Question 1

A 7-year-old riding his bike struck a tree stump throwing him off his bike. He received multiple
lacerations. He had a 3 cm dermis laceration on his scalp with two 0.5 cm lacerations on his face.
His right arm had a 5 cm laceration and right leg has a 5 cm laceration. The physician stapled the
laceration for the scalp. Physician used steri-strips (adhesive strips) to close the wounds on the
face. The legs and arms were cleaned by heavily irrigating them with normal saline and removal
of embedded debris performed on both wounds, followed with a single-layer closure. Select the
repair codes to report.
A. 12032, 12032-59, 12011-59, 12002-
59
B. 12002, 12002-59, 12011-59, 12002-
59
C. 12005, 11042-59
D. 12034, 12002-59
Question 2
A 55-year-old male presents in the office with an ingrown toenail on the right and left foot. The
procedure was discussed in detail and the patient elected to have it performed. The right foot was
prepped and draped in sterile fashion. The right great toe was anesthetized with 50/50 solution of
2 percent lidocaine and .05 percent Marcaine. A mini-tourniquet was placed around the toe for
hemostasis in which part of the nail plate and matrixectomy were performed. Phenol was then
applied, the toe was then flushed. Tourniquet was released and dressing applied. At this time the
patient elected to only have one performed and will return in two weeks for the left foot. Code
the procedure.

A. 11765-
T5
B. 11750-
T5
C. 11730-
T5
D. 11740-
T5
Question 3
Procedure Diagnosis: Basal cell carcinoma, left chin.
Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell carcinoma of the left
chin with a 4 cm closure.
Procedure: The patient’s left chin was examined. The site of intended excision was marked out.
The site was then prepped. The patient was then prepped and draped in the usual fashion. A 15
blade scalpel was then used to make an incision in the previously marked site. It was carried
down to the subcuticular fat. The lesion was then sharply dissected off underlying tissue bed
using a 15-blade scalpel. It was tagged for pathologic orientation. The hyfrecator was used for
hemostasis. The wound was then closed by advancing the tissue surrounding the lesion and
closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin. The
skin closure was in a running subcuticular fashion. Steri-Strips were then applied. What are the
procedure and diagnosis codes?
A. 11644, 12052-51,
C44.319
B. 11643, 12013-51,
C44.319
C. 11444, 12052-51, D49.2
D. 11443, 12013-51, D49.2
Question 4
The physician removes a tumor from the patient’s neck using the Mohs micrographic surgery
technique. During the first stage, the physician takes four tissue blocks and reviews them under a
microscope. The exam of the tissue blocks reveals a second stage is necessary to remove areas
where the tumor is still present. The physician examines two additional tissue blocks. What are
the appropriate CPT® codes for reporting the procedure?
A. 17311, 17312,
17315
B. 17313, 17315
C. 17313, 17314,
17315
D. 17311, 17312
Question 5
This 45-year-old male presents to the operating room with a painful mass of the right upper arm.
General anesthesia was induced. Soft tissue dissection was carried down thru the proximal aspect
of the teres minor muscle. Upon further dissection a large mass was noted just distal of the
IGHL(inferior glenohumeral ligament), which appeared to be benign in nature. With blunt
dissection and electrocautery, the 4.5 cm mass was removed en bloc and sent to pathology. The
wound was irrigated, and repair of the teres minor with subcutaneous tissue was then closed with
triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. What is the
correct CPT® code for this service?

A.
23076
B.
23066
C.
23075
D.
23077
Question 6
The physician performed manipulation of a closed fracture of the distal radius on a 12- year-old
male. He placed a short arm fiberglass cast. What is the HCPCS Level II code for the supply?
A.
Q4012
B.
Q4011
C.
Q4010
D.
Q4009
Question 7
The patient presented for medial meniscal bucket-handle tear left knee. Arthroscopy with partial
medial meniscectomy left knee and arthroscopic picking (drilling pick holes) of the lateral
femoral condyle left knee was performed. Code the procedure and diagnosis codes.

A. 29880-LT, 29879-51-LT,
S83.212A
B. 29881-LT, 29879-51-LT,
S83.212A
C. 29882-LT, 29885-51-LT,
S83.282A
D. 29881-RT, 29885-51-LT,
S83.242A
Question 8
A 47-year-old patient was previously treated with external fixation for a type IIIA open left tibia
fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction
of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the
iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned,
and repositioned. Interfragmentary compression was applied and three screws and the harvested
bone graft were packed into the fracture site. What are the correct codes for this diagnosis and
procedure?
A. 27724,
S82.102N
B. 27758,
S82.202S
C. 27722,
S82.202P
D. 27759,
S82.102N
Question 9
Patient had a dual chamber pacemaker put in two days ago. He is having problems with the
battery and the cardiologist found that it is malfunctioning. He is taken to the operating suite to
replace the pacemaker battery. What CPT® and ICD-10-CM codes are reported?
A. 33226-76,
T82.111A
B. 33235-52,
T82.110A
C. 33228-78,
T82.111A
D. 33213-58,
T82.119A
Question 10
A 2-year-old male requires a central venous catheter. Using xylocaine local anesthesia a
percutaneous approach is used in the neck and venous access is achieved. A subcutaneous tunnel
is created from the anterior chest wall to the venotomy site and the catheter passed through the
tunnel. The CV catheter is then placed at the superior vena cava and sutured in position. Which
procedure code is reported?

A.
36568
B.
36555
C.
36557
D.
36560
Question 11
What is the patient’s right when it involves making changes in the personal medical record?
A. Patient must work through an attorney to revise any portion of the personal medical
information.
B. They should be able to obtain copies of the medical record and request corrections of
errors and mistakes.
C. It is a violation of federal health care law to revise a patient medical record.
D. Revision of the patient medical record depends solely on the facility’s compliance
program policy.
Question 12
Which statement regarding an ICD-10-CM coding conventions is TRUE?
A. If the same condition is described as both acute and chronic and separate subentries
exist in the Alphabetic Index at the same indentation level, code only the acute condition.
 B. Sequela (Late effect) codes are reported for a current acute phase of the injury or illness
C. An ICD-10-CM code is still valid even if it has not been coded to the full number of
characters required for that code.
D. Signs and symptoms that are integral to the disease process should not be assigned as
additional codes, unless otherwise instructed.
Question 13
A 78-year-old patient, with known arrhythmia, presented to an outpatient clinic for the insertion
of a cardiac event recorder. What is the proper HCPCS Level II code for this device?
A.
C1767
B.
C1764
C.
C1777
D.
E0616
Question 14
Diagnostic esophagogastroduodenoscopy of the esophagus, stomach, and duodenum was performed
after esophageal balloon dilation (less than 30 mm diameter) was done at the same operative session.
Code the procedure(s).

A. 43249, 43235-
51
B. 43249
C. 43220, 43200-
51
D. 43220
Question 15
A 46-year-old female with history of cervical carcinoma underwent placement of an ileal
conduit, with subsequent development of left hydronephrosis. A retrograde ureteral catheter was
recently placed. She returns today for catheter exchange. Patient was placed in the supine on the
operating table. The ileal conduit was accessed. The existing catheter was removed over a
guidewire and replaced with a similar 10 French 50 cm long locking pigtail catheter. Contrast
was injected for monitoring, confirming good position of the catheter placement. Interpretation
and report is in the record. IMPRESSION: Left retrograde ureteral catheter exchange via the ileal
conduit. How is this reported?
A. 50435
B. 50693
C. 50385
D. 50688, 75984-
 26
Question 16
A 70-year-old with significant pelvic prolapse and grade IV cystocele who has failed previous
primary repair and is status post hysterectomy. She presents for anterior repair and colpopexy.
Procedure: Patient placed in the dorsal lithotomy position and general anesthetic was induced
without problems. A midline incision is made from just above the bladder neck to the vaginal
cuff. She is noted to have a grade IV cystocele. Vaginal flaps were dissected to the level of the
pubocervical fascia. Her vaginal mucosa was in good condition but near the urethra and bladder
neck it was a little thinner. There is significant scarring on the left side from previous procedures.
Ishcial spine is identified and swept fiber fatty tissue off of the sacrospinous ligament bilaterally.
No scarring or adhesions in this area. Anterior needles were passed into place on the elevate
mesh and these were fixed in a manner similar to the MiniArc. They were passed along just
below the bladder neck toward the obturator foramen and fixed in place. An anterior support was
created without tension at the vesicourethral junction. Apical needles were then used to pass the
apical arms into place. There were gently fixed into place along the sacrospinous ligament
approximately 2cm away from the ischial spine. This was done bilaterally. They passed in a
single pass and were fixed in place confirmed by gentle tugging on both arms. Three Vicryl
sutures had been placed and the vaginal apex were then passed over into the mesh and tied down.
The apical arms were placed through the eyelets of the mesh and passed down toward the
sacrospinous ligament bilaterally to create good apical support. Eyelet fasteners placed
bilaterally and mesh arms trimmed providing excellent apical and anterior support. Vaginal
mucosa was closed and vaginal packed placed. No complications. What CPT® code(s)
describe(s) this procedure?
A. 57250,
57280
B. 57240,
57282
C. 57240,
57283
D. 57250,
57283
Question 17
Which modifier is appended to a CPT®, for which the provider had a patient sign an Advance
Beneficiary Notice (ABN) form because there is a possibility the service may be denied because
the patient’s diagnosis might not meet medical necessity for the covered service?
A.
GJ
B.
GA
C.
GB
D.
 GY
Question 18
A 5-year-old male has diminished hearing in the left ear due to chronic otitis media. He has had
hearing aid prosthetic devices in the ear which have resulted in additional infections. Parents
have decided on an osseointegrated implant to restore hearing. The mastoid cortex is exposed.
Spiral drilling is performed to create a pilot hole. The stem of the titanium pedestal is placed in
the tunnel adjacent to the cochlea and abutment subsequently secured to the fixture. Which
CPT® code is reported?
A. 69717-
LT
B. 69719-
LT
C. 69714-
LT
D. 69716-
LT
Question 19
The physician performs a right thyroid lobectomy. The patient was prepped and draped. After
adequate general anesthesia, the neck was incised on the right side and sharp dissection was then
used to cut down onto the strap muscles and sternocleidomastoid muscles. The strap muscles
were separated and transected on the right side. A small thyroid lobe was visualized and
dissected free. There was no evidence of a tumor. The wound was closed with 3-0 interrupted
Vicryl for the platysma, 4-0 Vicryl for the deep tissues and 6-0 fast absorbing gut for the skin.
Code the encounter.
A. 60252-
RT
B. 60210-
RT
C. 60220-
RT
D. 60260-
RT
Question 20
PROCEDURE: Bilateral lumbar medial branch block under ultrasound guidance for the L3, L4,
L5 medial branches injecting the L4-L5, L5-S1 facets for diagnostic and therapeutic purposes.
PROCEDURE: The patient was placed in the prone position and automated blood pressure cuff
and pulse oximeter applied. The skin entry points for approaching the anatomic target points of
the bilateral segmental medial branches or dorsal ramus of L3, L4, L5 were identified with a 22.5
degree from an ultrasound view and marked. Following thorough Chloraprep preparation of the
skin and draping and 1% lidocaine infiltration of the skin entry points and subcutaneous tissues,
a 22 gauge 6" spinal needle was placed under ultrasound guidance for the L4-L5 and L5-S1 facet
joints. At each joint 1 mL consisting of 0.5% bupivacaine and Depo-Medrol was injected. A total
of 80 mg of Depo-Medrol was given in both sides. Which CPT® codes are reported?

A. 0216T-50, 0217T x 2, 0218T x 2, 76942-

26
B. 64493-50, 64494-50, 64495-50
C. 64493-50, 64494-50, 76942-26
D. 0216T-50, 0217T x 2
Question 21
15-year-old male is seen by the pediatrician in his office for having excessive thirst and frequent
urination. A urine dip is performed showing +3 sugar and with some ketones. Glucometer
reading is done showing a blood sugar range of 500-600. Physician sends the patient with his
father to the hospital for emergency admission and insulin drip. The pediatrician meets the
patient at the hospital and performs a detailed history, comprehensive exam and a high
complexity medical decision making. How should the pediatrician code the E/M service for this
visit?
A.
99214
B.
99221
C.
99223
D.
99285
Question 22
CC: Shortness of breath

History: A 62-year-old female returns to a family practice having shortness of breath for the last
week. It has been two years since her last visit to the practice. She also has nausea, diaphoresis,
chest pressure.

Past History: Celebrex® for her arthritis.

Hysterectomy 1 year ago.

Social History: Smoker-No Alcohol-No

Allergies: Penicillin

PHYSICAL EXAM

Vital Signs: BP 195/95 sitting, left arm

General/Constitutional: Mild distress. Some diaphoresis.

Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions.

Neck/Thyroid: Supple, without adenopathy or enlarged thyroid.

Respiratory: Shallow breathing, no wheezing.

Cardiovascular: Unequal pulses in both arms. Abnormal heart sounds heard.

EKG ordered.

Assessment/Plan

Severe exacerbation of congestive heart failure

Patient is sent to the hospital to be admitted. Will send hospital orders to start her on IV, order
chest X-ray and CBC.

A.
99202
B.
99215
C.
99204
D.
99214
Question 23
This morning a 48-year-old is placed in observation status from the emergency room with severe
diarrhea and extreme thirst. The physician performs a comprehensive history, comprehensive
examination and determines the patient is suffering from dehydration. The physician places the
patient on IV saline 500 ml and conducts normal saline hydration for a couple hours. The
medical making decision making is of moderate complexity. Patient is discharged home in the
late evening on the same day and is told to return if symptoms occur again. The E/M service(s)
for this encounter is:
A. 99285
B. 99219,
99217
C. 99235
D. 99217
Question 24
Physician was called to the floor to evaluate a 94 year-old that had sudden weakness,
hypotension, and diaphoresis. Physician found the patient in mild distress and dyspneic. Her BP
101/60, pulse 85. Labs were still pending. Arterial blood gas was drawn and interpreted by the
physician. She was admitted to CCU for Acute Antero-lateral MI and hypotension. Physician
spent total critical care time of 65 minutes. Select the appropriate CPT® coding for this visit:
A. 99291, 99292
B. 99233, 82803-
26
C. 99291
D. 99291, 82803-
26
Question 25
The anesthesiologist performed MAC (monitored anesthesia care) for a patient undergoing an
arthroscopy of the right knee. Code the anesthesia service.
A. 01382-AA
B. 01382-AA-
QS
C. 01400-AA
D. 01400-AA-
QS
Question 26
General anesthesia is administered to a 9-month-old undergoing a tracheostomy. Code the
anesthesia service.
A. 00320,
99100
B. 00320
C. 00326
D. 00326,
99100
Question 27
A 65-year-old woman is one year post with B-cell non-Hodgkin’s lymphoma. She is having
recurrent fever and pain. Tumor recurrence was confirmed by CT studies and chest X-ray. She
has failed prior chemotherapy and radiation treatments. A new treatment is being contemplated
and she is referred for a radiopharmaceutical distribution imaging as a requirement before
starting this new treatment. The provider injects small amounts of gamma-emitting radioactive
material paying particular attention for potential reaction. A gamma camera is used to take planar
images of the whole body for three days. Three sets of image data are interpreted. Qualitative
assessment of distribution and determination of treatment with monoclonal antibody are
provided. A report is dictated and placed in the medical record. Which CPT® code is reported?
 A. 78803-
26
B. 78802-
26
C. 78804-
26
D. 78801-
26
Question 28
Due to an elevated CEA level two years following a colon resection, the patient’s oncologist
ordered a diagnostic liver ultrasound. Which radiology code is reported for this encounter?
A.
76700
B.
76705
C.
76706
D.
76970
Question 29
A 52-year-old male has a 3.2 cm metastasized lung cancer in his left upper lobe. The tumor
cannot be removed by surgery due to the patient having severe respiratory conditions. He will be
receiving stereotactic body radiation therapy management under image guidance. There is a
delivery of 25 Gy for four fractions under direct supervision of the radiation oncologist. The
patient’s treatment set up is assessed to manage the execution of the treatment to make any
adjustments needed for accuracy and safety. The oncologist reviews and approves all the images
used to locate the tumor and images of fields arranged to deliver the dose. What CPT® and
ICD-10-CM codes should be reported?
A. 77373, Z51.0,
C34.92
B. 77435, Z51.0,
C78.02
C. 77435, C78.02,
Z51.0
D. 77402, C34.92,
Z51.0
Question 30
A 42-year-old has a lesion on his pancreas. The physician passes the biopsy needle through the
skin and removes tissue to be sent to pathology. Fluoroscopic guidance is used to obtain the
biopsy. Physician's report and interpretation is placed in the record. Code this encounter.
 A. 48100, 77002-
26
B. 48102, 77002-
26
C. 48120, 76942-
26
D. 48102, 76942-
26
Question 31
Patient is undergoing in vitro fertilization to get pregnant. Following the retrieval of follicular
fluid from the patient, the physician uses a microscope to examine the fluid to identify the
oocytes. What is the code for the laboratory service?
A.
89250
B.
89254
C.
89255
D.
89258
Question 32
A 22-year-old comes into the Emergency Department with convulsions. The ED physician
orders a drug screening without identifying any specific drug class to be tested. The lab runs two
drug classes screening using an immunoassay multiplex strip (dipstick) and the results are
visually read. The lab report comes back positive for alcohol and benzodiazepines. The ED
physician then orders a confirmatory test to be performed by the lab to confirm both positive
results. What CPT® codes are reported?
A. 80307, 80320, 80346
B. 80305, 80320, 80346
C. 80305 x 2, 80320, 80346
D. 80306 x 2, 80320 x 2, 80346
x2
Question 33
A pathologist performs a comprehensive consultation and report for surgical pathology on
referred material that involves reviewing a patient’s records, specimens and official findings
from other sources after a surgery. What is the correct code?
A.
88325
B.
 99244
C.
80505
D.
88329
Question 34
Photodynamic therapy involving application of light externally to destroy premalignant lesions
on the lower lip was provided to a 63 year-old patient. Code the encounter.
A.
96570
B.
96999
C.
96567
D.
96913
Question 35
A four-year-old patient presents with pain in the left forearm following a fall from a chair. The
injury occurred one hour ago. Her mom applied ice to the injury but it does not appear to help.
The ED physician performs a detailed history, expanded problem focused examination and
medical decision making of moderate complexity. An X-ray is ordered, which shows a fracture
of the distal end of the radius as read by the radiologist. The ED physician consults with an
orthopedic surgeon. The ED physician performs moderate conscious sedation with Ketamine for
30 minutes. The fracture is reduced and cast applied by an orthopedic surgeon. The child was
monitored with pulse oximetry, cardiac monitor and blood pressure by the ED physician
frequently. The patient was discharged with a sling and requested to follow up with the
orthopedic surgeon. Code the services performed by the ED physician.
A. 99284-25, 99151, 99153
B. 99283-25, 99155, 99157
C. 99283-25, 99152, 99157
D. 99284-25, 99151, 99157-
51
Question 36
In the inpatient setting, the psychiatrist provides psychotherapy for 30 minutes to affect a change
in the patient’s maladaptive behavior. What is the procedure code?
A.
90845
B.
90832
C.
 90847
D.
90853
Question 37
CKD is a disease of which system?

A. Circulatory
B. Genitourinary
C. Digestive
D.
Musculoskeletal
Question 38
A person who has nephritis has inflammation in what location?
A.
Gallbladder
B. Nerve
C. Uterus
D. Kidney
Question 39
What is ascites?
A. Fluid in the abdomen
B. Enlarged liver and
spleen
C. Abdominal
malignancy
D. Abdominal tenderness
Question 40
Which one of the following is a disorder in causing paralysis of the facial nerve?
A. Exotropia
B. Tarsal tunnel
syndrome
C. Brachial plexus
lesions
D. Bell’s palsy
Question 41
Complete this series: Pulmonary, Aortic, Mitral, and ________are valves of the heart.
A. Tricuspid
 B. Superior Vena
Cava
C. Carotid
D. Atrium
Question 42
Which term is one who has an overload of sodium?
A. Hyperkalemia
B.
Hyperpotassemia
C. Hypernatremia
D.
Hypercalcemia
Question 43
The term paracentesis found in CPT® code 49082 means:

A. A procedure performed to drain fluid that has accumulated in the abdominal

cavity
B. Biopsy of an abdominal mass
C. Removal of tissue samples from the abdominal cavity by an open approach
D. Removal of a cyst located in the abdominal cavity
Question 44
A 25-year-old is brought to the burn unit being rescued from a burning house. She sustained 25%
second degree burns on her anterior trunk and back and 20% third degree burns on her legs and
arms. Total body surface area burned is 45%. What ICD-10-CM code is reported for the burns
classified according to the extent of body surface involved?
A.
T31.22
B.
T32.42
C.
T31.24
D.
T31.42
Question 45
The patient is a 75-year-old woman who is here for follow-up after an incident last week in
which she had an FB lodged in her throat. An emergency esophagoscopy was performed and the
piece of hamburger meat removed and biopsy performed. She is positive for Barrett’s esophagus.
She has GERD which is currently being treated by medication and is here today to be evaluated
for photodynamic therapy.
What diagnosis codes should be reported for today’s visit?
A. K22.2, K22.70
B. T18.12XA, K22.70
C. T18.12XA, K22.70,
K21.9
D. K22.70, K21.9
Question 46
Preoperative Diagnosis: Right hydronephrosis
Postoperative Diagnosis: Right hydronephrosis
Procedure: Cystoscopy and right retrograde pyelogram
Procedure Description: Patient prepped and draped in the dorsolithotomy position. Placed
under general anesthesia a 23 French cystoscope was passed into the bladder. No tumors were
visualized. Urine from the bladder was sent for urine cytology. Then a 6 French access catheter
was passed into the right ureteral orifice. Contrast was injected and there were no filling defects
noted. There was no fixed tumor and no stone. There was mild hydroureteral nephrosis against
the bladder. There was a narrowing at the UVJ no abnormalities. Renal pelvis barbotaged with
saline and renal pelvis urine sent to pathology for urine cytology. After the retrograde pyelogram
was performed the access catheter was removed. Interpretation and report are in the medical
record.

What CPT® codes are reported?

A. 52000-RT, 74420-
26
B. 52281-RT, 74425-
26
C. 52007-RT, 74400-
26
D. 52005-RT, 74420-
26
Question 47
Preoperative Diagnosis: Lower left inguinal pain
Postoperative Diagnosis: Inguinal hernia

Procedure: Laparoscopic reduction of inguinal hernia with mesh

Indications: This 30 year-old patient presented with lower left inguinal pain and on examination
was found to have a left inguinal hernia. The decision to perform a left inguinal hernia repair was
made. The procedure was performed in the outpatient hospital surgery center. Risks and benefits
of the surgery were discussed with the patient and the patient decided to proceed with the
surgery.
Procedure Description: A skin incision was placed at the umbilicus where the left rectus fascia
was incised anteriorly. The rectus muscle was retracted laterally. Balloon dissector was passed
below the muscle and above the peritoneum. Insufflation and deinsufflation were done with the
balloon removed. The structural balloon was placed in the preperitoneal space and insufflated to
10 mm Hg carbon dioxide. The other trocars were placed in the lower midline times two. The
hernia sac was easily identified and was well-defined. It was dissected off the cord
anteromedially. It was an indirect sac. It was taken back down and reduced into the peritoneal
cavity. Mesh was then tailored and placed overlying the defect, covering the femoral, indirect,
and direct spaces, tacked into place. After this was completed, there was good hemostasis. The
cord, structures, and vas were left intact. The trocars were removed. The wounds were closed
with 0 Vicryl for the fascia, 4-0 for the skin. Steri-Strips were applied. The patient was awakened
and carried to the recovery room in good condition, having tolerated the procedure well.

What are the correct procedure and diagnosis codes?

A. 49650-LT, K40.90
B. 49651-LT, 49568,
K40.90
C. 49650-LT, K40.20
D. 49652-LT, K40.20
Question 48
Preoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis.
Postoperative Diagnosis: Same.
Procedure: Tonsillectomy and adenoidectomy.

Procedure Description: Patient is a 24 year-old male who was taken to the operating room and
put under IV sedation by the anesthesia department. An initial curettage of adenoids was done
and packing was placed. The left tonsil was then identified and dissected out extracapsular and
removed with scissors. Hemostasis was maintained by packing the left tonsil. Next, the right
tonsil was identified and incision was made. Dissection was done extracapsular and the right
tonsil was then removed. Both the right and left tonsil were sent as specimens as well as adenoid
tissue. What CPT® and ICD-10-CM codes are reported?

A. 42826, 42831-59, J35.02

B. 42820, J35.03
C. 42821, 42836-59, J35.01,
J35.02
D. 42821, J35.03
Question 49
Postoperative Diagnosis:
1. Impingement syndrome left shoulder.
2. AC synovitis left shoulder
Procedure: Arthroscopy with subacromial decompression and AC resection left shoulder.

Procedure Description: The patient was placed supine on the operating table and prepped and
draped in usual sterile fashion. The scope was introduced from a posterior portal and the joint
was inspected. The rotator cuff looked in good condition. The articular surfaces looked good.
The bicep also was in good condition. We went subacromially and there was a fair amount of
bursal inflammation encountered. We did a thorough bursectomy. A ligament chisel was used to
take down the coracoacromial ligament. A high-speed bur was used to do a subacromial
decompression going from lateral to medial. We took off about 2 cm of bone anteriorly. Part of
the acromion is surgically corrected.

Next we opened the AC joint through an anterosuperior portal. High-speed bur was used to grind
off about 10 mm of distal clavicle because there was a large subchondral cyst and we wanted to
get this totally ground out, which we did. Then the wounds were irrigated out, Nylon suture was
placed in our portals. The patient was placed in a bulky dressing and an arm sling and sent to the
recovery room in stable condition.

What CPT® codes are reported?

A. 29824-LT, 29826-
LT
B. 29825-LT, 29827-
LT
C. 23120-LT, 23130-
LT
D. 29827-LT, 29826-
LT
Question 50
Pre-Operative Diagnosis: Right lung mass

Indications: Patient with a mass in the right lung identified on routine X-ray presents for
bronchoscopy and biopsy.

Procedure: Bronchoscopy with lung biopsy

Procedure Description: The patient was brought to the endoscopy suite and the mouth and
throat were anesthetized. The bronchoscope was inserted and advanced through the larynx to the
bronchus. The bronchoscope was introduced into the right bronchus. Using fluoroscopic
guidance, the tip of the bronchoscope was maneuvered into the area of the mass. A closed biopsy
forceps was passed through the channel in the bronchoscope and then through the bronchial wall.
A tissue sample was obtained. There were no other abnormalities appreciated in the right side
and the bronchoscope was removed. The specimen was labeled and sent to pathology for testing.
The patient tolerated the procedure well.

Pathology indicates that the lung mass is cancer.

What are the procedure and diagnosis codes reported?
A. 31628, R22.2
B. 31628, C34.91
C. 31628, 31622-51,
C34.91
D. 31625, R22.2

1. D. The two face lacerations were closed with steri-strips (adhesive strips). When adhesive strips
are the only repair material used to close an open wound a repair code is not reported.
According to CPT® subsection guidelines for Repair (Closure), when wound closure uses
adhesive strips as the only repair material it should be coded using the appropriate E/M service.
Code 12011 is inappropriate to report for this scenario, eliminating multiple choices A and B.
The repairs for the wounds on the arm and leg are intermediate closures. According to CPT®
subsection guidelines for Repair (Closure), single-layer closure of heavily contaminated wounds
that have required extensive cleaning or removal of particulate matter also constitutes
intermediate repair. This eliminates multiple choice C. To report multiple wounds that are
repaired in the same classification and from the anatomic sites that are grouped together into
the same code descriptor, add the length of the wounds. The subsection guidelines also
indicates when more than one classification of wounds is repaired, append modifier 59 to the
least complicated repair(s).
2. B. This patient is coming in to have an in-grown toe nail removed, eliminating multiple choice
answer D (Evacuation of Subungual Hematoma), which is evacuating blood from under the nail.
You are now left with choices A, B, and C that involves the removal of an ingrown toenail.
Because there was a partial removal of the nail and nail matrix (matrixectomy) code 11750 is the
correct answer.
3. A. You need to first find out if this lesion is benign or malignant. For this scenario the patient has
a basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes
C and D as they deal with benign lesions. Now you need to find out where the lesion is located
and the size of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3
cm + .3 cm = 3.6 cm, leading you to code 11644. CPT® subsection guidelines for Excision-
Malignant Lesions state: For excision of malignant lesion(s) requiring intermediate or complex
closures should be reported separately. For this scenario the wound was closed in two layers
qualifying the closure to be coded with an intermediate repair of the chin (4 cm), 12052. The
diagnosis, basal cell carcinoma of the chin, look in the ICD-10-CM Table of Neoplasms, for
Neoplasm, neoplastic/skin NOS/face NOS/basal cell carcinoma C44.31-. In the Tabular List
complete the code with the 6th character 9.
4. D. The selection of codes are based on anatomic grouping, the stage of the removal, and
the number of tissue blocks used. For narrowing down to the correct procedure code for
the Mohs micrographic surgery, you should find out where on the body the tumor was
 removed. For this scenario, it is the neck; eliminating multiple choice codes B and C,
which involve the trunk, arms or legs. The tissue block removals were performed in two
stages, coding 17311 and 17312. Code 17315 is not coded for this scenario, because the
physician would have to remove more than five tissue blocks in any stage. There were
only four tissue blocks removed in the first stage and two tissue blocks removed in the
second stage, both falling short of six or more tissue blocks removed in either stage.
5. A. The selection of codes are based on the anatomic location, the deepness of the
excision, and the size of the tumor/mass. This patient is having a mass removed from
the shoulder area, eliminating multiple choice B, which is a biopsy. This is not a radical
resection because that includes removal of the entire tumor along with large
surrounding tissue, including adjacent lymph nodes. The size of the mass that was
excised was 4.5 cm, which leads you to code 23076.
6. C. The correct selection of this code is based on the length of the cast, anatomic location,
material used for the cast and age. The patient is a 12 years-old, which eliminates Q4011 and
Q4012. The cast is made of fiberglass, which makes Q4010 the correct answer.
7. B. One way to narrow down the choices is to code for the diagnosis first, which is a medial
meniscus tear of the left knee. In the ICD-10-CM Alphabetic Index, look for
Tear/meniscus/medial/bucket-handle; you are referred to code S83.21-. Complete code in the
Tabular List, S83.212A. You eliminated choices C and D. 29881 (medial OR lateral) is the correct
procedure code, because the menisectomy (removing torn fragments) was performed on the
medial meniscus only.
8. A. The selection of the code is based on the anatomic location and method of repair. Codes are
27758 and 27759 are not reported with this scenario because the fracture is not an acute
traumatic fracture. The physician is repairing a nonunion tibia fracture (failure of two ends of a
fracture to completely heal). Eliminating multiple choices B and D. To select the correct choice
you need to find out what type of graft was used. Your hints are “bone grafting” and “iliac
crest,” which leads you to the code 27724. The bone graft was harvested from the iliac crest,
and then the graft is placed at the fracture site of the tibia compressing it for desired position
and alignment and the screws were used to stabilize the fracture. In the ICD-10-CM Alphabetic
Index, look for Nonunion/fracture-see Fracture, by site. Look for Fracture, traumatic/tibia/upper
end referring you to code S82.10-. Compete code in the Tabular List, S82.102N. ICD-10-CM
Coding Guideline, I.C.19.c.1, indicates Care of complications of fractures, such as malunion and
nonunion, should be reported with the appropriate 7th character for subsequent care with
nonunion (K, M, N) or subsequent care with malunion (P, Q, R).
9. C. One way to choose the correct choice is by the modifiers. The patient is still in a post-op
period from an initial cardiac procedure and is having an unplanned return to the operating
room due to a malfunctioning pacemaker battery that is going to be replaced (modifier 78). In
the ICD-10-CM Alphabetic Index look for Malfunction/cardiac electronic device/pulse generator
referring you to code T82.111-. Go to the Tabular List to complete the code, T82.111A. The
selection of the pacemaker code is based on which system part of the system is being inserted
or replaced and the number of leads for the unit. Code 33228 is the removal of the pulse
generator or battery on a dual lead system with replacement.
10. C. The selection of the central venous codes are based on the technique of placement, if there is
a use of port or pump, and the age of the patient. Procedure performed is for placement of a
central venous catheter eliminating multiple choice A. An access device is not inserted
eliminating multiple choice D. The documentation supports that a subcutaneous tunnel is
created to place the catheter guiding you to code 36557.
11. B. Under HIPAA regulations, patients have the right to receive a copy of their medical record and
request that errors are corrected.
https://www.hhs.gov/hipaa/for-individuals/medical-records/index.html
12. D. Multiple choice D is the correct answer, according to the ICD-10-CM Official Coding
Guidelines, I.B.5. indicates not to report signs and symptoms that are integral to a definitive
diagnosis and are not assigned unless otherwise instructed. When the same condition is
diagnosed as acute and chronic and there is a separate code for both, report both codes (I.B.8).
Sequela (Late Effect) codes are the residual effect (condition produced) after the acute phase of
an illness or injury has terminated (I.B.10). An ICD-10-CM code is not valid unless it is coded to
the highest level of specificity. Do not rely solely on the ICD-10-CM Alphabetic Index to Diseases
and Injuries to select the correct code.
13. B. Multiple choices A and D are for a generator, and a cardioverter-defibrillator. Code C1764 is
the appropriate code to choose because documentation has the event recorder implanted
without memory, activator and programmer.
14. B. Patient is having an esophagogastroduodenoscopy, eliminating multiple choice answers C and D, which
reports an esophagoscopy. Your key terms to look for are “balloon dilation” which is in code description
43249. Code 43235 is noted as a separate procedure and a diagnostic procedure which means it is
included in a surgical endoscopy (43249) when performed at the same time, not coded separately
15. D. The patient presents for a ureteral catheter exchange via the ileal conduit. 50435 is not
correct because it is an exchange of the catheter percutaneously. 50693 is performed using a
percutaneous approach for placement of a ureteral stent, which is not performed in this case.
50385 is performed using a transurethral approach, which is not correct. The exchange is
performed via the ileal conduit, which is reported with 50688. Monitoring contrast imaging is
performed. There is a parenthetical note under 50688 that states that imaging is reported with
75984.
16. B. The colporrhaphy codes are based on the surgical approach and type of herniation. The
operative note indicates the patient had an anterior approach in correcting a grade IV cystocele
(herniation of the bladder causing the anterior vaginal wall to bulge downwards). The colpopexy
codes are also coded by approach. Colpopexy is suturing a prolapsed vagina to its surrounding
structures for vaginal fixation. Operative note documents a sacrospinous ligament fixation.
Correct codes are 57240 and 57282.
17. B. An Advance Beneficiary Notice (ABN) is a waiver of liability. When a patient has been
informed a service that is otherwise covered by Medicare but might not be covered in a
particular instance an ABN is signed by the patient prior to receiving the service. To inform
Medicare the ABN has been signed, append modifier GA. If an ABN is signed, the claim is the
patient’s responsibility if the claim is denied. This modifier is listed in the HCPCS Level II
codebook
18. C. The patient is implanting the osseointegrated implant for the first time, not a replacement of
a previous implant eliminating answer choices A and B. Documentation does not support that a
mastoidectomy was performed with an attachment to external speech processor, eliminating
answer choice D.
19. C. The patient is having a right “thyroid lobectomy,” eliminating multiple choice answers
A and D, which is a thyroidectomy (removal of the entire thyroid). 60220 is the correct
code since the scenario indicates that a small thyroid lobe (total lobe) is dissected free;
it does not indicate that part of the lobe was removed, eliminating multiple choice B.
20. D. When coding for facet joint or facet joint nerve injections, you report each level that
is injected. In this case, the joints for L4-L5 and L5-S1 were injected. A parenthetical note
states: If ultrasound guidance is used, report 0213T-0218T. The codes for facet joint and
facet joint nerve injections are unilateral. The procedure was performed bilaterally at
each level, therefore modifier 50 is reported on code 0216T. A parenthetical note is
given for add-on code 0127T that indicates to report it twice when performed
bilaterally, not with modifier 50. The ultrasound guidance is not reported separately,
eliminating answer choice A.
21. B. Patient was not seen in the Emergency Department, eliminating multiple choice
answer D. According to CPT® subsection guidelines for Initial Hospital Care: When the
patient is admitted to the hospital as an inpatient in the course of an encounter in
another site of service (eg, hospital emergency department, observation status in the
hospital, physician’s office, nursing facility) all evaluation and management services
provided by that physician in conjunction with that admission are considered part of the
initial hospital care when performed on the same of admission. The means the
evaluation that was performed in the physician’s office will not be reported since the
physician also admitted the patient to the hospital on the same date of service,
eliminating multiple choice A.
For the Initial Hospital Care codes (99221-99223) all three key components (History,
Examination, and Medical Making Decision) must meet or exceed to qualify for a
particular service Code 99221 requires a detailed or comprehensive history, detailed or
comprehensive examination, and medical decision making that is straightforward or of
low complexity. Because the lowest component is a detailed history, the highest level
that can be reached is 99221. To report code 99223 you need a comprehensive history.
22. B. Using the AMA CPT® Guidelines for Instructions for selecting a level of office or other
outpatient services table 2 in your CPT® code codebook:
High for number and complexity of problem addressed at the encounter – 1 acute or
chronic illness or injury that poses a threat to life or bodily function
Moderate for amount /or complexity of data to be reviewed and analyzed – ordering of
3 unique tests (EKG, CBC, and X-ray).
High risk of complication and/or morbidity or mortality of patient management –
Decision regarding hospitalization.
To qualify for a particular level of MDM, two of three elements for that level of MDM
must be met or exceeded. The overall E/M level is low reporting 99215.
23. C. The patient is designated as being in observation status, eliminating multiple choice
A. According to the Initial Observation Care guidelines it states: For a patient admitted
 and discharged from observation or inpatient status on the same date, the services
should be reported with codes 99234-99236.
24. C. According to CPT® Critical Care Services guidelines: “Critical care is the care of the
unstable critically ill or unstable critically injured patient who requires constant
physician attendance (the physician need not be constantly at bedside per se but is
engaged in physician work directly related to the individual patient's care). The critical
care codes may be reported wherever critical care services are provided. It is important
to recognize that the critical care codes are reported based upon the type of care
rendered not the location of where the care is rendered. The critical care codes are used
to report the total duration of time spent by a physician providing constant attention to
an unstable critically ill or unstable critically injured patient even if the time spent by the
physician providing critical care services on that date is not continuous.” For this
encounter the physician was called to the floor to evaluate a critically ill patient. The
physician documents 65 minutes of critical care time which is reported with 99291. Note
the Critical Care guidelines has a list of services that are included in critical care and not
reported separately. The blood gas (82803) service is included in the Critical Care and
not reported separately.
25. B. In this case MAC is performed, which requires modifier QS. This eliminates answer
options A and C. The selection of the code is based on the procedure being diagnostic or
surgical. The patient had a diagnostic arthroscopy. There is no indication that a surgical
procedure was performed, eliminating choice D. Because the service was provided by an
anesthesiologist, modifier AA is appended to the anesthesia code. Anesthesia modifiers
are found in your HCPCS Level II codebook.
26. C. The patient receives anesthesia for a tracheostomy. In the CPT® Index, look for
Anesthesia/Trachea. You are referred to 00320, 00326, 00542. The patient is a 9-month-
old which eliminates answer options A and B. There is a parenthetical note under code
00326 which states: Do not report 00326 in conjunction with 99100.
27. C. Multiple choice A is eliminated as the code indicates a single area and a single day. The whole
body was imaged, eliminating choice D. It was for three days, eliminating B.
28. B. Ultrasound codes are selected by anatomic site. The liver is an organ in the abdomen. The
selection of the code is based on complete vs limited scan. Because the ultrasound is performed
on one organ, it is reported as limited. Note the parentheses in the code description for 76705 it
states “single organ.” Code 76970 is not appropriate because this is an initial ultrasound and not
a follow-up.
29. B. Documentation supports stereotactic body radiation therapy, treatment management. This
eliminates multiple choices A and D. According to ICD-10-CM guidelines (Section I.C.2.e.2): If a
patient admission/encounter is solely for the administration of chemotherapy, immunotherapy
or radiation therapy, assign code Z51.0 (radiation), Z51.11 (chemotherapy), or Z51.12
(immunotherapy) as the first listed or principal diagnosis, and the diagnosis or problem for
which the service is being performed as a secondary diagnosis. For the metastasized or
secondary neoplasm in the left upper lobe lung, look in the Table of Neoplasm for
Neoplasm/lung/upper lobe/Malignant Secondary referring you to code C78.0-. Complete code
in the Tabular List, C78.02.
30. B. The first listed CPT® code is based on the technique used to obtain the sample. The physician
inserts the needle through the skin which indicates this is a percutaneous approach and not an
 open procedure. Answer options A and C can be eliminated. Fluoroscopic guidance was used,
which is reported with 77002 for this type of procedure.
31. B. The selection of the code is based on the process completed. The identification of
oocytes in the follicular fluid is performed. The stage in this scenario does not include
the culture or preparation of the oocyte, only the identification of them. This service is
reported with 89254.
32. B. The selection of codes are based on identifying the possible use or non-use of a drug
class or drug. To report codes for drug testing depends on the testing method used. The
scenario documents the immunoassay dipstick method, guiding you to code 80305.
CPT® subsection guidelines for Presumptive Drug Class Screening indicates to report
80305 once, irrespective of the number of direct observation drug class procedures
performed or results on any date of service. A drug confirmation was performed for
both the alcohol and benzodiazepines, report codes 80320 for alcohol and 80346 for
benzodiazepines.
33. A. The selection of the code is based on the timing of the consultation, such as during
surgery or not, the data to be reviewed such as the specimens or medical history. E/M
code 99244 is not reported because the patient was not evaluated or examined. Code
88329 is not reported because that is if the consultation was performed during a
surgery. The pathologist is presented with specimens, medical records for review and a
report on referred material for surgical pathology. This eliminated code 80505 which is
for clinical consultation reviewing pathology and laboratory findings (eg., radiology
findings).
34. C. The photodynamic therapy is performed externally in this case which eliminates
option A. Photochemotherapy is not used, which eliminates option D. The code
description for 96567 reports the services provided for this patient.
35. B. The ED physician performed an E/M service and moderate conscious sedation so the
orthopedic surgeon could provide fracture care. The E/M services are performed in the
ED setting, which is reported with codes 99281-99285. This category requires three of
three key components for the E/M code. The physician performs a detailed history,
expanded problem focused exam and moderate MDM. The documentation supports a
99283. Modifier 25 is appended to the E/M service because a significant and separately
identifiable E/M service is performed during the same encounter as a procedure which
is the moderate conscious sedation MCS). When coding for MCS, you need to know the
age of the patient, the amount of time and whether the physician providing MCS is the
same physician performing the diagnostic or therapeutic procedure for which the
patient requires MCS. In this case, the ED physician is providing the MCS only and is not
performing the fracture care (therapeutic) service. The patient is four years-old and the
MCS is provided for 30 minutes. The correct MCS codes are 99155, 99157. Code 99157
is an add-on code and modifier 51 is not reported.
36. B. The physician performs 30 minutes of psychotherapy (not psychoanalysis) with only
the patient not with family or with a group. 90832 is the correct code to report.
37. B. CKD is the abbreviation for Chronic Kidney Disease. The abbreviation is found in the ICD-10-
CM. Tabular List for category code N18 which falls under the Genitourinary System.
38. D. The term breaks down as: Nephr/o refers to kidney and the suffix -itis refers to inflammation.
Nephritis is inflammation of the kidney. In the ICD-10-CM Alphabetic Index look for
Inflammation/kidney-see Nephritis.
39. A. In ascites, fluid collects in the peritoneal cavity of the abdomen. Ascites is typically
caused by cirrhosis, malignancy, or heart failure. It is usually managed medically but
may be treated with paracentesis. Look in the ICD-10-CM Alphabetic Index for Ascites
(abdominal) referring you to code R18.8. In the Tabular List under category code R18
the includes note indicates: Fluid in peritoneal cavity.
40. D. Exotropia is an outward deviation of the eye. The muscles of the eye are controlled
by the fourth cranial nerve. The facial nerve is the seventh cranial nerve. This distinction
can be found in illustrations and written information within your ICD-10-CM and CPT®
codebooks. Tarsal tunnel syndrome is nerve impingement in the foot, and brachial
plexus lesions refer to a complex of nerves found between the neck and armpit. Bell’s
palsy, is a common disorder of the facial nerve, and causes an inability to control facial
muscles of expression. It may be caused by a brain tumor, stroke, or Lyme disease, but
can be idiopathic and transient. In the ICD-10-CM Alphabetic Index look for Palsy/Bell's
(see also Palsy, facial).
41. A. Tricuspid is the first heart valve that blood encounters as it enters into the heart. Superior
Vena Cava is a vein that returns blood to the heart from the head, neck and both upper
extremities. Carotid is a major artery located in the front of the neck. Atrium is one of the two
upper receiving chambers of the heart. An illustration of the heart is found in the Professional
Edition of the CPT® codebook in the Cardiovascular System Table of Contents or look in the
CPT® Index for Valve and you will note a complete valve listing.
42. C. In the ICD-10-CM Alphabetic Index look for each of the listed terms. Cross reference each
code in the Tabular List to note a brief definition. Hypernatremia is the when one has too much
sodium in the system. Hypernatremia is indexed to code E87.0.
43. A. The term breaks down as follows: prefix par or para refers near, beside or outside and the suffix -
centesis refers to puncture or insertion of the insertion of a needle to withdraw fluids. As it relates to
code 49082 the surgical procedure is performed by inserting a needle in the abdominal (peritoneal) cavity
to drain fluid that has accumulated, or to obtain a fluid sample for testing.
44. D. The selection of the burns codes for the extent of the body surface area involved are based
on the degree of total body affected by the burns, how much of the burn is third degree burns,
and the if it was caused by a burn or corrosion. The burn is not by a chemical, but with fire,
eliminating multiple choice B. Refer to ICD-10-CM Coding Guidelines I.C.19.d.6. To calculate the
burn total you need to add the percentages of the second degree and third degree burns (25% +
20% = 45%); the 4th character is identified by 4 for 45%. The 5th character is 2 to identify the
percentage of only the third degree burns (20%). In the ICD-10-CM Alphabetic Index look for
Burn/extent (percentage of body surface)/40-49 percent/with 20-29 percent third degree burns
referring you to T31.42.
45. D. The selection of the code is based on the reason the patient presents for the
encounter. The results from the biopsy showed she has Barrett's esophagus (K22.70). It
is usually caused by gastrointestinal reflux disease (GERD, K21.9). The FB (T18.12XA) has
been resolved, and would not be reported. Proper coding would be for the Barrett’s and
the GERD, multiple choice D.
46. D. Patent had a retrograde pyelogram eliminating multiple choices B and C. A
cystoscope is passed through the urethra into the bladder. Then a French catheter was
 passed into the right ureter (ureteral catheterization) to introduce the contrast for
radiologic study of the renal pelvis and ureter, eliminates code 52000. Note in the code
description for code 52005 that it states: exclusive of radiologic service. This is an
indication that radiology will be coded if performed.
47. A. The selection of the CPT® code is based on the type of hernia and clinical
presentation of the hernia (reducible, incarcerated, or strangulated). To start narrowing
down your choices, you need to identify the type of hernia. The operative note indicates
that it is an inguinal hernia. This eliminates code 49652. Next does the operative note
mention if the hernia is recurrent, incarcerated or strangulated? No, so this eliminates
code 49651. Add-on code 49568 (mesh) is not coded. According to CPT® guidelines the
mesh is reported only with hernia repair codes 49560-49566. There is a parenthetical
note under add-on code 49568 indicating which codes to report it with.
In the ICD-10-CM Alphabetic Index look for Hernia/inguinal/unilateral referring you to
K40.90. The operative note does not document that there were bilateral hernias, code
K40.20 is not reported; making answer choices C and D incorrect.
48. D.One way to narrow down your choices is to look up the diagnosis first. In the ICD-10-CM
Alphabetic Index, look for Adenoiditis/with tonsillitis, referring you to code J35.03. This
eliminates multiple choice answers A and C. The selection of the CPT® code is based on the
removal of the tonsils, adenoids, or both and the age of the patient. The patient is over the age
of 12 having a tonsillectomy and an adenoidectomy, which leads to code 42821. It is not
appropriate to report two separate procedure codes for a tonsillectomy and adenoidectomy,
because there is combination procedure code that reports the removal of both in one code.
49. A. This surgery is being performed by arthroscopy, eliminating multiple choice answer C, which
is an open procedure code without using any type of scope. The key words in the operative note
are “subacromial decompression” with release of the coracoacromial ligament was performed,
leads you to code 29826. The scenario does not mention that the physician lyses and resects
adhesions, eliminating multiple choice answers B and D. 29824 is performed when the physician
grinds off (technique used to remove) 10 mm of “distal clavicle” due to a cyst.
50. B. To narrow down your choices, you can start with coding the diagnosis first. The
patient is having the procedure performed on a right lung mass. A specimen was sent to
pathology and came back indicating that the lung mass is cancerous. In the ICD-10-CM
Table of Neoplasms look for Neoplasm, neoplastic/lung/Malignant Primary (column)
referring you to C34.9-. Go to the Tabular List to complete the code with a 5th
character. C34.91 is correct for right lung, eliminating multiple choice answers A and D.
The bronchoscopy codes are based on the use of a bronchoscope and what procedures
are performed. Note the guideline at the beginning of the section that indicates a
surgical bronchoscopy always includes a diagnostic bronchoscopy. You would not code
31622 because this is a diagnostic procedure. The diagnostic procedure is not coded,
because a surgical procedure was also performed in the same area by the same
physician. Fluoroscopic guidance, is included in code 31628 and not separately reported.