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CPC Mock Exam 3 Time: 4hrs

Integumentary System

1. 46-year-old female had a previous biopsy that indicated positive margins anteriorly on the right side of her neck. A 0.5 cm margin
was drawn out and a 15-blade scalpel was used for full excision of an 8cm lesion. Light undermining of all margins was performed
along with layered closure. The specimen was sent for permanent histopathologic examination. What are the code(s) for this
procedure?

a. 11426 b. 11626 c. 11626, 12044-51 d. 11426, 13132, 13133

2. 30-year-old female is having debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection,
the ulcer and eschar infection was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed
because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor
circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was
cleaned with saline and dressings and then wrapped. What CPT code should be reported?

a. 11000 b. 11012 c. 11044 d. 15004

3.64-year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek
and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each
extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The
forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with 6-0 Prolene sutures.
The arm and leg were repaired by 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed
with adhesive strips. Select the appropriate procedure codes for this visit.

a. 12014, 12034-51, 12002-51, 11042-51 b. 12053, 12034-51, 12002-51

c. 12014, 12034-51, 11042-51 d. 12053, 12034-51

4. 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. The lateral border was incised and excised in total. 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 b. 11750 c. 11730 d. 11740

5. 53-year-old male for removal of 2 lesions located on his nose and lower lip. Lesions were identified and marked. Tangential
biopsy was performed on the left supra-tip nasal area. The lower lip lesion of 4mm in size was shaved to the level of the superficial
dermis. What are the codes for these procedures?

a. 11102, 11103 b. 11102-59, 11310 c. 11311 d. 11440, 11310-51

6. 76-year-old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be performed on the eyelids. A lower incision
line was marked at approximately 5 mm above the lid margin along the crease. Then using a pinch test with forceps, the amount of
skin to be resected was determined and marked. An elliptical incision was performed on the left eyelid and the skin was excised. In
a similar fashion the same procedure was performed on the right eye. The wounds were closed with sutures. The correct CPT codes
are?

a. 15822, 15823-51 b. 15823-50 c. 15822-50 d. 15821-RT, LT

7. 52-year-old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is
beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the
mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4
centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT and ICD-10CM
should be reported?

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a. 21932, D17.1 b. 21935, D17.39 c. 21931, D17.1 d. 21925, D17.39

8. The patient presented for medial meniscal tear left knee. Arthroscopy with partial medial menisectomy 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-LT b. 29881-LT, 29879-LT

c. 29882-LT, 29885-LT d. 29881-RT, 29885-LT

9. 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 Ortho-fix 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
2-0 Vicryl and 3-0 Monocryl. What procedure code should be used?

a. 27470-50 b. 27475-50 c. 27477-50 d. 27485-50

10. 42-year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the glenohumeral joint. The
articular cartilage was normal except for some minimal grade III-IV changes, about 5% of the humerus just adjacent to the rotator
cuff insertion of the supraspinatus. The biceps were inflamed, not torn at all. The superior labrum was not torn at all, the labrum
was completely intact. The rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted and this was released with electrocautery and the Bovie including the superior
glenohumeral ligament. After this was all released, the middle glenohumeral ligament was released as well as the tendinous portion
of the subscapularis. After this was all done with a shaver and electrocautery, the arthroscope was placed anteriorly and the shaver
and used to debride some of the posterior capsule and the posterior capsule was released in its posterosuperior and then
posteroinferior aspect. After this was done, the arthroscope was then placed back posteriorly and used to release the anteroinferior
capsule down to 6’oclock. This was done with electrocautery. The arthroscope was then placed anteriorly and used to release the
posteroinferior capsule. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope
was then placed back posteriorly and used to confirm that there was still one little strip of capsule around the biceps superiorly and
there was one little strip from 6-7 o’clock posteroinferiorly that was only partially cut. The rest of the capsule was completely
circumferentially released. What CPT code describes this procedure?

a. 23450-LT b. 23466-LT c. 29805-LT, 29806-51, LT d. 29825-LT

11. After adequate anesthesia was obtained the patient was turned prone in a kneeling position on the spinal table. A lower midline
lumbar incision was made, and the soft tissues divided down to the spinous processes. The soft tissues were stripped away from the
lamina down to the facets and discectomies and laminectomies were then carried out at L3-4, L4-5 and L5-S1. Interbody fusions
were set up for the lower three levels using the Danek allografts and augmented with structural autogenous bone from the iliac crest.
The posterior instrumentation of a 5.5 mm diameter titanium rod was then cut to the appropriate length and bent to confirm to the
normal lordotic curve. It was then slid immediately onto the bone screws and at each level compression was carried out as each of
the two bolts were tightened so that the interbody fusions would be snug and as tight as possible. Select the appropriate CPT code(s)
for this visit?

a. 22612, 22614 x 2, 22842, 20938, 20930 b. 22533, 22534 x 2, 22842

c. 22630, 22632 x 2, 22842, 20938, 20930 d. 22554, 22632 x 2, 22842

12. Preoperative diagnosis: Displaced impacted Colle’s fracture, left distal radius and ulna. Postoperative
diagnosis: Displaced impacted Colle’s fracture, left distal radius and ulna.
Operative procedure: Reduction with application external fixator, left wrist fracture.
Findings: The patient is a 46-year-old right-hand-dominant female who fell off stairs 4 to 5 days ago sustaining an impacted distal
radius fracture with possible intraarticular component and an associated ulnar styloid fracture. Today in surgery, fracture was
reduced anatomically, and an external fixator was applied.
Procedure: Under satisfactory general anesthesia, the fracture was manipulated, and C-arm images were checked. The left upper
extremity was prepped and draped in the usual sterile orthopedic fashion. Two small incisions were made over the second metacarpal
and after removing soft tissues including tendinous structures out of the way, drawing was carried out and blunt-tipped pins were
placed for the EBI external fixator. The frame was next placed and the site for the proximal pins was chosen. Small incision was
made. Subcutaneous tissues were carried out of the way. The pin guide was placed, and 2 holes were drilled, and blunt-tipped pins
placed. Fixator was assembled. C-arm images were checked. Fracture reduction appeared to be anatomic. Suturing was carried out
where needed with 4-0 Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings were applied. Vascular
supply was noted to be satisfactory. Final frame tightening was carried out. What CPT codes should be reported?

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a. 25600-LT, 20692-51 b. 25605- LT, 20690-51 c. 25606-LT d. 25607-LT

13. The patient is a 67 -year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for
placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire
placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a
subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port
line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under
fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking
mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It
was secured to the underlying soft tissue with 2-0 silk stitch. What code should be used for this procedure?

a. 36556, 77001-26 b. 36558, 77002-26 c. 36561, 77001-26 d. 36571, 77002-26

14. A CT scan identified moderate-sized right pleural effusion in a 50-year-old male. This was estimated to be 800 cc in size and
had an appearance of fluid on the CT Scan. A surgical puncture using an aspirating needle punctured through the chest tissues and
entered the pleural cavity. Fluid was aspirated, draining the effusion under ultrasound guidance using 1% lidocaine as local
anesthetic. What procedure code should be used?

a. 32554 b. 32555 c. 32408 d. 32400

15. The patient is a three-year-old boy who attempted to swallow a half-dollar. The boy’s mother immediately brought the child to
the ED, which was only a short distance from the house, and the thoracic team was called emergently. The patient was in acute
respiratory distress when we arrived in the ED. A temporary tracheostomy was accomplished, allowing oxygen exchange. X-ray
revealed the coin to be deeply wedged in the trachea. Several attempts were made to remove the coin in the ED with the use of
forceps, without success. The patient was given a mild sedative and taken to the OR where a scope was used to successfully
remove the coin. The trach was discontinued. The patient was admitted for overnight observation and discharged the next day in
satisfactory condition.

a. 31600, 31530-59 b. 31603, 31635-59

c. 31603, 31530-59 d. 31600, 31635-59

16. 79-year-old male with symptomatic bradycardia and syncope is taken to the Operating Suite where an insertion of a DDD
pacemaker will be performed. A left subclavian venipuncture was carried out. A guide wire was passed through the needle, and the
needle was withdrawn. A second subclavian venipuncture was performed, a second guide wire was passed, and the second needle
was withdrawn. An oblique incision in the deltopectoral area incorporating the wire exit sites. A subcutaneous pocket was created
with the cautery on the pectoralis fascia. An introducer dilator was passed over the first wire and the wire and dilator were withdrawn.
A ventricular lead was passed through the introducer, and the introducer was broken away in the routine fashion. A second introducer
dilator was passed over the second guide wire and the wire and dilator were withdrawn. An atrial lead was passed through the
introducer and the introducer was broken away in the routine fashion. Each of the leads were sutured down to the chest wall with
two 2-0 silk sutures each, connected the leads to the generator, curled the leads, and the generator was placed in the pocket. We
assured hemostasis. We assured good position with the fluoroscopy. What code should be used for this procedure?

a. 33208 b. 33212 c. 33226 d. 33208, 33222

17. The patient is a fifty-eight-year-old white male, one-month status post pneumonectomy. He had a post pneumonectomy
empyema treated with a tunneled cuffed pleural catheter which has been draining the cavity for one month with clear drainage. He
has had no evidence of a block or pleural fistula. Therefore, a planned return to surgery results in the removal of the catheter. The
correct CPT code is:

a. 32440-78 b. 32035-58 c. 32036-79 d. 32552-58

18. This 67-year-old man presented with a history of progressive shortness of breath, mostly related to exercise. He has had a
diagnosis of a secundum atrioseptal defect for several years and has had atrial fibrillation intermittently over this period. He was in
atrial fibrillation when he came to the operating room, and with the patient cannulated and on bypass, the right atrium was then
opened. A large 3 x 5 cm defect was noted at fossa ovalis, and this also included a second hole in the same general area. Both holes
were closed with a single pericardial patch. What CPT code should be reported?

a. 33675 b. 33647 c. 33645 d. 33641

19. A 52-year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic cholecystectomy will be
performed. A transverse infra-umbilical incision was made sharply dissecting to the subcutaneous tissue down to the fascia using
access under direct vision with a Vesi-Port and a scope was placed into the abdomen. Three other ports were inserted under direct

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vision. The fundus of the gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were taken
down sharply and bluntly. The gallbladder appeared chronically inflamed. Dissection was carried out to the right of this identifying
a small cystic duct and artery, was clipped twice proximally, once distally and transected. The gallbladder was then taken down
from the bed using electrocautery, delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port.
What CPT and ICD-10 codes should be reported?

a. 47564, K80.20 b. 47562, K81.1 c. 47610, K80.10 d. 47600, K81.1

20. Katherine had a hernioplasty to repair a of an incarcerated ventral hernia of 3cm and reducible ventral hernia of 2cm both
separated by a distance of 1cm with implantation of mesh for closure. How would you report this procedure?

A. 49594, 49591-59 B. 49594

C. 49593, 49592-59 D. 49616

21. The patient is a 50-year-old gentleman who presented to the emergency room with signs and symptoms of acute appendicitis
with possible rupture. He has been brought to the operating room. An infra-umbilical incision was made which a 5-mm Versa Step
trocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm trocar was placed suprapubic and a 12-mm
trocar in the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture noted. The base
of the appendix was then divided and placed into an Endo-catch bag and the 12-mm defect was brought out. Select the appropriate
code for this visit:

a. 44970 b. 44950 c. 44960 d. 44979

22. An 82-year-old female had a CAT scan which revealed evidence of a proximal small bowel obstruction. She was taken to the
Operating Room where an elliptical abdominal incision was made, excising the skin and subcutaneous tissue. There were extensive
adhesions along the entire length of the small bowel: the omentum and bowel were stuck up to the anterior abdominal wall. Time-
consuming tedious lysis of adhesions was performed to free up the entire length of the gastrointestinal tract from the ligament to
Treitz to the ileocolic anastomosis. The correct CPT code is:

a. 44145, 44005-51 b. 44180-22 c. 44005-22 d. 44005

23. 55-year-old patient was admitted with massive gastric dilation. The endoscope was inserted with a catheter placement. The
endoscope is passed through the cricopharyngeal muscle area without difficulty. Esophagus is normal, some chronic reflux changes
at the esophagogastric junction noted. Stomach significant distention with what appears to be multiple encapsulated tablets in the
stomach at least 20 to 30 of these are noted. Some of these are partially dissolved. Endoscope could not be engaged due to high
grade narrowing in the pyloric channel. It seems to be a high-grade outlet obstruction with a superimposed volvulus. What code
should be used for this procedure?

a. 43246-52 b. 43241-52 c. 43235 d. 43232

24. The patient is a 78-year-old white female with morbid obesity that presented with small bowel obstruction. She had surgery
approximately one week ago and underwent exploration, which required a small bowel resection of the terminal ileum and
anastomosis leaving her with a large inferior ventral hernia. Two days ago, she started having drainage from her wound which has
become more serious. She is now being taken back to the operating room. Reopening the original incision with a scalpel, the intestine
was examined, and the anastomosis was reopened, excised at both ends, and further excision of intestine. The fresh ends were
created to perform another end- to-end anastomosis. The correct procedure code is:

a. 44120-78 b. 44126-79 c. 44120-76 d. 44202-58

25. 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

26. 67-year-old female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy performed with a
placement of a sling. An incision was made over the mid urethra dissected laterally to urethro-pelvic ligament. Cystoscopy revealed
no penetration of the bladder. The edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic
incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What code should be used for this
procedure?

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a. 57288 b. 57287 c. 52000, 57288 d. 52000, 51992

27. 16-day-old male baby is in the OR for a repeat circumcision due to redundant foreskin that caused circumferential scarring from
the original circumcision. Anesthetic was injected, and an incision was made at base of the foreskin. Foreskin was pulled back and
the excess foreskin was taken off and the two raw skin surfaces were sutured together to create a circumferential anastomosis. Select
the appropriate code for this surgery:

a. 54150 b. 54160-78 c. 54163 d. 54161-58

28. 5-year-old female has a history of post void dribbling. She was found to have extensive labial adhesions, which have been
unresponsive to topical medical management. She is brought to the operating suite in a supine position. Under general anesthesia
the labia majora is retracted and the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent
granulation tissue was excised on either side. What code should be used for this procedure?

a. 58660 b. 58740 c. 57061 d. 56441

29. 5-year-old male with a history of prematurity was found to have penile curvature, congenital hypospadias. He presents for
surgical management for straightening the curvature. Under general anesthesia, bands were placed around the base of the penis and
incisions were made degloving the penis circumferentially. The foreskin was divided in Byers flaps and the penile skin was
reapproximated at the 12 o’clock position. Two Byers flaps were reapproximated, recreating a mucosal collar which was then
crisscrossed and trimmed in the midline to accommodate median raphe reconstruction. This was reconstructed with use of a
horizontal mattress suture. The shaft skin was then approximated to the mucosal collar with sutures correcting the defect. Which
CPT code should be used?

a. 54304 b. 54340 c. 54360 d. 54440

30. The patient is a 22-year-old who was found to be 7-1/2 weeks pregnant. She has consented for a D&E. She was brought to the
operating room where MAC anesthesia was given. She was then placed in the dorsal lithotomy position and a weighted speculum
was placed into her posterior vaginal vault. Cervix was identified and dilated. A 6.5-cm suction catheter hooked up to a suction
evacuator was placed and products of conception were evacuated. A medium size curette was then used to curette her endometrium.
There was noted to be a small number of remaining products of conception in her left cornual. Once again, the suction evacuator
was placed, and the remaining products of conception were evacuated. At this point she had a good endometrial curetting with no
further products of conception noted. Which CPT code should be used?

a. 59840 b. 59841 c. 59812 d. 59851

31. The patient is a 64-year-old female who is undergoing a removal of a previously implanted Medtronic pain pump and catheter
due to a possible infection. The back was incised; dissection was carried down to the previously placed catheter. There was evidence
of infection with some fat necrosis in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump
pocket was opened with evidence of seroma. The pump was dissected from the anterior fascia. A 7-mm Blake drain was placed in
the pump pocket through a stab incision and secured to the skin with interrupted prolene. The pump pocket was copiously irrigated
with saline and closed in two layers. What are the CPT and ICD-9-CM codes for this procedure?

a. 62365, 62350-51, T85.79XA b. 62360, 62355, T81.40XA

c. 62365, 62355-51, T85.79XA d. 36590, T58.81XA, T88.8XXA

32. The patient is a 73-year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic
resonance imaging demonstrated a ventriculomegaly. It was recommended that the patient proceed forward with right frontal
ventriculoperitoneal shunt placement with Codman programmable valve. What is the correct code for this surgery?

a. 62220 b. 62223 c. 62190 d. 62192

33. What is the CPT code for the decompression of the median nerve found in the space in the wrist on the palmar side?

a. 64704 b. 64713 c. 64721 d. 64719

34. 2-year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia.
With an #11 blade the chalazion was incised and a small curette was then used to retrieve any granulomatous material on both lids.
What code should be used for this procedure?

a. 67801 b. 67805 c. 67800 d. 67808

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35. MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical laminectomy at C3 through
C6 and fusion. The edges of the laminectomy were then cleaned up with a Kerrison and foraminotomies were done at C4, C5, and,
C6. The stenosis is central: a facetectomy is performed by using a burr. Nerve root canals were freed by additional resection of the
facet, and compression of the spinal cord was relieved by removal of a tissue overgrowth around the foramen. Which CPT codes
should be used for this procedure?

a. 63045-50, 63048-50 b. 63020-50, 63035-50, 63035-50

c. 63015-50 d. 63045, 63048 x 3

36. An extra capsular cataract removal is performed on the right eye by manually using an iris expansion device to expand the pupil.
A phacoemulsification unit was used to remove the nucleus and irrigation and aspiration was used to remove the residual cortex
allowing the insertion of the intraocular lens. What code should be used for this procedure?

a. 66985-RT b. 66984-RT c. 66982-RT d. 66984 -22, RT

37. 80-year-old patient is returning to the gynecologist’s office for pessary cleaning. Patient offers no complaints. The nurse removes
and cleans the pessary, vagina is swabbed with betadine, and pessary replaced. For F/U in 4 months.

a. 99203. b. 99211 c. 99202 d. 99212

38. Patient was in the ER complaining of constipation with nausea and vomiting when taking Zovirax for his herpes zoster and
Percocet for pain. His primary care physician came to the ER and admitted him to the hospital for intravenous therapy and
management of this problem. His physician documented a detailed history, comprehensive examination and a medical decision
making of moderate complexity. Which E/M service is reported?

a. 99285 b. 99284 c. 99221 d. 99222

39. 20-day-old infant was seen in the ER by the neonatologist admitting the baby to NICU for cyanosis and rapid breathing. The
neonatologist performed intubation, ventilation management and a complete echocardiogram in the NICU and provided a report for
the echocardiography which did indicate congenital heart disease. Select the correct code(s) for the physician service.

A. 99468-25, 93303-26 C. 99460-25, 31500, 94002, 93303

B. 99471-25, 31500, 94002, 93303 D. 99291-25, 93303

40. A 40-year-old patient is coming to see her primary care physician for hypertension. Her physician performs an expanded problem
focused exam and low medical decision making. After the exam the patient discusses with her physician that the OBGYN office
had just told her that her Pap smear came back with an abnormal reading and is worried since her aunt had passed away with cervical
cancer. The physician spends an extra 45 minutes face-to-face time discussing with her the awareness, other screening procedures
and treatment if it turns out to be cervical cancer. What code(s) should be used for this visit?

a. 99215 b. 99213, 99417 c. 99213 d. 99213, 99403

41. A patient was admitted yesterday to the hospital for possible gallstones. The following day the physician who admitted the
patient performed a detailed history, a detailed exam and a medical decision making of moderate complexity. The physician tells
her the test results have come back positive for gallstones and is recommending having a cholecystectomy. What code should be
reported for this evaluation and management service performed today?

a. 99254 b. 99222 c. 99232 d. 99235

42. A patient came in to the ER with wheezing and a rapid heart rate. The ER physician documents a comprehensive history,
comprehensive exam and medical decision of moderate complexity. The patient has been given three nebulizer treatments. The ER
physician has decided to place him in observation care for the acute asthma exacerbation. The ER physician will continue examining
the patient and will order additional treatments until the wheezing subsides. Select the appropriate code(s) for this visit.

a. 99284, 99222 b. 99222 c. 99284 d. 99235

43. A 42-year-old with renal pelvis cancer receives general anesthesia for a laparoscopic radical nephrectomy. The patient has
controlled type II diabetes otherwise no other co-morbidities. What is the correct CPT® and ICD-10-CM code for the anesthesia
services?

a. 00860-P1 b. 00840-P3 c. 00862-P2 d. 00868-P2

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44. A healthy 32-year-old with a closed distal radius fracture received monitored anesthesia care for an ORIF of the distal radius.
What is the code for the anesthesia service?

a. 01830-P1 b. 01860-QS-P1 c. 01830-QS-P1 d. 01860-QS-G9-P1

45. A 10-month-old child is taken to the operating room for removal of a laryngeal mass. What is the appropriate anesthesia code?

a. 00320 b. 00326 c. 00320, 99100 d. 00326, 99100

46. A 6-month-old patient is administered general anesthesia to repair a cleft palate. What anesthesia code(s) should be used for this
procedure?

a. 00170, 99100 b. 00172 c. 00172, 99100 d. 00176

47. A catheter is placed in the left common femoral artery in retrograde fashion. Which was directed into the right iliac system
advancing it to the external iliac. Dye was injected and select right lower extremity angiogram was performed which revealed
patency of the common femoral and profunda femoris. The catheter was then manipulated into the femoral artery in which a select
lower extremity angiogram was performed which revealed occlusion from the popliteal to the peroneal artery. What are the
procedure codes that describe this procedure?

a. 36217, 76716-26, 75774-26 b.36247,75716-26

c. 36217, 75710-26 d. 36247, 75710-26

48. 56-year-old female is having a bilateral mammogram with computer aid detection conducted as screening since the patient has
had a previous cyst in the right breast. What radiological services are reported?

a. 77067 b. 77066, 77065 c. 77067, 77063 d. 77066, 77067

49. 63-year-old patient with bilateral ureteral obstruction presents to an outpatient facility for placement of right and left ureteral
stent along with an interpretation of a retrograde pyelogram. What codes should be reported?

a. 52332, 7400 0 b. 52332-50, 74420-26 c. 52005, 74420 d. 52005-50, 74425-26

50. A patient came to the radiology department of the hospital on Monday morning for CT study of the abdomen and pelvis. An
unenhanced Ct of the abdomen and enhanced CT of the pelvis was done on the same session and interpretation was also provided.

a. 74150, 72193 b. 74160, 72193 c. 74178 d. 74177

51. This gentleman has localized prostate cancer and has chosen to have complete transrectal ultrasonography performed for
dosimetry purposes following calculation of the planned transrectal ultrasound, guidance was provided for percutaneous placement
of 10 sources. Select the appropriate codes for this procedure.

a. 55860, 76942-26 b. 55875, 76965-26

c. 55860, 76873-26 d. 55875, 77778-26, 76965-26

52. 76-year-old female had a ground level fall when she tripped over her dog earlier this evening in her apartment. The emergency
department took x-rays of the wrist in oblique and lateral views which revealed a displaced distal radius fracture, grade I open right
wrist. What radiological service and ICD 10 codes should be reported?

a. 73100-26, S52.501B, W18.31XA, Y92.039 b. 73110-26, S52.601B, W18.41XA, Y92.039

c. 73115-26, S52.509A, W18.31XA, Y92.039 d. 73100-26, S52.601B, W18.31XA, Y92.039

53. Patient is coming in for a pathological examination for ischemia in the left leg. The first specimen is 1.5 cm of a single portion
of arterial plaque taken from the left common femoral artery. The second specimen is 8.5x2.7 cm across x 1.5 cm in thickness of a
cutaneous ulceration with fibro purulent material on the left leg. What surgical pathology codes should be reported for the pathology?

a. 88302, 88304 b. 88304, 88305

c. 88305, 88307 d. 88307, 88309

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54. During a craniectomy the surgeon performed a frozen section of a large piece of tumor and sent it to pathology. The pathologist
received a rubbery pinkish tan tissue measuring in aggregate 3x0.8x0.8 cm. The entire specimen is submitted in one block and a
microscope was used to examine the tissue. The frozen section and the pathology report are sent back to the surgeon indicating that
the tumor was medulloblastoma. What CPT codes will be pathologist report?

a. 80500 b. 88331-26 c. 80502 d. 88331-26, 88304-26

55. Physician orders a comprehensive metabolic panel but also wants blood work on calcium ions and also orders a basic metabolic
panel. Select the codes on how this is reported?

a. 80053, 80047 b. 80053

c. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 d. 80053, 82330

56. 18-year-old female with a history of depression comes into the ER in a coma. The ER physician orders a drug screen on
antidepressants, phenothiazines and benzodiazepines. The lab performs a screening for each single drug class using an immunoassay
in a random-access analyzer. Presence of antidepressants is found, and a drug confirmation is performed to identify the
antidepressant. What correct CPT codes are reported?

a. 80306, 80342, 80338 b. 80305, 80342, 80338

c. 80307, 80338 d. 80306, 80338

57. A patient uses topiramate to control his seizures. He comes in every two months to have a therapeutic drug testing performed to
assess serum plasma levels of this medication. What lab code is reported for this testing?

a. 80150 b. 80372 c. 80201 d. 80201, 86965

58. Patient that is a borderline diabetic has been sent to the laboratory to have an oral glucose tolerance test. Patient drank the glucose
and five blood specimens were taken every 30 to 60 minutes up to three hours to determine how quickly the glucose is cleared from
the blood. What codes should be reported for this test?
a. 82947x5 b. 82946 c. 80422 d. 82951, 82952x2

59. 4-year-old is getting over his cold and will be getting three immunizations in the pediatrician’s office by the nurse. The first
vaccination administered is the Polio vaccine intramuscularly. The next one is the influenza (live) administered in the nose. The last
vaccination is the Varicella (live) by subcutaneous route. What CPT® codes are reported for the administration and vaccines?

a. 90713, 90658, 90716, 90460, 90461x2 b. 90713, 90656, 90716, 90460, 90461x1
c. 90713, 90660, 90716, 90471, 90472, 90474 d. 90713, 90658, 90716, 90471, 90472, 90473

60. A patient with chronic renal failure is in the hospital being evaluated by his endocrinologist after just placing a catheter into the
peritoneal cavity for dialysis. The physician is evaluating the dwell time and running fluid out of the cavity to make sure the volume
of dialysate and the concentration of electrolytes and glucose are correctly prescribed for this patient. What code should be reported
for this service?

a. 90935 b. 90937 c. 90947 d. 90945

61. An established patient had a comprehensive exam in which she has been diagnosed with ocular surface diseases in both eyes.
The ophthalmologist measures the cornea for placement of the soft contact lens for treatment of this syndrome. What codes are
reported by the ophthalmologist?

a. 92014-25, 92071-50 b. 99214-25, 92325-50

c. 92014-25, 92325-50 d. 92014-25, 92310

62. A patient who is a singer has been hoarse for a few months following an upper respiratory infection. She is in a voice laboratory
to have a laryngeal function study performed by an otolaryngologist. She starts off with the acoustic testing first. Before she moves
on to the aerodynamic testing she complains of throat pain and is rescheduled to come back to have the other test performed. What
CPT® code(s) should be reported?

a. 99211, 92520 b. 92700 c. 92520-52 d. 99211, 92700-52

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63. A new patient is having a cardiovascular stress test done in his cardiologist’s office. Before the test is started the physician
documents a comprehensive history and exam and moderate complexity medical decision making. The physician will be supervising
and interpreting the stress on the patient’s heart during the test. What procedure code should be documented for this encounter?

a. 93015-26, 99204-25 b. 93016, 93018, 99204-25

c. 93015, 99204-25 d. 93018-26, 99204-25

64. A cancer patient is coming in to have a chemotherapy infusion. The physician notes the patient is dehydrated and will first
administer a hydration infusion. The infusion time was 1 hour and 30 minutes. Select the code(s) that should be reported for this
encounter?

a. 96360 b. 96360, 96361 c. 96365, 96366 d. 96422

65. What is difference between entropion and ectropion?

a. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid.
b. Entropion is the incomplete closure of the eyes and ectropion is the drooping of the eyelids.
c. Entropion is the outward turning of the eyelid and ectropion is the inward turning of the eyelid.
d. Entropion is the drooping of the eyelid due to nerve disorder and ectropion is the drooping of the eyelid due to muscle disorder.

66. What type of graft is used when pigskin is applied to a burn wound?

a. Xenograft b. Allograft c. Autograft d. Pinch graft

67. Ventral, Umbilical, Spigelian and incisional are types of

a. Surgical approaches b. Hernias

c. Organs found in the digestive system d. Cardiac catheterizations.

68. Fracturing the acetabulum involves what areas?

a. Skull b. Shoulder c. Pelvis d. Leg

69. When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located.

a. Foot b. Upper arm c. Upper Leg d. Hand

70. What is the term used for Inflammation of the bone and bone marrow.

a. Chondromatosis b. Osteochondritis c. Costochondritis d. Osteomyelitis

71. The root word Trich/o means

a. Hair b. Sebum c. Eyelid d. Trachea

72. Complete this series: Frontal lobe, Parietal Lobe, Temporal lobe____

a. Medulla Lobe b. Occipital Lobe c. Middle lobe d. inferior lobe.

73. 44-year-old had a history of adenocarcinoma of the cervix on a conization in March 20XX who has been following with twice
early endocervical curettages and pap smears that were all negative for 2 years as per the recommendation of the Gyn oncologist.
Her pap smear results from the last visits noted atypical glandular cells. Despite this she underwent a colposcopy and biopsy of the
normal appearing cervix on colposcopy was benign. The endocervical curettage was benign endocervical glands and the endometrial
sampling was benign endometrium. Although she had previous atypical glandular cells that let to diagnosis of adenocarcinoma and
that concerns that this may have recurred she had been recommended for a cone biopsy and fractional dilation and curettage which
she is undergoing today. What ICD 10 CM codes should be reported.

a. R87.619, C53.1 b. D39.0 c. R87.619, Z85.41 d. Z12.4, Z85.41

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74. Patient comes in to see her PCP for a productive cough and shortness of breath the physician takes a chest x ray which indicates
the patient has congestive pneumonia. Select the ICD 10 cm code for this visit.

a. J18.9, R05, R06.02 b. R05, R06.02, J18.9 c. J18.9 d. J18.0

75. 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, T40.2X5A b. T40.2X5A, R00.1 c. R00.1, T40.2X5A d. T40.2X1A, R00.1

76. What statement is true when reporting pregnancy codes

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 7th digits assigned to these codes indicate the complication during the pregnancy

77. 27-year-old was frying chicken when an explosion of the oil had occurred, and she sustained second-degree burns on her face
(3%), third degree burns on both hands (4%), and second degree burns on her lower left forearm (3%). There was a total of 10
percent of the body surface that was burned. Select which ICD-10-CM codes should be used.

a. T20.20XA, T23.309A, T22.20XA, T31.10, [Link]

b. T23.309A, T20.20XA, T22.20XA, T31.10, [Link]
c. T23.309A, T20.20XA, T22.219A, T31.10, [Link]
d. T23.309A, T31.0, [Link]

78. Which statement is true about Z codes:

a. Z codes are never reported as primary code

b. Z codes are only reported with injury codes
c. Z codes may be used either as primary code or secondary code
d. Z codes do not have to correspond with procedure codes

79. Which of the following is true regarding ICD-10-CM codes with the words “in diseases classified elsewhere” in their
descriptions?

a. They can never be the first listed code.

b. They should always be the first listed code.
c. They are unspecified codes and should be used only when more specific diagnoses cannot be found. d. None of the above.

80. Which of the following statements is true regarding sequencing of External cause codes?
a. External cause codes for place of occurrence take priority over all other External Cause.
b. External cause codes for medical history take priority over all other External Cause codes.
c. External cause codes identifying screening exam as the reason for encounter take priority over all other External Cause codes.
d. External cause codes for transport accidents take priority over ll other External Cause codes except cataclysmic events and child
and adult abuse and terrorism.

81. Which of the following is an example of a case in which a diabetes-related problem exists and code for diabetes is never
sequenced first?

a. If the patient has an under dose of insulin due to an insulin pump malfunction
b. If the patient is being treated for secondary diabetes
c. If the patient is being treated for Type II diabetes
d. If the patient has hyperglycemia that is not responding to medication

82. Which place of service code should be reported on the physician’s claim for a surgical procedure performed in an ASC?

a. 21 b. 22 c. 24 d. 11

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83. If an AMI is documented as nontransmural or subendocardial, but the site is provided, how is it reported, according to ICD-
10-CM guidelines?

a. As unspecified b. As a subendocardial AMI c. As STEMI d. AS NSTEMI

84. Which of the following is an example of Mid- level provider

a. Pathologist. b. Assistant Surgeon c. Nurse d. Phlebotomist

85. 66-year-old Medicare patient, who has a history of ulcerative colitis, presents for a colorectal cancer screening. The screening is
performed via barium enema. What HCPCS Level II code is reported for this procedure?

a. G0106 b. G0105 c. G0120 d. G0121

86. Patient with corneal degeneration is having a cornea transplant. The donor cornea had been previously prepared by punching a
central cornea button with a guillotine punch. This had been stored in Opti sol GS. It was gently rinsed with BSS Plus Solution and
was then transferred to the patient’s eye on a Paton spatula and sutured with 12 interrupted 10 nylon sutures. Select the HCPCS
Level II code for the corneal tissue.

a. V2790 b. V2785 c. V2628 d. V2799

87. The patient presents to the office for an injection. Joint prepped using sterile technique.
Muscle group location: gluteus maximus. Sterilely injected with 1cc of 10 mg kenalog-40 Sterile bandage applied. Choose the
HCPCS Level II code for these treatments.

a. J3301x40 b. J3301 c. J3300x40 d. J3300

88. What is PHI?

a. Physician-health care interchange b. Private health insurance

c. Protected health information d. Provider identified incident-to

89. Which of the following is a BENEFIT of electronic claims submission?

a. Privacy of claims b. Security of claims c. Timely submission of claims d. None of the above

90. Which of the following is an example of electronic data?

a. A digital X-ray b. An explanation of benefits

c. An advance beneficiary notice d. A written prescription

91. Pre-Op Diagnosis: Left Breast Abnormal MMX or Palpable Mass; Other Disorders of Breast
Procedure: Automated Stereotactic Biopsy Left Breast
Findings: Lesion is located in the lateral region, just at or below the level of the nipple on the 90-degree lateral view. There is a sub
glandular implant in place. I discussed the procedure with the patient today including risks, benefits and alternatives. Specifically
discussed was the fact that the implant would be displaced out of the way during this biopsy procedure. Possibility of injury to the
implant was discussed with the patient. Patient has signed the consent form and wishes to proceed with the biopsy. The patient was
placed prone on the stereotactic table; the left breast was then imaged from the inferior approach. The lesion of interest is in the
anterior portion of the breast away from the implant which was displaced back toward the chest wall. After imaging was obtained
and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped with Betadine. 1% lidocaine was
injected subcutaneously for local anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling needle.
The SenoRx needle was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy samples using
vacuum and cutting technique. The specimen radiograph confirmed representative sample of calcification was removed. The tissue
marking clip was deployed into the biopsy cavity successfully. This was confirmed by final stereotactic digital image and confirmed
by post core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left breast in satisfactory
position. No obvious calcium is visible on the final post core biopsy image in interest. The patient tolerated the procedure well.
There were no apparent complications. The biopsy site was dressed in Steri-Strips, bandage and ice pack in the usual manner. The
patient did receive written and verbal post-biopsy instructions. The patient left our department in good condition.
Impression:
1. Successful Stereotactic core biopsy of left breast calcifications.
2. Successful Deployment of the tissue marking Clip into the biopsy cavity.

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3. Patient left our department in good condition today with post-biopsy instructions.
4. Pathology report is pending; an addendum will be issued after we receive the pathology report. What are the codes for the
procedures?

a. 19081-LT b. 19101-LT,19283-LT c. 19100-LT, 76942-26 d. 19100-LT, 19283-LT

92. Preoperative diagnosis: Right scaphoid fracture.

Type of procedure: Open reduction and internal fixation of right scaphoid fracture.
Description of procedure: The patient was brought to the operating room, anesthesia having been administered. The right upper
extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was
elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches
were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and
entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did
not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending
from the proximal pole of the scaphoid distal ward. The guidewire was positioned appropriately and then measured. A 25-mm
Accutrak drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted, and rigid internal fixation was accomplished
in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in
layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition.
What code should be used for this procedure?

a. 25628-RT b. 25624-RT c. 25645-RT d. 25651-RT

93. The patient is a 59-year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago.
A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. He
is taken to the operating room for re-do left carotid endarterectomy. The left neck was prepped, and the previous incision was
carefully reopened. Using sharp dissection, the common carotid artery and its branches were dissected free. The patient was
systematically heparinized and after a few minutes clamps applied to the common carotid artery and its branches. A longitudinal
arteriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis.
A silastic balloon-tip shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima were
removed and the endarterectomized surfaces irrigated with heparinized saline. An oval Dacron patch was then sewn into place with
running 6-0 Prolene. Which CPT code should be used?

a. 35301 b. 35301, 35390 c. 35302 d. 35311, 35390

94. Code the CPT procedural codes for the Op Report below.
Diagnosis: Diverticular disease of the sigmoid colon and appendix with resolving diverticulitis of the sigmoid colon.
Operation: 1. Resection of sigmoid colon 2. Appendectomy.
Findings: The patient was found to have the sigmoid colon showing the evidence of resolved diverticular disease. This involved
only the mid portion of the sigmoid colon with this area being thickened and showing evidence of inflammatory reaction around the
colon. There were numerous diverticula noted. The sigmoid colon was adherent to the lateral peritoneum as well as to the bladder
with inflammatory adhesions. These were easily taken down. The appendix showed evidence of past scarring. Numerous diverticula
were noted, and it was taken down.
Procedure: Under general anesthesia, after routine prepping and draping, the abdomen was entered through a low midline
abdominal incision. After limited explorations, the pelvis was exposed, and the involved area of sigmoid colon was identified. The
blood supply to the sigmoid colon was taken, and the sigmoid colon was resected between clamps. The distal descending colon was
then brought down to the rectosigmoid area, and an end to end anastomosis was accomplished. This provided a good lumen and a
watertight closure and the appendix was removed. The mesentery over the bowel was closed using a running 3-0 vicryl suture. The
operative area was thoroughly irrigated. The bowel was all returned to a normal position. Sponge and needle counts were all correct.
The abdominal wall was closed in layers routinely. No intra-operative complications were encountered. Dressings were applied.
The patient returned to the recovery room in satisfactory condition.

a. 44950 b. 44140 c. 44140, 44955 d. 44140, 44955-51

95. Pre-operative diagnosis: Missed abortion with fetal demise,11 weeks.

Post-operative diagnosis: Missed abortion with fetal demise,11 weeks.
Procedure: Suction D &C
The patient was prepped and draped in a lithotomy position under general mask anesthesia, and the bladder was straight catheterized;
a weighted speculum was placed in the vagina. The anterior lip of the cervix was grasped with a single-tooth tenaculum. The uterus
was then sounded to a depth of 8cm. The cervical OS was then serially dilated to allow passage of a size 10 curved suction curette
was then used to evacuate the intrauterine contents, sharp curette was used to gently palpate the uterine wall with negative return of
tissue and the suction curette was again used with negative return of tissue. The tenaculum was removed from the cervix. The

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speculum was removed from the vagina. All sponges and needles were accounted for at completion of the procedure. The patient
left the operating room in apparent good condition having tolerated the procedure well. Pathology report indicate benign polyp.

a. 59821, O03.9 b. 59812, O03.9 c. 59820, O02.1 d. 59856, O02.1

96. Code the correct CPT code for the Op report below:
Diagnosis: Cataract left eye.
Anesthesia: Topical
Operation: Phacoemulsification with intraocular lens implantation, left eye.
History: This patient complains of progressive loss of vision and progressive cataract, admitted for phacoemulsification with
implant. The patient is taken to surgery at this time for the above procedure. Technique is as follows.
Procedure: The patient was prepped and draped in the usual sterile fashion. Following peribulbar and topical anesthesia with
preservative-free lidocaine, a wire lid speculum was placed and the supratemporal conjunctiva was approached with a fornixbased
conjunctival flap. A groove was placed 2mm posterior to the limbus with a #64 Beaver blade and carried into clear cornea with an
angled beaver. A3.0 keratome was used to enter the anterior chamber after a paracentesis was performed on the opposite at the
limbus. Viscoelastic was used to fill the anterior chamber and a capsulorrhexis was started in the center with a triangular flap, torn
circularly in a counterclockwise fashion to complete a 360-degree anterior capsulorrhexis tear. Irrigation under the anterior capsule
was then performed with balanced salt solution to perform hydro dissection, separating the nucleus from peripheral cortical
attachments, spinning the nucleus free. The nucleus was then bisected with the phacoemulsification tip and rotated. These
hemispheres were then sectioned into quadrants and splitting was performed with the cyclo-dialysis spatula, and the cannula for the
viscoelastic. The aspiration was turned up on the phacoemulsification machine into position#2 with higher suction. The remaining
nuclear quadrants were aspirated, and phacoemulsification completed without difficulty. The irrigation and aspiration machine were
then used to clean up the peripheral cortex and polish the posterior capsule. A 11-diopter lens was the rotated into position over the
capsular bag. The inferior haptic was rotated into the bag and the superior haptic dilated into the bag. Miostat was used to constrict
the pupil. The viscoelastic was removed under irrigation and aspiration control. One-half cc Tobramycin and Decadron, 20mg
vancomycin were injected subconjunctival at the end of the case. Maxitrol and pressure patch were applied. The patient returned to
the recovery room in good condition, to be discharged as an outpatient.

a. 66984-52, LT b. 66982-LT c. 66984-LT d. 66982-52, LT

97. BILATERAL SCREENING MAMMOGRAM

CLINICAL: NONE
No prior exams were available for comparison. The tissue of both breasts is extremely dense, which lowers the sensitivity of
mammography. No significant masses, calcifications, or other findings are seen in either breast.
IMPRESSION: NEGATIVE MAMMOGRAM
There is no mammographic evidence of malignancy. A 4 year screening mammogram is recommended.

a. 77067-50 b. 77066 c. 77063-50 d. 77067

98. Operative Procedure: Excision of back lesion

Indications for surgery: The patient has an enlarging lesion, on the upper mid back.
Findings at surgery: There was a 5 cm upper midback.
Operative surgery: With the patient prone, the was prepped and draped in the usual sterile fashion. The skin and underlying tissues
were anesthetized with 30 ml of lidocaine with epinephrine. Through a 5-cm transverse skin incision the lesion was excised.
Hemostasis was ensured. The incision was closed using 3-0 Vicryl for the deep layers and running 3-0 prolene subcuticular stitch
with Steri-Strips for the skin. The patient was returned to the SDS center in stable postoperative condition. All sponge, needle, and
instrument counts were correct. Estimated blood loss 0 ml. Pathology report late indicate: Follicular cyst, Infundibular type, skin
of back.

a. 11406, 12002 b.11426 c. 11406, 12032 d. 11606

99. Diagnosis: Scaphoid nonunion, right.

Name of operation: Open reduction and internal fixation of right scaphoid fracture nonunion with autogenous bone graft from the
distal radius; filling of bone graft donor site with coralline bone graft substitute.
Findings at operation: The distal pole of the scaphoid at the level of the tuberosity was fractured and had failed to heal. The distal
pole had resorbed partially, leaving a shell of bone which did not allow screw fixation. The proximal pole appeared to be viable, as
did the distal pole. The distal radio scaphoid joint appeared normal. The scaphocapitate joint appeared normal.
Procedure: The patient was taken to the operating room and placed supine on the operating table. He underwent satisfactory
uneventful induction of general inhalation anesthesia. The right upper extremity was scrubbed with Betadine scrub solution,
prepared with Betadine prep solution, and sterile drapes were applied to expose the right upper extremity. The limb was
exsanguinated with an elastic wrap, and an Incision was made along the radio volar side of the thumb metacarpal base extending
across the carpometacarpal joint and the scapho-trapezoidal joint and the radio scaphoid joint. At the flexor carpi radialis sheath,

13 | P a g e
the Incision extended proximally, approximately 6-8 cm. The subcutaneous tissues were dissected sharply. Care was taken to avoid
injury to the terminal branches of the superficial radial nerve and to the radial artery. Care was taken to avoid injury to the median
nerve. The flexor carpi radialis sheath was opened, and the flexor carpi radialis tendon was reflected ulnar ward. The sheath opened
dorsally, and the distal radius was exposed, and the radiocarpal joint was exposed, as was the radio scaphoid and scapho-trapezoidal
joint. The crossing vessels from the radial artery were cauterized and suctioned. Care was taken to avoid injury to the terminal
branches of the superficial radial nerve. Care was taken to avoid injury to the major trunk of the radial artery. The capsule of the
wrist joint was opened. The scaphoid nonunion was identified. The 0.062-inch Kirschner wires were use as manipulating handle to
control the proximal and distal fragments while the nonunion was cleaned of fibrous tissue and scarred, dense bone. A satisfactory,
though nonanatomic reduction could be achieved, and it appeared that there was a slight flexion of the scaphoid. The pronator
quadratus was reflected from the distal radius and a window measuring approximately 1 x 2 cm was opened in the transverse axis
of the distal radius. The margins of window were rounded with Kirschner-wire drill holes to diminish stress-rising effect. Ample,
good, viable cancellous bone was removed from the distal radius. The wound was irrigated with saline and packed with coralline
bone graft (interpore). The bone graft was placed in the exposed raw surfaces of the proximal and distal fragments of the scaphoid
bone. A cortico-cancellous bone graft was placed slightly to the volar side to prevent further volar collapse. Using th e image
intensifier video monitor after placement of .062-inch Kirschner wires across the fracture site, the K- wires appeared to be
satisfactory, after they were repositioned. The image intensifier AP and lateral projection revealed satisfactory, though nonanatomic
reduction of the carp scaphoid. The radio scaphoid articulation did not appear to be threatened. The fracture was stably fixed with
no motion evident on radial or ulnar deviation. The wound was irrigated with saline, infiltrated with 0.25% Marcaine, and the
tourniquet was deflated. Hemostasis was ascertained, and the capsular structures were closed with interrupted 4-0 Vicryl sutures so
that, the capsule- ligamentous portion of the volar wrist capsule was restored. The wound was irrigated with saline. Hemostasis was
ascertained, and the subcutaneous tissues were closed with interrupted 4-0 Vicryl suture.

a. 25431-RT b. 23431-RT c. 25440-RT d. 25443-RT

100. HISTORY: He came with his sister as usual. He says he had been feeling fine, continues to have low back pain, bothers
him intermittently, but with current Percocet regimen. He is able to function. He is able to do some back stretch exercise on a
more regular basis. He continues to take lisinopril. His blood pressure was under good control before.
PHYSICAL EXAMINATION: Looks well, in no distress. Weight: 258 pounds. BP: 120/68. HR: 80.
ASSESSMENT/PLAN:

1. Hypertension, BP under good control. I instructed him to continue lisinopril current dosage. We discussed weight reduction
issue.
2. Chronic low back pain, relatively stable. I refilled Percocet. I reviewed our narcotic medication policy. He declined flu
vaccination. He had that before, became sick with it. Return visit in four weeks.

a. 99203 b. 99213 c. 99214 d. 99204

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