3470 HEALTHCARE TRAINING AND PLACEMENT SOLUTIONS

1.B - The guidelines with excision–benign lesion provide directions to code additionally for intermediate
and complex closures.

2.a - Code 11056 includes two to four lesions.

3.- For narrowing down to the correct procedure code for the Mohs micrographic surgery, you should
find out where on the body the tumor was removed. For this scenario, it is the neck; eliminating
multiple choice codes B and C, which involve the trunk, arms or legs. The tissue block removals were
performed in two stages, coding 17311 and 17312. Code 17315 is not coded for this scenario, since the
physician would have to remove more than five tissue blocks in any stage. There were only four tissue
blocks removed in the first stage and two tissue blocks removed in the second stage, both falling short
of six or more tissue blocks removed in either stage.

4.d - The two face lacerations were closed with steri-strips (adhesive strips). According to CPT®
guidelines when wound closure uses adhesive strips as the only repair material it should be coded using
the appropriate E/M service. Code 12011 is inappropriate to report for this scenario, eliminating
multiple choices A and B. The repairs for the wounds on the arm and leg are intermediate closures.
According to CPT® guidelines single-layer closure of heavily contaminated wounds that have required
extensive cleaning or removal of particulate matter also

constitutes intermediate repair. This eliminates multiple choice C. To report multiple wounds that are
repaired in the same classification and from the anatomic sites that are grouped together into the same
code descriptor, add together the length of the wounds. When more than one classification of wounds is
repaired, append modifier 59 to the least complicated repair(s). (OR)Laceration of arm was 5 cm and leg
was also 5cm = 10 cm, method of closure is single layered closure (i.e. Intermediate closure) therefore
assign code 12034 is the only option correct in this scenario.

5.You need to first find out if this lesion is benign or malignant. For this scenario the patient has a basal
cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as they
deal with benign lesions. Now you need to find out where the lesion is located and the size of the
removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm = 3.3 cm, leading you to
code 11644. CPT® guidelines state: For excision of malignant lesion(s) requiring intermediate or complex
closures should be reported separately. For this scenario the wound was closed in two layers qualifying
the closure to be coded with an intermediate repair of the chin (4 cm), 12052.

6.d - One way to find this answer in the CPT® Professional Edition index is under the main term
Breast, then Reconstruction, and with free flap. The operating microscope is bundled with this procedure.
Notice the parenthetical note following the surgical code

7.c - One way to find this answer in the index of the CPT is under the main term Removal, then
Foreign Body, Subcutaneous Tissue, and with Debridement.

8.b - This patient is coming in to have an in-grown toe nail removed, eliminating multiple choice answer
D (Evacuation of Subungual Hematoma), which is evacuating blood from under the nail. You are now left
with choices A, B, and C that involves the removal of an ingrown toenail. Code 11752 is not correct. The
scenario does not mention an amputation. The clue to help you narrow down between the codes 11765
and 11750 is that there is a partial removal of the nail and nail matrix (maxtrixectomy).

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9.c – Index of CPT- main term Destruction – Skin – Benign lesions 17110-17111.

10.c - Index of CPT- main term rhytidectomy (15824-15829), lipectomy/ aspiration (see Liposuction)
(15876-15879), it was done bilaterally need to append modifier

50, since the procedures were distinct need to append modifier 59.

11.d - 9 planter warts removed and 6 flat warts all destroyed with cryosurgery (9+6=15 warts or lesions,
leads to code 17111).

12.D - Because the simple repairs all occur in the same general location (the forearm), you should add
together the lengths of all the repairs (2.0 cm + 3.0 cm +

3.0 cm = 8.0 cm) to choose a single code, 12004 Simple repair of superficial wounds of scalp, neck,
axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 to 12.5 cm. The final
repair, although occurring at the same location, is of a different severity (intermediate).You, therefore,
would report it separately using 12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or
extremities (excluding hands and feet); 2.5 cm or less. When reporting several wounds of differing
severity and/or location, claim the most extensive (i.e, highest-valued) code as the primary service, and
append modifier 59 Distinct procedural service to any subsequent repair codes.

13.c - Complex repair codes (unlike simple and intermediate repair codes) employ add-on codes to
describe wounds greater than 7.5 cm. You may report as many units of the add-on codes as necessary to
describe the size of the wound repaired. In this case, 13101 Repair, complex, trunk; 2.6 cm to 7.5 cm
describes the first 7.5 cm; the first unit of +13102 Repair, complex, trunk; each additional 5 cm or less
(List separately in addition to code for primary procedure) describes an additional 5.0 cm, and a second
unit of +13102 describes the remaining 2.5 cm. Modifier 59 should not be appended to add-on codes.

14.d - Excision of pressure ulcer may you separately report skin graft to close (15956).

15.d - Patient is having Mohs Micrographic Surgery being performed only, eliminating multiple choice
answer C. The first stage had three tissue blocks removed to report code 17313. The second stage had
six blocks removed requiring two codes to be reported. Code 17314 covers the first five tissue blocks
and code 17315 covers the remaining tissue block (or the sixth tissue block) removed in the second
stage. (OR) Mohs micrographic surgery technique on his upper back, three tissue blocks removed in the
first stage. Second stage had six tissue blocks (17313, 17314 and 17315).

16.c - The abscess had already burst, with no need to perform an incision to open it, eliminating multiple
choice answers A and B. The difference between multiple choice answers C and D is that the patient is
having the debridement performed due to a soft tissue infection in the perineum area. Multiple choice C
is the correct answer.

17.c - Breast biopsy, with placement of localization devices and imaging guidance (19081-19086).

18.d - To start narrowing your choices down, the hand and foot were closed with adhesive strips. The
Section Guidelines in the CPT® manual for Repair (Closure) states Wound closure utilizing adhesive strips
as the sole repair material should be coded using the appropriate E/M code. Eliminating multiple choice
answers A and B. The lacerations on the face are intermediate repairs, since debridement and glass debris
was removed. The Section Guidelines in the CPT® manual for Repair (Closure) states Single-layer closure of

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heavily contaminated wounds that have required extensive cleaning or removal of particulate matter
also constitutes intermediate repair. Eliminating multiple choice answer C. The intermediate repair of
the lacerations to the face totaled 6 cm (12053). The right arm and left leg had cuts measuring 5 cm
each which totaled 10 cm requiring intermediate repair (12034).

19.d - Dressing change under general anesthesia (15852-LT).

20.b - Excision of chest wall tumor involving mediastinal lymphadenectomy (19272).

21.d - In this case, add the size of the lesion (1.5 cm) and double the width of the narrowest margin (1.5
cm x 2 = 3.0 cm) for a total of 4.5 cm (1.5 cm x 3 = 4.5 cm).Appropriate coding is 11606 Excision,
malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm.

22.d - If the surgeon performs the re-excision during the same operative session, you may report only a
single code to describe both the excision and re-excision, based on the widest overall excision diameter,
including margins.

23.c - CPT® 11603 Excision, malignant lesion including margins, trunk, arms or legs; excised diameter 2.1
to 3.0 cm is the most extensive procedure (removal of malignant lesion); 11402-59 Excision, benign
lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter
1.1 to 2.0 cm is for excision of the larger benign lesion, and 11401-59 Excision, benign lesion including
margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm) is
for excision of the smaller benign lesion. Appending modifier 59 to the second and subsequent codes
describing excisions at the same location is necessary to avoid duplication denials.

24.d - Code 27600 is listed below code 27892 in parenthetical note. For decompression fasciotomy of
the leg without debridement.

25.d - Excision of sacral pressure, with skin flap closure without ostectomy (15934).

26.d - For incision and drainage of paronchyia (10060).

27.c - For the skin biopsy and frozen section of pathology (11100, 88331-59), two distinct procedures
performed therefore modifier 59 is appended

28.c - For narrowing down to the correct procedure code for the Mohs micrographic surgery, you should
find out where on the body the tumor was removed. For this scenario, it is the arms; eliminating
multiple choice codes A and D, which involve the head, neck, hands, feet, genitalia. The tissue block
removals were performed in two stages, coding 17313 and 17314. Code 17315 is not coded for this
scenario, since the physician would have to remove more than five tissue blocks in any stage. There
were only four tissue blocks removed in the first stage and two tissue blocks removed in the second
stage, both falling short of six or more tissue blocks removed in either stage. Eliminating multiple
choices C, do not report 88314 in conjunction with 17311-17315 for routine frozen section performed
during Mohs surgery.

29.c - Puncture was done for the aspiration of cyst with magnetic resonance guidance (19000, 77021- RT)

30.c - breast reconstruction by free flaps (19364 includes 69990)

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31, D. 11043 identifies the debridement of the skin, subcutaneous tissue, and muscle.
RATIONALE:
A. 11000 reports only debridement of skin, not the subcutaneous tissue or muscle. Furthermore, this code
is for extensive eczematous or infected skin which was not stated in this case.
B. 11010 reports debridement of skin and subcutaneous tissue, not of muscle, and is associated with an
open fracture or dislocation. C. 11042 reports debridement of skin and subcutaneous tissue, partial
thickness, but not of muscle.

ANSWER: 32, A. 17272 identifies the destruction by cryosurgery of a malignant lesion of the genitalia,
lesion diameter 1.1 to 2 cm.
RATIONALE:
B. 11602 is excision of a malignant lesion but not of the genitalia; further, the report indicated that the
lesion was removed by means of cryosurgery, not excision as is reported with 11602.C. 11420 reports
excision of a benign lesion of the genitalia, not cryosurgery for a malignant lesion.D. 11622 is excision of a
malignant lesion from the genitalia, but the report indicated that the lesion was removed by means of
cryosurgery, not by excision.

33. a. You would report this excision to a benign lesion. In the CPT Professional Edition under the
heading Excision – Benign Lesions, cystic lesion is given as an example, (layered) intermediate closure
should be reported in addition to the excision. The local anesthesia is included per the CPT Surgery section
guidelines. 12053 - size 5.1 to 7.5 cm.

Answer: 34.c, this question refers to the debridement depth as muscle and subcutaneous tissue. The par-
enthetical note at the beginning of active wound care management states that codes from this section
should not be reported with codes from code range 11041–11047 for the same wound.
Modifier -51 should not be attached to add-on codes (see modifier -51 in CPT® Professional Edition
Appendix A).

35. ANSWER c. Repair (closure) guidelines indicate the most complicated repair should be coded as the
primary procedure and modifier -51 should be reported when more than one classification of wound is
repaired. It is important to review the anatomic groupings associated with repair codes.

36. ANSWER b. The guidelines in the CPT® Professional Edition listed with excision of malignant lesions
state that, incases of excision performed in conjunction with adjacent tissue transfer, the coder should
report only the adjacent tissue transfer code. The lesion excision is not separately reportable.

37. ANSWER D- Code 19000 also provides the most detail because it has a specific an atomic allocation
along with the correct description (a puncture aspiration).

38. B This patient is coming in to have an in-grown toe nail removed, eliminating multiple choice answer D
(Evacuation of Subungual Hematoma), which is evacuating blood from under the nail. You are now left
with choices A, B, and C that involves the removal of an ingrown toenail. Code 11752 is not correct. The
scenario does not mention an amputation. The clue to help you narrow down between the codes 11765
and 11750 is that the lateral border of the nail was incised and “excised in total”. Those words lead you to
the code description in 11750.
39. C The abscess had already burst, with no need to perform an incision to open it, eliminating multiple
choice answers A and B. The difference between multiple choice answers C and D, is that the patient is
having the debridement performed due to a soft tissue infection in the perineum area.

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40. A .You need to first find out if this lesion is benign or malignant. For this scenario the patient has a
basal cell carcinoma. This falls under malignant lesion, which eliminates multiple choice codes C and D as
they deal with benign lesions. Now you need to find out where the lesion is located and the size
of the removal. The malignant lesion is on the chin (face) and the size is 3.0 cm + .3 cm = .3 cm
= 3.6 cm, leading you to code 11644. CPT® guidelines state: For excision of malignant lesion(s)
requiring intermediate or complex closures should be reported separately. For this scenario the wound
was closed in two layers qualifying the closure to be coded with an intermediate repair of the chin (4 cm),
12052. The diagnosis, basal cell carcinoma of the chin, is indexed in the ICD-9-CM manual in the
Neoplasm Table, under Skin/chin/malignant (column), referring you to code 173.3

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