चश्मा
अपने बच्चे की प्रगति देखें

10000 Series (Integumentary system): 6 Question

                               

1.Stacey a 35-yearold female presents for biopsies of both breasts. The biopsies were done using fine-needle aspiration.

A. 19100-50

B. 19085-50

C. 10022-50

D. 10021-50

 

2.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 9.6cm 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

 

3.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 x2

D. 17311, 88302, 17314 x 3,17312 x 7

 

4.76-year-old female had a recent mammographic and ultrasound abnormality in the 6 o’clock position of the left breast. She underwent core biopsies which showed the presence of a papilloma. The plan now is for needle localization with excisional biopsy to rule out occult malignancy. After undergoing preoperative needle localization with hook wire needle injection with methylene blue, the patient was brought to the operating room and was placed on the operating room table in the supine position where she underwent laryngeal mask airway (LMA) anesthesia. The left breast was prepped and draped in a sterile fashion. A radial incision was then made in the 6 o’clock position of the left breast corresponding to the tip of the needle localizing wire. Using blunt and sharp dissection, we performed a generous excisional biopsy around the needle localizing wire including all of the methylene blue-stained tissues. The specimen was then submitted for radiologic confirmation followed by permanent section pathology. Once hemostasis was assured, digital palpation of the depths of the wound field failed to reveal any other palpable abnormalities. At this point, the wound was closed in 2 layers with 3-0 Vicryland 5-0 Monocryl. Steri-Strips were applied. Local anesthetic was infiltrated for postoperative analgesia. What CPT and ICD10-CM codes describe this procedure?

A. 19100, N63

B. 19120, C50.919

C. 19120, R92.8

D. 19125, D24.2

 

5.A 32-year-old male skidded out of control on a wet road while riding his motorcycle. He sustained an open fracture of the shaft of the tibia. The wound was grossly contaminated with road debris. The wound was debrided down to the level of the exposed bone (no bone was debrided) to remove the foreign material on the first day. A planned additional debridement was performed on the third day, which did include some bone, and planned open reduction was performed on the fourth day (a plate and screws were used). Select the codes for the services on all three days.

A. 11012, 11012-78, 27759

B. 11011-58, 11012-58, 27758

C. 11011, 11012-58, 27758-58

D. 11012, 11011-78, 27752-58

 

6.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. 11104

c. 11606, 11104-59

d. 11104, 12001, 11606-51

                                                                                                                                                       See answer

​

20000 SERIES (Musculoskeletal system): 6 Marks

​

7.Tracy a 5-year-old female fell down stairs at a daycare. She hit her coccygeal bone and fractured it. The doctor manually manipulated the bone into the proper alignment and told Tracy's mom to have her sit on a rubber ring to alleviate pain.

A. 27200

B. 27202

C. 27510

D. 28445

 

8.A 12-year-old female sustained multiple tibial tuberosity fractures of the left knee while playing soccer at her local track meet. The physician extended the left leg and manipulated several fragments back into place. The knee was then aspirated. A long-leg knee brace was then placed on the knee.

A. 27330-LT         B. 27550-LT             C. 27334-LT           D. 27538-LT

 

9.Charley was playing in the backyard when his sister fired a pellet gun at his left leg and hit him from close range. The pellet penetrated the skin and lodged in the muscle underlying the area. The doctor removed the pellet without complication or incident. Code the procedure only.

A. 10121-LT             B. 20520-LT              C. 20525-LT                 D. 10120-LT

 

10.Brandon comes into the orthopedic department today with his father after falling from the top bunk bed, where he and his sister were playing. He is having pain in his left lower leg and is unable to bear weight on it. Brandon is taken to the x-ray department. After the physician talks with the radiologist regarding the diagnosis of sprained ankle, the physician decides to apply a short leg cast, designed for walking, just below Brandon's knee to his toes.

A. 29405-LT, S93.402A, W06.XXXA, Y92.013

b. 29425-LT, S93.402A, W06.XXXA, Y92.013

c. 29515-LT, S93.402A, W19.XXXA, Y92.013

d. 29425-LT, S93.402A, W06.XXXA

 

11.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 2-0Vicryl and 3-0 Monocryl®. What procedure code is reported?

A. 27470-50              B. 27475-50           C. 27477-50            D. 27485-50

 

12.A patient, under general anesthesia, underwent a primary repair to the left ankle for a disrupted ligament. During the same procedure, the patient required a percutaneoustenotomy to lengthen the Achilles tendon. How should you report the surgeon's services?

A. 27695-LT, 27606-59-LT

C. 27695-LT, 27685-59-LT,01472-47

B. 27698-LT, 27685-59-LT,01472-47

D. 27698-LT, 27605-59-LT

                                                                                        

​

3 series (Cardiovascular/Respiratory system) : 6 Marks

​

13.PREOPERATIVE DIAGNOSIS : Deviated septum. PROCEDURE PERFORMED : Septoplasty; Resection of inferior turbinates The patient was taken to the operating room and placed under general anesthesia. The fracture of the inferior turbinates was first performed to do the septoplasty. Once this was done, the septoplasty was completed and the turbinates were placed back in their original position. The patient was taken to recovery in satisfactory condition. Code the procedure(s) and the diagnosis :

A. 30520, 30140-51, J34.2

B. 30520, 30130, J34.2

C. 30520, 30130-51, Q67.4

D. 30520, 30140-51, S02.2XXA

 

14.A catheter is placed in the left common femoral artery which was directed into the right the external iliac (antegrade). Dye was injected and a right lower extremity angiogram was performed which revealed patency of the common femoral and pro funda femoris. The catheter was then manipulated into the superficial femoral artery (retrograde) in which a lower extremity angiogram was performed which revealed occlusion from the popliteal to the tibioperoneal artery. What are the procedure codes that describe this procedure?

A. 36217, 75736-26

B. 36247, 75716-26

C. 36217, 75658-26

D. 36247, 75710-26

 

15.Select the codes for exploration with a flexible fiberoptic bronchoscope with trans bronchial lung biopsy and washing from a LUL mass and bronchial brushings from a RLL mass.

A. 31622, 31623-50, 31628-51

B. 31628, 31623-51

C. 31625

D. 31625-50

 

16.A 37-year-old patient was placed under moderate sedation for a repair to her peripheral insertion central venous access device with a subcutaneous port. During the same operative session, the catheter was repositioned under fluoroscopic guidance. How should the operating physician report his professional services?

A. 36575, 77001

B. 36575,36597,77001-26

C. 36576, 36597, 77001-26

D.36561,36576-59,36597-59,77001

 

17.Roger had a rhinoplasty to correct damage caused by a broken-nosed. 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

 

18.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

 

​

40000 series (Digestive System): 6 Marks

​

19.Excision of parotid tumor or gland or both. Once the patient was under general anesthesia, successfully, Dr. White assisted by Dr. Green, opened the area in which the parotid gland is located. After inspecting the gland, the decision was made to excise the total gland because of the size of the tumor (5cm). With careful dissection and preservation of the facial nerve, the parotid gland was removed. The wound was cleaned and closed, and the patient was brought to recovery in satisfactory condition. Report one Dr. Green's service.

a. 11426, D49.89

b. 42420-80, D49.89

c. 42410-80, 97597, C07

d. 42426-62, D11.0

 

20.The patient is a 50-year-old gentleman who presented to the emergency roomwith signs and symptoms of acute appendicitis with possible rupture. He has been broughtto the operating room. An infraumbilical incision was made which a 5-mm VersaStepTMtrocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar in the left lower quadrant. A window wasmade in the mesoappendix using blunt dissection with no rupture noted. The base of theappendix was then divided and placed into an Endo-catch bag and the 12-mm defect wasbrought out. Select the appropriate code for this procedure:

A. 44970                 B. 44950               C. 44960              D. 44979

 

21.A patient underwent an EGD with transendoscopic ultrasoundguidedtransmural fineneedle aspiration. How should you code this procedure?

A. 43242, 76942-26

B. 43242

C. 43235, 43238-59

D. 43235, 43242-51, 76942-26

 

22.A patient with rectal bleeding undergoes a proctosigmoidoscopy. During the proctosigmoidoscopy, the physician identifies internal hemorrhoids. The proctoscope was withdrawn, and the anus was prepped and draped. A field block with Marcaine 0.25% wasthen placed. Anoscope was inserted. There was a prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by applying two bands. In the posterior midline, there was another hemorrhoid that was banded in the same manner. Code the procedures.

A. 46221, 45300-51, 46600-51

B. 46221, 45300-51

C. 46945, 45300

D. 46930, 45300-51, 46600-51

 

23.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. Code this encounter.

A. 48100, 77002

B. 48102, 77002

C. 48120, 76942

D. 48102, 76942

 

24.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, K63.5, Z80.0, 45384

c. 45378

d. K63.5, 45378, 45384

 

​

50000 SERIES (Genitourinary system): 6 Marks

​

25.DIAGNOSIS: Large bladder neck obstruction.

PROCEDURE PERFORMED: Cystoscopy and transurethral resection of the prostate. The patient is a 76-year-old male with obstructive symptoms and subsequent urinary retention. The patient underwent the usual spinal anesthetic, was put in the dorsolithotomy position, prepped, and draped in the usual fashion. Cystoscopic visualization showed a marked high-riding bladder. Median lobe enlargementwas such that it was difficult even to get the cystoscope over. Inside the bladder, marked trabeculation was noted. No stones were present. The urethra was well lubricated and dilated. The resectoscopic sheath was passed with the aid of anobturator with some difficulty because of the median lobe. TURP of the median lobe was performed, getting several big loops of tissue, which helped to improve visualization. Anterior resection of the roof was carried out from the bladder neck. Bladder-wall resection was taken from the 10 to 8'o clock position. The eliminated the rest of the median lobe tissue as well. The patient tolerated the procedure well. Code the procedures performed and the diagnosis.

A. 52450, 52001-51, N32.0

C. 52450, 52001, Q64.31

B. 52450, 52000, Q64.31

D. 52450, 52000-59, N32.0

 

26.Sara is a 36-year-old female diagnosed with an ectopic pregnancy. The patient was taken to the operating room for treatment of a tubal ectopic pregnancy, abdominal approach.

A. 59121              B. 59120                C. 59150                D. 59130

 

27.45 year-old male is going to donate his kidney to his son. Operating ports where placed in standard position and the scope was inserted. Dissection of the renal artery and vein was performed isolating the kidney. The kidney was suspended only by the renal artery and vein as well as the ureter. A stapler was used to divide the vein just above the aorta and three clips across the ureter, extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT® code is:

A. 50543                 B. 50547               C. 50300                   D. 50320

 

28.A 30-year-old disabled Medicare patient is scheduled for surgery due to the finding of what looks like an ovarian mass on the right ovary. On entering the abdomen, the surgeon finds an enlarged ovarian cyst on the right, but the ovary is otherwise normal. The left ovary is necrotic looking. The decision is made, based on the patient’s age, to remove the cyst from the right ovary, but perform a left salpingo-oophorectomy. Code this encounter.

A. 58720-RT, 58925-LT

B. 58925-RT, 58720-51-LT

C. 58925, 58720-50

D. 58720, 58925-51

 

29.A 65-year-old male patient has an indwelling nephroureteral doubleJstent 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, 99143

C. 50385

D. 52283

 

30.A 48-year-old patient with BPH has his prostate removed via alaser enucleation. Duringthis procedure he also has a vasectomy.What code(s) would report this procedure?

A. 52648                   B. 52649                C. 52649, 55250-51                D. 52647

 

​

6 series (Nervous system) : 6 Marks

​

31.Strabismus correction involving the lateral rectus muscle

A. 67314              B. 67311           C. 67318              D. 67312

 

32.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

 

33. An infant born at 33 weeks underwent five photocoagulation treatmentsto both eyes due to retinopathy of prematurity at six months of age. Thephysician used an operatingmicroscope during these procedures. Thesetreatments occurred once per day for a definedtreatment period of five days.How would you report all of these services?

A. 67229 -50          B. 67229 x 5              C. 67229, 69990            D. 67229

 

34.Max had an endolymphatic sac operation with shunt. How would you report this procedure?

A. 69805                         B. 69806                  C. 69979                       D. Both a and b

 

35.Dr. Martin performed an excision at the middle cranial fossa for avascular 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

 

36.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

 

​

Evaluation and management (6 Marks)

 

37.The admitting physician requests a confirmatory consultation from an interventional radiologist for a second opinion about a 60-year-old male with abnormal areas within the liver. The recommendation for a CT guided biopsy is requested, which the attending has recommended be performed. During the comprehensive history, the patient reported right upper quadrant pain. His liver enzymes were elevated. Previous CT study revealed multiple low attenuation areas within the liver (infection not tumor). The laboratory studies were creatinine, 0.9; hemoglobin, 9.5; PT and PTT, 13.0/31.5 with an INR of 1.2. The comprehensive physical examination showed that the lungs were clear to auscultation and the heart had regular rate and rhythm. The mental status was oriented times three. Temperature, intermittent lowgrade fever, up to 101 deg. Fahrenheit, usually occurs at night. The CTguided biopsy was considered appropriate for this patient. The medical decision making was of high complexity.

A. 99223                B. 99245                      C. 99255                    D. 99221

 

38.The provider performed an internet assessment for ten minutes, visited three other patients for 5 minutes each, then came back and finished the session for another 20 minutes. The provider called the requesting physician and verbally reviewed the call. Code for this service.

a. 99446

b. 99447

c. 99448

d. This is not a reportable service

 

 39.A 60-year-old male presents for a complete physical. There are no new complaints since my previous examination on June 9 of last year. The patient spends 6 hours a week golfing and reports a brisk and active retirement. He does not smoke and has only an occasional glass of wine. He sleeps well but has been having nocturia times three. On physical examination, the patient is a well- developed, well-nourished male. The physician continues and provides a complete examination of the patient lasting 45 minutes.

a. 99396                    b. 99386                        c. 99403                         d. 99450

 

40.A 4 year-old patient presents with pain in the left forearm following a fall form 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 medical decision making of moderate complexity. An XX-ray is ordered, 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, 99155, 99157

B. 99283-25, 99155, 99157

C. 99238-25, 99151, 99153

D. 99283

 

41.Brandon was seen in Dr. Shaw’s office after falling off his bunk bed. Brandon’s mother reported that Brandon and his sister were jumping on the beds when she heard a “thud.” Brandon complained of knee pain and had trouble walking. Dr. Shaw ordered a knee x-ray that was done at the imaging center across the street. The x-ray showed no fracture or dislocations. Dr. Shaw had seen Brandon for his school physical six months ago. Today, Dr. Shaw documented a detailed examination and decision-making of moderate complexity. He also instructed Brandon’s mother that if Brandon had any additional pain or trouble walking he should see an orthopedic specialist. How should Dr. Shaw report her services from today’s visit?

A. 99204             B. 99394, 99214                       C. 99214                    D. 99203

 

42.Andrea, a 52-year-old patient, had a hysterectomy on Monday morning. That afternoon, after returning to her hospital room, she suffered a cardiac arrest. A cardiologist responded to the call and delivered one hour and 35minutes of critical care. During this time the cardiologist ordered a single view chest x-ray and provided ventilation management. How should you report the cardiologist’s services?

a. 99291, 99292

b. 99291, 99292, 71046,94002

C.71045, 94002, 99231

D. 99291, 99292, 99292-52

 

​

Anesthesia : 4 Question

 

43.This type of sedation decreases the level of patient's alertness but allows the patient to cooperate during the procedure

A. Topical             B. Local                C. Regional              D. Conscious

 

44.Patient is admitted in labor for delivery. She received a labor neuraxial epidural for a vaginal delivery. The baby goes into fetal distress and a cesarean section is performed. Following delivery the patient starts to hemorrhage. The physician decides, with family approval, to perform a hysterectomy. Code the anesthesia services.

A. 01967, 00840                      B. 01962               C. 01968                D. 01967, 01969

 

45.A healthy 11-month-old patient with bilateral cleft lip and palate undergoes surgery. The surgeon performs a bilateral cleft lip repair, single stage. Code the anesthesia service

A. 00170-P1, 99100                B. 00102-P1                C. 00102-P1, 99100             D. 00170-P1

 

46.Katherine is a 77-year-old patient with a severe hypertensive disease. She underwent a cataract surgery to both eyes under general anesthesia. Dr. Sharon, the anesthesiologist, performed the anesthesia. Prior to induction of anesthesia Dr. Sharon completed a preoperative visit on this new patient. How would you report Dr. Sharon’s services?

A. 99203, 00142-P2, 99100

B. 66820, 00144

C. 00140-P1, 99116-59

D. 00142-P3, 99100

 

 

 

Radiology (7 series): 6 Question

​

47.This patient received a prescription for a therapeutic radiology for a cancerous neoplasm ofthe adrenal gland. What code would you use for complex treatment planing?

A. 60520                B. 77307                   C. 77401            D. 77263

 

48. The physician orders an ultrasound on a patient 25 weeks pregnant with twins to access fetal heart rate and fetal position. Select the code(s).

A. 76805, 76810

B. 76811, 76812

C. 76816 x 2

D. 76815

 

49.A 76-year-old female had a ground level fall when she tripped over her dog earlierthis evening in her apartment. The Emergency Department took x-rays of the wrist inoblique and lateral views which revealed a displaced distal radius fracture, grade I openright wrist. What radiological service and ICD-10 codes should be reported?

A. 73100-26, S52.509B,W18.49XA,Y92.099

B. 73110-26, S52.509B,W18.49XA,Y92.099

C. 73115-26, S52.509A,W18.49XA,Y92.099

D. 73100-26, S52.509A,W18.49XA,Y92.099

 

50.A patient presents to a freestanding radiology center and had ultrasonic guidance needle placement with imaging supervision and interpretation of two separate lesions in the left breast. The procedure required several passes to complete. How would you report the imaging procedure?

A. 76932 x 2           B. 76941                      C. 76942 x 2-LT                D. 76942-LT

 

51.A patient had a myocardial perfusion imaging single study at rest with quantification, ejection fraction, and wall motion study. The procedure was performed in the nuclear medicine department of the hospital. How would you report the professional services for this study?

A. 78473-26             B. 78451-26                C. 78452-26                      D. 78453-26

 

52.Which of the following codes are unlisted procedures? *

A. 76498, 78199, 76496,77799

B. 75600, 75801, 76506, 76830

C. 74181, 74280, 75574, 75600

D. 75810, 75801, 75860, 75989

 

​

Pathology (8 series) : 6 Question

​

53.A patient presents to the laboratory in the clinic for the following tests :TSH, comprehensive metabolic panel, and an automated hemogram with manual differential WBC count (CBC). How would you code this lab?

A. 84445, 80051, 85025

B. 84443

C. 80050

D. 84443, 80053, 85027, 85007

 

54.Surgical pathology, gross examination, or microscopic examination is most often required when a sample of an organ, tissue, or body fluid is taken from the body. What code(s) would you use to report biopsy of the colon, hematoma, pancreas, and a tumor of the testis ?

A. 88307, 88304, 88309

B. 88305, 88304, 88307

C. 88305, 88302, 88307, 88309

D. 88305, 88304, 88307,88309

 

55.The 62-year-old female who suffers from treatment-resistant schizophrenia comes into the lab today to have aquantitative drug assay performed for the anti-psychotic medication clozapine, a regular white blood cell and absolute neutrophil count due to concern with agranulocytosis.

A. 80159

B. 80159, 85048

C. 80159, 85048, 85004

D. 80159, 85025

 

56.The 67-year-old female suffers from Chronic liver disease and needs a hepatic function panel performed every six months. Tests include total bilirubin (82247), direct bilirubin (82248), total protein(84155), alanin aminotransferases (ALT and SGPT) (84460), as part ate aminotransferases (AST and SGOT) (84450) and what other lab tests ?

A. 82040, 84075

B. 80061, 83718

C. 82040, 82247

D. 84295, 84450

 

57.This 69-year-old female presents to the laboratory after her physician orderedquantitative and qualitative assays for troponin to assist in the diagnosis of her chiefcomplaint of acute onset of chest pain

A. 84484, 80299

B. 84512, 84484, 80299

C. 84484, 84512

D. 84484, 84510

 

58.Dr. Monday provided a comprehensive clinical pathology consultation at the request of Dr. Adams. This request was regarding a patient with various infections, drug allergies, skin rash, and Down’s syndrome. The patient is in the hospital intensive care unit being treated with intravenousantibiotics. Dr. Monday did not see the patient but he reviewed the patient’s history, complex medical records, and provided a written report back to Dr.Adams regarding his findings and recommendations for further treatment. How would Dr. Monday report his services?

A. 80502

B. 99244

C. 99244-25, 80502

D. 99255-25, 80500

 

 

Medicine (9 series) : 6 Question

​

59.This 70-year-old male is taken to the emergency room with severe chest pain. The physician provided an expanded problem-focused history and examination. While the physician is examining the patient, his pressures drop and he goes into cardiac arrest. Cardiopulmonary resuscitation is given to the patient, and his pressure returns to normal; he is transferred to the intensive care unit in critical condition. Code the cardiopulmonary resuscitation and the diagnosis. The medical decision making was of low complexity.

 

A. 99282, 92950, I46.9

B. 99283, 92970, I46.9

C. 92950, I46.9

D. 92960, I46.9

 

60.An adult patient had the following immunizations with administration:Yellow fever vaccine, subcutaneous injectionHepatitis B (adult dose) vaccine, intramuscular injectionPneumococcal conjugate vaccine, intramuscular injectionHow would you report these services?

A. 90460, 90461 x 2, 90717-51,90746-51, 90670-51

B. 90471, 90472 x 2, 90717,90746, 90670

C. 90473, 90474 x 2, 90746,90670, 90717

D. 90471, 90472 x 2, 90670-51,90746-51, 90717-51

 

61. A patient had a bronchoscopy with destruction for relief of stenosis by laser therapy. During this procedure photodynamic therapy by endoscopic application of light was used to ablate abnormal tissue via activation of photosensitive drugs. The photodynamic therapy lasted 60 minutes. How would you report this procedure?

A. 31645, 96567

B. 96567 x 2

C. 31643, 96570-51, 96571-51

D. 31641, 96570, 96571 x2

 

62. Dr. Thompson was in attendance for 29 minutes during afunctional cortical mapping of the brain surface to identify brain structures. The study was stopped after 29 minutes due to recordings and mapping that provided adequate information for a diagnosis. How should Dr. Thompson report his service?

A. 95961-52

B. 95961

C. 95970

D. 95872, 95961-22

 

63.  Code 95904 could describe studies to which of the following nerves? Which of the following must be included to assign a code from code range 93040-93042?

A specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report

B. A verbal request for aconsultation including only arecord review

C. A specific order for an electrocardiogram or rhythm strip followed by a separate, signed, verbal, and non-retrievable report report

D. A written request for aconsultation including only a record.

 

64. 10-year-old patient had a recent placement of a chochlear implant. She and her family see an audiologist to check the pressure and determine the strength of the magnet. The transmitter, microphone and cable are connected to the external speech processor and maximum loudness levels are determined under programming computer control. Which CPTR code should be used?

A. 92603          B. 92601             C. 92602               D. 92604

 

​

Anatomy : 6 Question

​

65.Name a malignant cartilage-based tumor found in middleaged and older people.

A. Rhabdomyosarcoma

B. Osteosarcoma

C. Chondrosarcoma

D. Chondroblastoma

 

66.What condition has predominant symptoms of rapid, involuntary eye movement?

A. Astigmatism

B. Nystagmus

C. Diplopia

D. Hyperopia

 

67.Which below is located in a depression in the skull at the base of the brain

A. Thymus           B. Pituitary                   C. Pineal              D. Adrenal

 

68. Which autoimmune disorder will eventually destroy the thyroid gland?

A. Hayem-Farber disease

B. Alzheimer’s thyroiditis

C. Lou Gehrig’s disease

D. Hashimoto’s thyroiditis

 

 

ICD 10 CM : 5 Question             

                                                                       

69. A 50-yearold female patient had two separate carbuncles removed from the left axilla. Pathology report indicated staphylococcal infection.

a. L02.432, B95.8

b. L02.92, B95.5

c. L02.92, B95.4

d. L02.432, B95.7

 

70.A 50-year-old male has staphylococcal septicemia which causes Acute respiratory and hepatic failure.

a. A41.2, J96.00, K72.00

b. A41.2, J96.00, R65.20

c. J96.00, K72.00, A40.8, R65.20

d. A41.2, R65.20, J96.00,K72.00

 

71.A patient with a history of myocardial infarction is admitted for cardiac catheterization. It is also noted the patient has unstable angina and diabetes with hypoglycemia.

a. I20.0, E13.9, D10.9

b. I20.8, E11.65, I25.2

c. I20.0, E11.649, I25.2

d. I20.8, E11.649, I25.2

 

72.Patient comes into see her primary care physician for a productive cough and shortness of breath. The physician takes a chest X-ray which indicates the patient has double pneumonia. Select the ICD-10-CM code(s) for this visit.

A. J18.9, R05, R06.2

B. R05, R06.2, J18.9

C. J18.9

D. J15.9

 

​

73.What is the correct way to code a patient having bradycardia due to Demerol that was correctly prescribed and properly administered?

A. T40.2X1A, R00.1

B. T40.2X3A, R00.1

C. R00.1, T40.2X5A

D. R00.1, T40.2X2A

 

​

HCPCS : 3 Question

​

74. A male 62-year-old presents for a digital rectalexam and total prostate-specific antigen test (PSA),which code would be used?

A. G0102

B. G0103

C. G0102, G0106

D. G0102, G0103

 

75.A patient received a 12 sq. cm. dermal tissue substitute of human origin, derma graft. This treatment was completed due to a burn on the abdomen. How would you report the supply?

A. Q4107 x12 B. Q4105 x12 C. Q4106 x12 D. Q4111 x12

 

76.During an emergency room visit, Sally was diagnosed with pneumonia. She was admitted to the hospital observation unit and treated with 500 mg of Zithromax through an IV route. How would you report the supply of this drug?

A. J0456 B. Q0144 C. J1190 x 2 D. J2020 x 2

 

​

Medical Terminology : 4 Question

 

77. An ERG is what type of a procedure? *

A. Electroretinography

B. Electrorenalography

C. Electroretinograph

D. Electrorhidogram

 

 

78.Which term refers to the anus, rectum, and the cecum? *

A. rectal              B. anorectal               C. esophageal              D. ilium

 

79.Which term does not refer to a level of consciousness?

A. Syncope        B. Stupor                    C. Coma                        D. Sciatica

 

80.What does the term cystopexy mean? *

A. Inflammation of the spinal cordand brain

B. Surgical fixation of theurinary bladder

C. Surgical suture of the kneejoints

D. Crushing procedure to removecysts

 

​

Guidelines : 7 Question

​

81. A separate procedure is coded per CPT guidelines : *

A. Is considered to be an integral part of a larger service B. Is coded when it is performed as a part of another, larger procedure C. Is never coded under any circumstances D. Both a and b above

 

82.Which is true of the category I codes of CPT : *

A. They describe non-physician services.

B. They are numeric.

C. Only physicians can report them.

D. All of the above are correct

 

83.When using the ICD-10-CM

A. Always use the index only when coding

B. Check the tabular before assigning a code

C. It is perfectly appropriate to memorize codes

D. B and c are correct

 

84. ICD-10-CM codes are composed of 3-7 alpha and numeric digit codes, when using them:

A. Code to the greatest detail

B. It is appropriate to code the 3digit code when the category is further defined

C. Code to the 4th digit when you don't have the information in your note.

D. B and C is correct.

 

85.When Acute and Chronic conditions are noted:

A. Always code the Chronic condition first

B. Always code the Acute Condition first

C. Code both and sequence the acute (sub-acute) code first D. B and C are correct

 

86.Which is not true of external cause Codes?

A. Cannot be used at primary diagnosis

B. Are used for indicating context/other reasons for the accident

C. Only 1 external cause is enough for an encounter

D. All the above

 

87.Which statement is TRUE when reporting pregnancy codes (O00- O90A)

A. These codes can be used on the maternal and baby records.

B. These codes have sequencing priority over codes from other chapters.

C. Code Z33.1 should always be reported with these codes

D. The seventh character assigned to these codes only indicate a complication during the pregnancy.

 

​

Compliance: 3 Question

​

88.What tool is in place that manages multiple third-party payments to ensure that over-payment does not happen?

A. EOB                     B. DME                 C. COB                 D. PRO

 

89.A PAR provider

A. Signs an agreement with the Fiscal Intermediary

B. Submits charges directly to CMS

C. Receives 5% less than some other providers

D. Can bill the patient after payment from Medicare

 

90. Which act was established to define and regulate meaningful use related to electronic medical record standards?

A. –Health Insurance Portabilityand Accountability Act (HIPAA)

B. –Health InformationTechnology for Economic andClinical Health (HITECH) Act

C. –Recovery Audit ContractorAct (RAC)

D. –Balanced Budget Act (BBA)

 

Case study : 10 Question

91.Patient went into respiratory failure. ET Tube 8.0mm placed. Sedation: None. Number of attempts: 1 Breath Sound after intubation: Equal O2 saturation: 100% Total time: 15 minutes Critical Care Note: Total Time: 90 Minutes Diagnosis: Septic Shock, Respiratory Failure, Neutropenia, Thrombocytopenia

A.99291,99292,31500 – A41.9,R65.21,J96.00

B.99291-25,99292-25,31500 – A41.9,R65.21,J96.00

C.99291-25,99292,31500 – A41.9,J96.00,R65.21

D.99291,99292- A41.9,R65.21,J96.00

 

92. A patient arrives at the ED complaining of chest pain and during the encounter becomes critically ill, requiring the one-on-one attention of the physician for a total of one hour and 45 minutes. The physician interprets two sets of chest X-rays, and the patient and place a temporary transcutaneous pacer.

A.99291,99291*2,71045,92953

B.99291-25,99291*2,71045,92953

C.99291,99292*2

D.99291-25,99291*2

 

93. CHIEF COMPLAINT: Pain and swelling in abdomenHISTORY OF PRESENT ILLNESS: Patient is a 67-year-old female presents to the emergency room with sharp, shooting pain in her lower abdomen and pronounced swelling. Patient is nauseous, has vomited, and has a fever. Abdomen is firm and slightly distended. Patient states she has no history of abdominal problems, disease, or hernia.INTERVENTION: Physical examination suggests appendicitis. Ultrasound test ordered, and diagnosis of appendicitis is confirmed. Patient is rushed to surgery and is prepped for general anesthesia. Once anesthetized, patient receives appendectomy via laparoscopy. Exploration during surgery reveals no signs of peritonitis, local or general. Following surgery, patient is taken to observation room, and then to hospital room. Patient responds well to surgery, and is discharged later that night with a prescription for pain medication.Diagnosis: Acute appendicitis

A.44970 – K35.80

B.44950 – K36,R50.9,R10.30,R11.2

C.44970,76705-K35.7,R50.9,R10.30,R11.2

D.44979-K35.80,

 

94. A 56yrs old female patient with a history of lung cancer treated completely and no further treatment is required at that site, and recently diagnosed with a lump in the right breast, Assign appropriate ICD 10 CM codes?

A.N63.0,Z85.118

B.C34.30.N63.0

C.N63.0,C43.30

D.N63.0,C43.30,Z85.118

 

95. CHIEF COMPLAINT“I am here for my quarterly evaluation of my diabetes.”HISTORYPatient is a 50-year-old woman with Type 1 diabetes since childhood. She has been on insulin since age 13.As a result of her diabetes she has chronic kidney disease (ESRD). She also has diabetic neuropathy affecting both lower extremities.REVIEW OF SYSTEMS, PHYSICAL EXAM, LABORATORY TESTSNo changes in underlying condition during the last 3 months. She continues to perform self testing of her blood sugar levels on a daily basis, is on dialysis every other day, most recently 24 hours ago, and has not noticed any changes in the numbness in her legs.BP 140/75, P 80, R 16 and T 98.8 Dialysis fistula without any signs of infectionDecreased sensation over lower extremities below the kneesLab: BUN/Cr nl, K+ 3.5, glu 105, Hgb A1c 7.9ASSESSMENTFollow up of DM and ESRDPLANContinue BS checks daily with sliding scale as previously prescribedStart Capsaicin topically and defer to nephrologist for any Rx at this time. She has an appointment 10 am tomorrow.

A. E10.22, N18.6, E10.40, Z79.4, Z99.2

B.E11.22,N18.6,E11.40,Z79.4,Z99.2

C.E10.22,N18.6,E11.40,Z99.2

D.E10.22,N18.6,E10.40,Z79.4

 

96. 65-year-old male admitted with congestive heart failure. Patient presented with shortness ofbreath, pedal edema, and tachycardia. B/P 180/94, H/R 104, R/R 22. BNP 420. Chest X-ray:showed pleural effusion. HR with preserved ejection fraction of 55% (HFpEF). Patient startedon Lasix 40mg IV or PO with Amlodipine 5mg PO, daily, and discharged on the fourth day ofadmission.Final diagnosis: Hypertension with acute diastolic heart failure

A.I10,I50.31

B.I11.0,I50.31

C.I11.9,I50.31

D.I11.0,I50.30

 

97. History of Present Illness50-year-old female with known carcinoma of the left breast with widespread right pulmonary and bone metastases. No further treatment since mastectomy. Patient has completed her third round of chemotherapy for the lung and bone metastases. The patient was now admitted for treatment of lumps of the lower-outer quadrant of the right breast.Past Medical HistoryHistory of Left breast carcinomaBone and lung metastasesHistory of Left breast mastectomyPertinent Physical ExamTemperature temp 36.2, HR 102, RR 18 B/P 126/88Neuro: AAOX3, PEARLResp: Bilateral Breath Sounds, decrease on right sideCardiac: pulses strong and equal, positiveExtremities: Trace edema in upper extremities, lower extremities with evidence of chronic insufficiencyABD: round and soft to palpation with positive bowel sounds.Impression and PlanThe patient was now admitted for treatment of lumps of the lower-outer quadrant of the right breast. A right mastectomy has been recommended as treatment for the lumps of the right breast due to the patient’s history of right breast carcinoma with metastases. The patient has agreed to the recommended treatment.Course in HospitalPercutaneous needle biopsy of upper quadrant of right breast. Biopsy specimen was sent for frozen section with adenocarcinoma of right breast being diagnosed. An open total right mastectomy was then performed.

A. D24.2 ,C79.51,C78.01,Z85.3 ,Z90.12 – 19100,19303

B. D24.2 ,C79.51,C78.01,Z85.3 ,Z90.12 – 19100,19301

C. D24.2 ,C79.51,C78.01,Z85.3 ,Z90.12 – 19303

D. D24.2 ,C79.51,C78.01,Z85.3 ,Z90.12 – 19100

 

98. INDICATION: Hepatic metastatic disease from neuroendocrine tumor                                                                                                    

TECHNIQUE:  lidocaine was infiltrated within the skin overlying the right common femoral artery for local anesthesia. Ultrasound was performed for guidance and an image stored in the patient's medical record.

An 035 Wire was advanced into the abdominal aorta and a 5 French sheath advanced over the Wire. A sniper microcatheter and microwire was advanced into the righthepatic artew over a guidewire and an angiogram performed. The antireflux balloon was inflated and arepeat acquired. Ille plæscribed dose Of 106.3 mCi Of Yttrium 90 microspheres was infusedaccording to protocol. antireflux balloon was deflated and the microcatheter was removed. Ilme sheathwas removed, and hemostasis Obtained with After the placement Of a 6 French Angio-Seal. patient tolerated the procedure well. There were no immediate complications.                                        

FINDINGS:Ultrasound demonstrates a patent right common femoral anery. ne celiac arteriogram demonstrates apatent GDA, left hepatic artery, middle hepatic artety and right hepatic artery. Selective injection of theright hepatic arteh' branch supplying segments 6 and 7 demonstrates tumor vascularity

A.37243,36247-59

B.37243,36245-59

C.37243,75894

D.37243,73645,75894

 

 

99. pre-op Diagnosis: Left hip recurrent acetabular labral tear                      

post-op Diagnosis: Same

Procedure: Left hip acetabular labral reconstruction using semi tendinosis allograft 6 mm in diameter

Revision cam resection or femoral osteoplastyImplants: Five cinch lock anchors and NanoTack anchor from Stryker                                            

Anesthesia Type: GETA and regional (Fascia iliacus block)                                                                          

Estimated blood loss (mL): 20                                                                                                            

Findings: Recurrent tear Of the superior labrum. Normal articular cartilage and no significant weave sign orbubble in the articular cartilage Of the acetabulum. Small amount Of wear on the superior aspect Of the femoral head where there was some recurrent impingement from the acetabulum.                      

Tourniquet Time: Traction time was 2:00 a.m. and 10 minutes                                                                                        

 

Indication and consent: Jamie is a A1-year-old female with significant pain and dysfunction to her left hipshe had failed conservative measures and initially did quite well after her labral repair but that was over 5years ago and recently over the last year to it has been bothering her more. She had a another MRI whichrevealed a recurrent labral tear and so we discussed surgical intervention and she wanted to proceed we didso her request knowing full well risks benefits possible complications associated with the surgery. We proceeded her request and the plan was possible revision repair versus reconstruction.                                                                                            

Description of procedure: Patient was seen and evaluated in the preop holding mea where she identified theleft hip as the operative extæmity was marked and then she was taken back to the OR suite after the fasciailiacus block was administered. She was then anesthetized on the hana table and her feet were placed inwell-padded boots. Gentle traction was administered just to affirm that we could adequately distract andget good visualization. Once that was visualized under C-arm we then sterilely prepped and draped the leftleg in standard fashion after which formal time-out indicated the correct side antibiotics beenadministered. We then commenced the formal traction and anterior lateral portal was created and then amid anterior portal was then created. An interpo capsulotomy was done and our evaluation revealed anormal-appearing anterior and anterior superior labrum however posterior or the superior aspect of thelabrum was torn again and vew small and diminutive. I contemplated for quite some time whether not arevision æpair would be in order. There was some irregularity on the acetabulum so as I trimmed some Ofthat irregularity while I tried to decide what to do I noted that the labrum in that region was very small andtherefore I decided that reconstruction would be in her best interest. We decided at approximately 40minutes of traction time and so we opened up the graft and Camryn Watson Pac worked on that diligentlyon the back table. I did removed the labrum from the 10-2 0'clock region and pæpared the rim withacetabular rim trimming. Once everything was nice and smooth and the transitions appropriate I thendrilled 5 holes with the cinch lock drill bit mostly from the mid anterior portal but had to do 1 from thelateral portal as well as the NanoTack anchor which was drilled from the anterior lateral portal. Once thatwas done the graft was finished præparing on the back table so we passed it through from posterior toanterior and we used the then a tack anchorto pull it into position and tightened down. The transition therewas acceptable so we left that transition and we went ahead and placed the rest of the cinch lock anchors allthe way around to tell we got to the anterior-most anchor and that tightened it down very nicely and weamputated the graft after that. Once that was done we cleaned up that transition as well with the the ablatorWand and cleaned up the graft and then took final pictures and at that point we noted some irregularity onher prior femoral osteoplasty that needed some revision so did a slight revision of the femoral osteoplastyuntil no further impingement sites were noted. At that point we did a capsular closure With for interportalcapsular stitches. Of note the capsule was healed and prior capsular stitches were noted to be intact in thecapsule was completely intact. There was some adhesions on the far anterior and posterior aspect butsuperiorly there were no significant adhesions of the capsule on the labral tissue. These were trimmed andcleaned prior to the labral reconstruction. After the capsule was closed we closed the portal sites With interrupted nylon Sutulæs and the patient was awakened and taken to PACU in stable condition with sterile dressings in place.

A.29914,29915,64450

B.29862

C.29914,29915,64449

D.29862,29915

 

100. During the surgery the patient experienced tachycardia due to thyrotoxic storm. The thyrotoxic storm is a complication Of the surgery. The procedure was stopped and propylthiouraeil (YrU) was administered. patient was admitted to the ICU. Iodine therapy was administered approximately 1 hour following the administration Of PTU.What is the principal diagnosis for the inpatient admission?

A. E05-91 Thyrotoxicosis. unspecified With thyrotoxic crisis or storm

B. ROO.O. Tachycardia. unspecified

C. E36.8, Other intraoperative complications of endocrine system

D. T88.9XXA, Complication Of surgical and medical care, unspecified. initial encounter

​

​