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CPC Practice Exam D with Complete Solutions
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CPC Practice Exam D with Complete Solutions
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CPC Practice Exam D with Complete SolutionsA 30-year-old disabled Medicare patient is scheduled for surgery due to the discovery 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 and to remove the entire left ovary and fallopian
tube.
Code this encounter. - ANSWER-58925, 58720-59
Rationale :
A different procedure was performed on each ovary, so there will be two procedure
codes.
The removal of the cyst from the right ovary (cystectomy) is coded 58925.
The removal of the left ovary and fallopian tube (salpingo-oophorectomy) is coded
58720.
Modifier 50 is not appended to codes 58925 and 58720 because the words "unilateral or
bilateral" are already included in the code description.
Modifier 59 is appended to code 58720, because it is designated as a "separate
procedure" code.
CPT Surgery Guidelines for Separate Procedure indicates that modifier 59 should be
appended to the specific "separate procedure" code to indicate it is not considered a
component of another procedure, but is a distinct, independent procedure.
A 32-year-old pregnant female has gestational diabetes at 34 weeks gestation. Her
doctor is concerned about decreased fetal movement. The patient is sent to the
radiology department of the hospital for a biophysical profile (BPP). The radiologist
performs and interprets four elements scored by the ultrasound and it was reassuring,
8/8. A non-stress test will be performed by the obstetrician at the patient's next office
visit, not the radiologist.
What is the correct CPT code for the fetal profile performed by the radiologist? -
ANSWER-76819
Rationale :
A biophysical profile is an evaluation of the fetal well-being during pregnancy. There are
either four or five tests performed with a BPP.
,A full BPP includes five tests.
Four of the tests are ultrasound evaluations; the fifth is a non-stress test.
The non-stress requires a fetal monitor, so a radiology department would not perform
the non-stress test.
Documentation does support that the non-stress test will be performed in the
obstetrician's office, indicating the non-stress test was not performed in the radiology
department by the radiologist.
A 35-year-old female patient presents with acute onset of severe pain since October.
Her workup has revealed evidence of disk herniation with loss of lordosis at the C5-C6.
Intraoperative findings were consistent with two large fragments of free disk fragments
in the foramen at C5-C6 on the right side. After general anesthesia, the patient was
placed on the operative table in the supine position. All pressure points were cushioned
and a transverse skin incision was fashioned under fluoroscopic guidance over the C5-
C6 disc space. Dissection through the platysma eventually allowed for exposure of the
anterior entrance to the vertebral body of C5 and C6 and retractors were inserted to
maintain adequate exposure. The operating microscope was brought into the field.
Caspar posts were placed and slight distraction allowed exposure. A complete
discectomy was performed at C5-C6 by using endplate curets pituitary rongeurs and -
ANSWER-22856
Rationale :
The keyword in this operative note is "discectomy," which in this scenario is a removal
of the herniated disk in the cervical spine.
There is no documentation of the vertebrae being fused together (arthrodesis).
The scenario documents end plates were decorticated to insert an artificial disk
(Kineflex-C device) to replace the cervical disk that was removed, guiding you to code
22856.
A 35-year-old female returns to her primary care provider for follow up of an upper
respiratory infection diagnosed the previous week. Her condition has not improved and
her cough has increased. She has a long history of smoking and currently smokes one
pack a day. She uses a bronchodilator for her chronic bronchitis which is caused by her
smoking history. The physician changes her antibiotics to treat both her chronic and
acute bronchitis.
Provide the diagnosis codes for this visit. - ANSWER-J20.9, J41.0, Z72.0
Rationale :
, The patient has acute and chronic bronchitis. In the ICD-10-CM Alphabetic Index look
for Bronchitis/acute or subacute, referring you to code J20.9.
Next, look in the Alphabetic Index for Bronchitis/chronic/due to tobacco smoking,
referring you to code J41.0. Verify both codes in the Tabular List for accuracy.
ICD-10-CM Coding Guidelines (Section I.B.8): If the same condition is described as
both acute (subacute) and chronic, and separate subentries exist in the alphabetic index
as the same indentation level, code both and sequence the acute (subacute) code first.
Code Z72.0 is reported for her current tobacco use., as indicated in a parenthetical note
underneath J41.0.
A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions
on his face are destroyed and five actinic keratoses on his left arm are destroyed.
The CPT code(s) to report is (are) : - ANSWER-17000, 17003 x 4, 17110
Rationale :
Keywords in this scenario are "actinic keratoses," of which there are five.
Code 17000 is the correct code because the code description gives an example of what
a "premalignant lesion" is in parenthesis and it is reported for the first lesion being
destroyed.
Code 17003 has the word "each" in its code description, which indicates each of the
four remaining actinic keratoses lesions is reported separately.
Code 17110 is the correct code for the destruction of the three benign lesions. Code
17110 is not reported by each lesion separately destroyed because the code description
shows to report it once for destroying 1-14 lesions.
A 42-year-old patient was in the hospital three days ago in which a lumbar puncture was
performed to find the etiology of the patient's headaches. Today he is in the neurology
clinic because after having the lumbar puncture the headaches have increased in
intensity over the past three days. The neurologist examines the patient and finds a
CSF leak from the lumbar puncture. A blood patch is performed by epidural injection to
repair the leak.
Code the CPT code(s) for today's visit. - ANSWER-62273
Rationale :
The key words in this encounter to guide you to the correct answer choice are "blood
patch" and "injection."
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