indication: Patient has a hypertrophic scar on the posterior side of the left leg, at
the level of the knee. This has begun to restrict his mobility. His physical therapy trial
was
unsuccessful. Procedure: After the proper induction of anesthesia, the subcutaneous
tissue of
the patient's left leg beneath the scar was infiltrated with crystalloid solution containing
epinephrine to minimize blood loss. The scar was then excised down to viable dermis.
Hemostasis was obtained with epinephrine soaked pads. Skin was harvested from the patient's
thigh in a split thickness fashion and was used to cover the 90 sq cm defect created by the
surgery. The graft was secured with skin staples, and then dressed with fine mesh gauze
followed by medication-soaked gauze. The donor site was dressed with mesh followed by
Adaptic™, followed by a dry dressing and an Ace wrap. What are the CPT® codes?
A. 15110-52, 15002
B. 15100, 11406
C. 15100, 15002
D. 15110, 15002 Answer - 2. The physician is called in to perform repairs for a 17 year-old girl involved in a motor
vehicle accident. She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her
right cheek, a 4 cm laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm
laceration to her chest. The wound on her chin required a layered closure. All other wounds
required complex closure. The CPT® codes to report are:
A. 13132, 13133 x 4, 13101, 12052
B. 13132, 13133 x 3, 13133-52, 13101, 13102, 12052
C. 13132, 13133 x 3, 13101, 13102, 12052
D. 13131, 13132, 13133 x 3, 13101, 13102, 12052 Answer - 3. A 36 year-old male presents to have multiple lesions destroyed. Three benign
lesions on his face are destroyed and five actinic keratoses on his left arm are destroyed. The
CPT® code(s) to report is (are):
A. 17000, 17003 B. 17000, 17003 x 4, 17110
C. 17110
D. 17260 x 5, 17110 x 3 Answer - 4. Patient is having ongoing back and hip pain. The physician elects to perform a
sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is placed
prone position. A needle is placed under fluoroscopic guidance into the SI joint and a
mixture of
20 mg of Celestone and Marcaine is injected for pain relief. Report the CPT® code(s).
A. 27096, 77003-26
B. 20611
C. 20552
D. 27096 Answer - 5. Patient is seen in the hospital's outpatient surgical area with a diagnosis of a
displaced comminuted closed fracture of the lateral condyle, right elbow. An ORIF procedure
was performed, which included the following techniques: An incision was made in the area of
the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was
easily exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees.
It was possible to manually reduce this quite easily, and the manipulation resulted in an almost
anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut
off below skin level. The wound was closed with plain catgut subcutaneously and 5-0
nylon for
the skin. Dressings and a long arm cast were applied. Which is the correct ICD-10-
CM and CPT®
code assignment?
A. 24579-RT, 29065-51-RT, S42.451B
B. 24577-RT, S42.451A
C. 24579-RT, S42.451A
D. 24575-RT, S42.451B Answer - 6. A 35 year-old female patient presents with acute onset of severe pain since
October. Her workup has revealed evidence of disk herniation with loss of lordosis at
the C5-C6.
Intraoperative findings were consistent with two large fragments of free disk fragments in the
foramen at C5-C6 on the right side. After general anesthesia, the patient was placed on the
operative table in the supine position. All pressure points were cushioned and a transverse skin
incision was fashioned under fluoroscopic guidance over the C5-C6 disc space. Dissection through the platysma eventually allowed for exposure of the anterior entrance to the vertebral
body of C5 and C6 and retractors were inserted to maintain adequate exposure. The
operating
microscope was brought into the field. Caspar posts were placed and slight distraction allowed
exposure. A complete discectomy was performed at C5-C6 by using endplate curets pituitary
rongeurs and Kerrison rongeurs. The posterior longitudinal ligament was resected and beneath
the posterior longitudinal ligament, two significant sized disc fragments were noted in
the
foramen at C5-C6. These were removed using pituitary and Decker instruments. The
endplates
were then decorticated so that they were parallel to each other and a midline keel was
performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody Kineflex-C device was
placed under fluoroscopic guidance. Satisfied with the positioning of the device, the decision
was made to close. What is the correct CPT® code for this procedure?
A. 63075
B. 63081
C. 22856
D. 22554 Answer - 7. OPERATION: Dual chamber transvenous implantable pacing
cardioverter-defibrillator system implantation with leads. INDICATIONS: A 67 year-
old, white
gentleman has significant underlying ischemic cardiomyopathy with EF of 25 percent, prior
infarcts, remote history of syncope, and at a high risk for malignant ventricular arrhythmias. He
has had a recent T wave alternans test which was clearly abnormal. He has had episodes of
resting bradycardia, also noted. He meets Madit II criteria for insertion of a transvenous
implantable pacing cardioverter-defibrillator (ICD). PROCEDURE: After informed consent had
been obtained, the patient was brought to the outpatient hospital lab in the fasting state. The
left anterior chest was prepped and draped in a sterile fashion. Intravenous sedation and local
anesthetic were given. After local anesthetic, a 5 cm incision was made at the left deltopectoral
groove. With blunt dissection and cautery, this was carried down through the pre pectoralis
fascia. The cephalic vein was identified and ligated distally. Through the venotomy, a
subclavian venogram was performed to provide a roadmap. The atrial and ventricular leads were then
advanced into the vessel to the level of the right atrium under fluoroscopic guidance. The
ventricular lead was maneuvered to the right ventricular outflow tract, and then through the RV
apex where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The
lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10-volt
pacing did not result in diaphragmatic capture. The atrial lead was maneuvered to the
anterolateral right atrial wall where it was actively fixed. Good sensing and pacing thresholds
were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0
Tycron sutures. 10-volt pacing did not result in diaphragmatic capture. A subcutaneous pocket
was created with good hemostasis achieved. The pocket was subsequently irrigated with
solution of Bacitracin. The generator was connected to the lead, and then placed in the pocket
with no tension on the lead. The deep fascial layer was closed with interrupted 2-0 Vicryl suture.
The subcutaneous closure was made with running 3-0 Vicryl suture. Subcuticular closure was
made with running 4-0 Vicryl suture. Steri-strips were applied. Ventricular fibrillation was
induced with a T wave shock. This was successfully sensed and terminated with a 15 joule shock
to sinus rhythm. High voltage impedance was 39 ohms. Dry dressing was placed over the
wound. The patient returned to the floor in stable condition without apparent complications.
Which of the following CPT® code(s) accurately describes the basic procedure summarized in
this report?
A. 33208
B. 33249, 76000-26
C. 33241, 33243, 33249
D. 33249 Answer - 8. The patient comes in today to have an arteriovenous fistula created to facilitate
dialysis. The surgeon performs an upper arm basilic vein transposition based on the patient's
previous arterial duplex scan. Which is the appropriate CPT® code for this procedure?
A. 36825
B. 36830
C. 36818
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