MOCK 7 (100 Questions)

Medicine

1. Which code is appropriate to report meningococcal recombinant lipoprotein vaccine, serogroup B?

a. 90620 b.90621 c.90625 d.90697

2. Which is the appropriate code (s) to report vaccine administration, with counselling; for a 12 year
old patient, single vaccine component?

a. 90460 b.90461 c.90471 d.90473

3. Which CPT codes are currently used for the administration of vaccinations when counselling is
provided to a patient who is 18 years of age or younger

a. 90471 and +90472 b. 90473 and +90474

c. 90460 and +90461 d. 90460 and 90471

4. A patient is seen for her 12 month, well-child visit. The patient receives the HPV, Tdap and menin-
gococcal vaccines. Counselling is not provided, Which administration codes are billed for these
vaccinations?

a. 90471 x 1 and +90472 x 2 b. 90471 x 1 and +90472 x 1

c. 90460 x 1 and 90461 x 1 d. 90471 x 2 and 90473 x 1

5. A patient presents to a hospital outpatient department and receives an antibiotic IV infusion for 14
minutes, fluids for hydration infused over 28 minutes, and a chemotherapy injection of a anti-
neoplastic. What are the correct codes for this drug administration visit?

a. 96413, 96360, 96374 b. 96417, 96361, 96365

c. 96409, 96374 d. 96409, 96375

6. Which is the proper coding for physician supervision of cardiovascular stress test?

a.93015-26 b. 93015-52 c. 93016 d. 93016-26

10000 series

7. A 16 year old boy is brought is because of a skateboarding accident. He sustained open wounds
on both lower legs. The surgeon takes the patient to the OR for debridement. The wound of the left
leg is 4 cm x 6 cm. The surgeon irrigates the wound and debrides the subcutaneous tissue and
skin. When all of the debris is removed, he applies a dressing and then addresses the right

1
 leg, which has a wound measuring 3 cm x 5cm. This wound is deeper than last, and requires
debridement of nonviable muscle, subcutaneous tissue, and skin. What is the proper code se-
lection?
a. 11043, 11042 b. 11043, 11046
c. 11043, 11042, 11045 d. 11042, 11045, 11043, 11046

8. A patient has pressure ulcer requiring the surgeon to debride all the necrotic muscle, subcutane-
ous tissue, and skin. The size of the ulcer was 4 cm x 6 cm. which is the proper coding?

a. 11043, 11046 b. 11043 c. 11046 d. 11042, 11043

9. Multiple wound debridement are planned prospectively at the time of an initial debridement. Which
is the proper modifier to append to subsequent debridement during the postoperative period?

a. Modifier 58 b. Modifier 59 c. Modifier 78 d. Modifier XE

10. True or False: Documentation stating, “trimming of skin fragments surrounding wound “ is suffi-
cient to support coding for excisional debridement.

a. True b. False

11. A patient presents with a cyst on the arm. Upon examination, the physician decides to incise and
drain the cyst. The site is prepped and the physician cuts into the cyst. Purulent fluid is extracted
from the cyst and a sample of the fluid is sent to the laboratory for evaluation. The wound is irrigated
with normal saline and covered with a bandage. The patient is instructed to return in a week to 10
days for follow up. Select the CPT code for this procedure.

a. 10060 b. 11400 c. 11102 d. 10061

12. A male patient with gynecomastia undergoes extensive resection of right breast tissue. Correct
reporting of this procedure would be:

a. 19120-RT b.19300-RT c. 19301-RT d. 19303-RT

ICD -10-CM

13. The provider documents CKD stage 5 and ESRD. What ICD-10-CM code(s) is/are reported?

a.N18.5 b. N18.6, N18.5 c. N18.4, N18.6 d. N18.6

14. Which is NOT a relevant documentation concept when selecting an appropriate diagnosis code for
sinusitis ICD-10-CM?

a. Anatomy b. Contributing factors

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 c. Temporal factors d. Relationship to (with/without) COPD

15. A patient suffering from burns was seen at the emergency room evaluation. Documentation
indicates first – and second –degree burns on the lower- right leg, second –and third degree burns
on the right ankle, and first-, second-, and third degree burns on the right foot. Which ICD- 10-CM
codes should be reported for these injuries?
a. T24.131A, T24.231A, T25.211A, T25.311A, T25.121A, T25.221A, T25.321A
b. T25.321A, T25.311A, T24.231A
c. T25.322A, T25.312A, T24.231A
d. T25.721A, T25.711A, T24.731A

16. A 3 month old female presents with cleft of the soft palate with right cleft lip.Which is the appro-
priate ICD- 10-CM diagnosis?

a. Q35.9 b.Q36.9 c. Q37.3 d. Q37.5

17. A patient is seen in the nursing home for dizziness and a healed stage II pressure ulcer is also
noted. What ICD-10-CM code(s) is/are reported?

a. R42, L89.90 b. R42, L89.92 c. R42, L89.95 d. R42

Coding guidelines

18. Can Z codes be listed as a primary code?

a. No; Z codes are never listed as primary codes.

b. No; Z codes are always reported as secondary codes.
c. No; Z codes are reported for external injuries and where it happened, which is always
listed as secondary.
d. Yes; Z codes can be sequenced as primary and secondary codes.

19. In which circumstances would an external cause code be reported?

a. Delivery of a newborn.
b. Causes of injury or health condition.
c. Chemotherapy treatment of neoplasms.
d. Only for the cause of motor vehicle accidents.

20. What does the 7th character A indicate in Chapter 19?

a. Initial encounter c. Subsequent encounter

b. Sequela d. Adverse effect

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21. According to the ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 15: Preg- nancy,
Childbirth, and the Puerperium (O00-O9A), codes in this range have sequencing priority over what
codes?

a. Chapter 15 codes do not have sequencing priority over other codes.

b. All codes including Z33.1
c. Codes from all other chapters.
d. Codes from Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99).

22. Which statement is TRUE for reporting burn codes?

a. Burn codes are coded by the anatomical site and sequenced from top to bottom of the
anatomical body.
b. First degree burns involve the epidermis and dermis and should always be sequenced
first for multiple degrees of burns.
c. Sunburns are classified with traumatic burns and is the only burn code reported.
d. The highest degree of burn is reported as the primary code.
23. What would be considered an adverse effect?

a. Wound infection after surgery.

b. Hemorrhaging after a vaginal delivery.
c. Shortness of breath when running.
d. Rash developing when taking penicillin.

24. What is a TRUE statement in reporting pressure ulcers?

a. When documentation does not provide the stage of the pressure ulcer, report the
unstageable pressure ulcer code (L89.95).
b. When a pressure ulcer is at one stage and progresses to the higher stage, report the
lowest stage for that site.
c. Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to
another stage during the admission.
d. The site of the ulcer and the stage of the ulcer are reported with two separate codes.

HCPCS

25. The HCPCS Level II code to report tissue marker supply is:

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 a. J3490 b. E0766 c. A4648 d. A4649

26. Code for the supplies for two way silicone Foley catheter

a. A4311 b.A4312 c.A4314 d.A4316

27. Code for 1mg epoetin beta injection given to a patient on dialysis with ESRD.

a. J0881 b.J0888 c.J0885 d.J0887

Anatomy

28. Haemolysis is

a. The breakdown of blood clots

b. A method of chemotherapy
c. Visualization of blood vessels
d. Visualization of the bile ducts.
29. Renal disease results from damage to all of the following structures except:

a. Tubules b.Adrenal gland c. Glomeruli d. Intrarenal blood vessels

30. What are the two main branches of the nervous system?
a. Central and somatic
b. Central and autonomic
c.Central and spinal
d.Central and peripheral

31. What is the No. 1 medical condition that causes neuropathy?

a. Human immunodeficiency virus b.Diabetes mellitus
c.Kidney disorders d. Trau ma

Medical Terminology

32. What does the root word colp/o stand for?

a. Cervix b. Uterus c. Vagina d.Fallopian Tubes

33. What does the abbreviation CKD stand for?

a. Chronic Kidney Dysfunction c. Chronic Kidney Disease

b. Congenital Kidney Disorder d.Chronic Keratoderma

34. crushing of stone is

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 a. Lithotomy b. Lithotrite c. Lithotripsy d. All the above

35. Which of the following terms is pertaining to heart?

a.coronary b.cardiac c.valvular d.both a and b

20000 Series

36. A 63 year old man undergoes a partial medial meniscectomy of the right knee with synovec tomy
of the medical, lateral, and patellofemoral compartments. Proper coding is ?
a.29881-RT,29875-51 b. 29876-RT, 29881-51-RT
c. 29876-RT, 29882-51-RT d. 29882-RT, 29875-59-RT

37. A 17 year old boy slipped and fell and severely injured his left knee in a high school football game.
He is diagnosed with a left ACL and lateral meniscus tear. He undergoes an arthroscopically – aided
ACL repair, plus a lateral meniscus repair. Proper coding is:

a. 29888-LT, 29881-LT b. 29889-LT, 29881-LT

c. 29888-LT, 29882-LT d. 29889-LT, 29882-LT

38. Mr Smith had an arthroscopic right shoulder rotator cuff repair done by his orthopedic surgeon. This
was done as an outpatient procedure at 10:00 am, and he was discharged home at 1:00 pm. That
afternoon, while using the bathroom, Smith slipped and fell, injuring his left wrist. He is rushed to
the hospital, where X-rays confirm a Colle’s fracture of his left wrist. The same ortho- pedic surgeon
performs a closed reduction on his left wrist at 4:00 pm proper coding is:

a. 25520, 23410 b. 29827, 25605-59

c. 29827, 25600 d. 25600, 29827-59

39. A patient is seen in the same day surgery unit for an arthroscopy to remove some loose bodies in
the shoulder area. What CPT® code is reported?

a. 29805 b. 29807 c. 29806 d. 29819

40. fixation with pins, screws, plates, or wires is placed directly on or in the bone to immobilize a
fractured bone and to maintain alignment while it heals.
a. Reduction b. Manipulation c. Internal d. Casting

41. A patient is given Xylocaine, a local anesthetic, by injection in the thigh above the site to be biopsied.
A small bore needle is then introduced into the muscle, about 3 inches deep, and a muscle biopsy

6
 is taken. What CPT® code is reported for this service?

a. 20205 b. 20225 c. 20206 d. 27324

30000 series

42. A surgical procedure for repair/reconstruction of the nose is called:

a. Palatoplasty b. Rhinoplasty
c. Blephroplasty d. Rhytidectomy

43. Blood must be drawn from a 5 year old patient. A nurse is unavailable to perform the venipunc-
ture; therefore, the physician performs the procedure herself. Which is the correct code?

a.36400 b.36410 c. 36415 d. 36425

44. A physician places a centrally inserted, tunneled central venous access device with a subcutane-
ous pump in a 7 year-old patient.

a. 36561 b. 36560 c. 36563 d. 36558

45. Physician changes the old battery to a new one on a patient’s dual chamber permanent pace-
maker. What CPT® code(s) is/are reported?

a. 33212c. 33213, 33233-51

b. 33229d. 33228

46. Patient undergoes three artery CABG. A surgical assistant procures the artery used for the grafts.
What CPT® code(s) is/are reported for the assistant surgeon.

a. 33535-80 c. 33510-80
b. 33533-80, 35600-80 d. 33517-80, 35600-80

47. A patient is brought to the operating suite when she experiences a large output of blood in her
chest tubes post CABG. The physician performing the original CABG yesterday is concerned about
the postoperative bleeding. He explores the chest and finds a leaking anastomosis site and he
resutured.

a. 35501 b. 35820-78 c. 35654 d.35241

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40000 series

48. The patient has unilateral incomplete cleft lip. Repair was accomplished of the alveolar ridge, which
included a bone graft to the alveolar ridge. Which is the proper CPT code?

a. 42205 b. 42220 c. 42210 d. 42200

49. A patient has a secondary cleft deformity of hard and soft palate repaired by elevating the adjacent
mucosa for coverage and suturing in layers. Which is the proper CPT code?

a. 42235 b. 42215 c. 42225 d. 42227

50. Surgeon repairs bilateral cleft lip via a one stage procedure. Proper coding is:

a. 40700 b. 40701 c. 40702 d. 40761

51. The most common surgical position is:

a. Supine b. Lithotomy c. Reverse Trendelenberg d. Prone

52. hernias are the most common hernia diagnosed in patients.

a. Inguinal b. Ventral c. Umbilical d. Vertebral disc

53. What codes should you report with the add-on code 49623?

a.11004-11006 b.49500-49521 c.49591-49622 d. None of the above

50000 series

54. Mary presents for care in the OB triage for symptoms of mild preeclampsia. The physician docu-
ments a comprehensive exam and history and moderate complexity of medical decision making
observation service. Mary is admitted and discharged on the same date after treatment and an NST,
which does not require a hospital admission. Which of following would represent correct coding in
this situation?

a 99235-25, 59025-26 b. 99235-57, 59025-26 c. 99235-

24, 59025-26 d. 99235-25, 59025

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55. True or False: The patient must have had at least 13 visits to report a global OB care code (e.g.
5940 0 Routine obstetric care including antepartum care, vaginal delivery (with or without epi-
siotomy, and/or forceps) and postpartum care.

a. True b. False

56. Proper coding for SpaceOAR system used to reduce rectal injury in men receiving prostate
cancer radiation therapy is:

a.55874 b.55874, 76942 c. 55880 d. 55700

57. What CPT® code is used to report 50% removal of the vulva and deep subcutaneous tissues?

a. 56630 b.56625 c.56633 d.56620

58. Patient has a LEEP conization for CIN II. What are the CPT® and ICD-10-CM codes reported
for this procedure?

a. 57522, N87.1 c. 57461, N87.1

b. 57460, N87.0 d. 57520, D06.0
59. Patient wishes permanent sterilization and elects laparoscopic tubal ligation with Falope ring. What
is the CPT® code reported for this service?

a. 58671 b. 58615 c. 58600 d. 58670

60000 series

60. Which is the appropriate code to report removal of impacted cerumen by lavage?

a. E/M service code, as supported by documentation

b. 69209 c. 69210 d. 69399
61. What code would you assign to report a left partial thyroid lobectomy, with isthmusectomy?

a. 60210 b. 60212 c. 60220 d. 60225

62. This 66-year-old male has been diagnosed with a senile cataract of the posterior subcapsular and
is scheduled for a cataract extraction by phacoemulsification of the right eye. The physician has
taken the patient to the operating room to perform a posterior subcapsular cataract extrac- tion with
IOL, diffuse of the right eye.

a. 66982-RT c. 66983-RT
b. 66984-RT d. 66830-RT

63. This patient came in with an obstructed ventriculoperitoneal shunt. The procedure performed was
to be

9
 a revision of shunt. After inspecting the shunt system, the entire cerebrospinal fluid shunt system
was removed and a similar replacement shunt system was placed. Patient has normal pressure
hydrocephalus (NPH).

a. 62180, T85.192D b. 62258, T85.09XD

c. 62256, T85.09XA d. 62190, T85.199A

64. This patient is in for a recurrent herniated disc at L5-S1 on the left. The procedure performed is a
repeat laminotomy and foraminotomy at the L5-S1 interspace.

a. 63030-LT, M46.45 b. 63030-LT, M30.3

c. 63042-LT, M51.25 d. 63042-LT, M51.27

65. What CPT and ICD-10-CM codes would you assign to report the removal of 30% of the left thyroid
lobe, with isthmusectomy? The diagnosis was benign growth of the thyroid.

a. 60210, D34 b. 60220, D44.0

c. 60212, D49.7 d. 60225, D44.0, D49.7

66. A 6-month old patient required a bilateral subdural tap through a suture. How would this initial
procedure be reported?
a.61000 b.61001-63
c.61000-50 d.61020
E/M

67. A 35 year old female new patient presents to a family practice physician with no complaints and
requests a preventive medicine visit at 100 percent. Which is the correct code?

a. 99395 b.99499 c.99204 d. 99385

68. When selecting a code for the preventive medicine visit, the provider should:

a. Select the code based on the patient’s age, only

b. Select the code based on the how much time was spent with the patient
c. Select the code based on the patient’s age and status (new or established)
d. Ask the patient what code they would like reported to his or her insurance.

69. You are reporting an outpatient E/M service for an established patient, using time as the control-
ling factor to determine the level of service. The physician documents 12 minutes of counselling,
face to face with the patient. Which is the correct service E/M service level?

a. 99212 b. 99213 c. 99214 d. 99215

70. Which may be separately reported with critical care codes 99291, +99292?

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 a. 31500 b. 43752 c. 43753 d. All of the above

71. All of the above following are true regarding new CPT codes 99446-99449, except:

a. The services are time based

b. The services are face to face
c. The codes describe consultative services
d. The services are typically provided in complex and/or urgent situations

72. What is the minimum number of minutes needed to bill one unit of critical care time with proce-
dure code 99291?

a. 74 minutes b. 60 minutes c. 30 minutes d. 75 minutes

Anesthesia

73. A teaching anesthesiologist has two concurrent cases involving student nurses. Presuming all
medical direction documentation requirements are met, which modifier is reported for anesthesi-
ologist ?

a. QY on both cases b. QK on both cases

c. QZ on both cases d. AA on both cases

74. Which HCPCS modifier indicates an anesthesia service in which the anesthesiologist medically
directs one CRNA?

a. QX b. QY c. QZ d. QK

75. Anesthesia service for a pneumocentesis for lung aspiration.

a. 00522 b. 00500 c. 00520 d. 00524

76. This type of anesthesia is also known as a nerve block.

a. Local b. Epidural c. Regional d. MAC

Compliance and regulatory

77EHR stands for:

a. Extended health record c. Electronic health record

b. Electronic health response d. Established health record
78. What type of insurance is Medicare Part D?

a. A Medicare Advantage program managed by private insurers.

b. Hospital coverage available to all Medicare beneficiaries.

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79. ABN stands for .

a. Advance Beneficiary Notice c. Advisory Beneficial Notice

b. Admitting Beneficiary Notice d. Advanced Benefits Notification

70000 series

80. Which is the appropriate code to report Remote after loading high dose rate radionuclide intersti-
tial or intracavitary brachytherapy, 10 channels?

a.77770 b.77771 c.77772 d. 77789

81. True or False: You should report limited ultrasound assessment for ovarian screening using 76856?.

A. True B.False
c. Prescription drug coverage available to all Medicare beneficiaries.
d. Provider coverage requiring monthly premiums.

82. Proper coding for bilateral rib X-ray, five views, is :

a. 71101 b. 71110 c. 71111 d. 71120

83. AP and Lateral chest X-rays were performed for a cough. What CPT® and ICD-10-CM codes are
reported?

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 a. 71045, R07.2 c. 71046, F45.8
b. 71046, R05 .9 d. 71045, F45.8
84. A non-Medicare patient reports for a bilateral screening mammography with CAD. What CPT®
code(s) is/are reported?

a. 77062 b. 77061 c. 77066 d. 77067

85. A patient on estrogen replacement therapy (ERT) receives a DXA study of the hips. What is the
CPT® code reported for the bone density study?
a. 77077 b. 77080 c. 77078 d. 77081

80000 series

86. Which modifier should you report when the provider orders basic metabolic panel 80047, and one
or more of the labs are not done during the panel service?

a. 52 b. 22 c. 91 d. No modifier

87. If the provider orders an electrolyte panel (80051) and a blood glucose(82947), it’s appropriate
to report :

a. The panel code only

b. 80051-22
c. All of the individual codes included in the panel, plus the blood glucose
d. Both the panel code (80051) and the blood glucose code (82947)

88. The provider orders two panel codes: basic metabolic panel 80047 and comprehensive meta-
bolic panel 80053. Which should you report?

a. 80047 and 80053 b. 80053 and 82330

c. 80047 and 80053-22 d. Only 80047

89. What is/are the code(s) for thawing 4 units of fresh frozen plasma?

a. 86927 c. 86931
b. 86927 x 4 d. 86931 x 4

90. A physician orders a quantitative FDP. What CPT® code is reported?

a. 85362 b. 85379 c. 85366 d. 85378

91. Flow cytometry is performed for DNA analysis. What CPT® code is reported?

a. 88182 c. 88187

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 b. 88184 d. 88189

Case studies

92. Operative Note

History of Present Illness: Ms. Moore is status post lap band placement, the band was placed just
over a year ago and she is here for a lap band adjustment. She has a history of problems
previously with her adjustments. She has been under a lot of stress recently due to a car acci-
dent she was in a couple of weeks ago. Since the accident she has been experiencing problems
of “not feel full”. She states that she is not really hungry but she does not feel full either. She also
states that when she is hungry at night she is having difficulty waiting until the morning to eat. She
also mentioned that she had a candy bar and that seemed to make her feel better. Physical
Examination: On exam, her temperature is 98, pulse 76, weight 197.7 pounds, blood pressure
102/72, BMI is 38.5, and she has lost 3.8 pounds since her last visit. She was alert and oriented
in no apparent distress.
Procedure: I was able to access her port. She does have an AP standard low profile. I aspirated 6
mL, I did add 1 mL, so she has got approximately 7 mL in her restrictive device, she did tolerate
water post procedure.

Assessment: The patient’s status post lap band adjustments; doing well, has a total of 7mL within
her lap band, tolerated water pos procedure. She will come back in two weeks for another
adjustment as needed.

a. 43771 b. 43886 c.43842 d. 43848

93. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Brain tumor versus abscess. PROCEDURE: Craniotomy.

DESCRIPTION OF PROCEDURE: Under general anesthesia, the patient’s head was prepped and
draped in the usual manner. It was placed in Mayfield pins. We then proceeded with a craniotomy.
An inverted U-shaped incision was made over the posterior right occipital area. The flap was turned
down. Three burr holes were made. Having done this, I then localized the tumor through the burr
holes and dura. We then made an incision in the dura in an inverted U-shaped fashion. The cortex
looked a little swollen but normal. We then used the localizer to locate the cavity. I separated the
gyrus and got right into the cavity and saw pus, which was removed. Cultures were taken and sent
for pathology report, which came back later describing the pres- ence of clusters of gram-positive
cocci, confirming that this was an abscess. We cleaned out the abscessed cavity using irrigation
and suction. The bed of the abscessed cavity was cauterized. Then a small piece of Gelfoam was
used for hemostasis. Satisfied that it was dry, I closed the dura. I approximated the scalp. A dressing
was applied. The patient was discharged to the recov- ery room.

a. 61154, G06.0 c. 61320, G06.0

b. 61154, D49.6 d. 61150, D49.6

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94. OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Fever.
PROCEDURE PERFORMED: Lumbar puncture.
DESCRIPTION OF PROCEDURE: The patient was placed in the lateral decubitus position with the
left side up. The legs and hips were flexed into the fetal position The lumbosacral area was sterilely
prepped. It was then numbed with 1% Xylocaine. I then placed a 22-gauge spinal needle on the
first pass into the intrathecal space between the L4 and L5 spinous processes. The fluid was
minimally xanthochromic. I sent the fluid for cell count for differential, protein, glucose, Gram stain,
and culture. The patient tolerated the procedure well without apparent complication.
The needle was removed at the end of the procedure. The area was cleansed, and a Band-Aid was
placed.

a. 62272 c. 62272,62270
b. 62268 d. 62270

95. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Missed abortion with fetal demise, 11 weeks. POSTOPERA- TIVE
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 ante- rior lip
of the cervix was grasped with a single-tooth tenaculum. The uterus was then sounded to a depth
of 8 cm. The cervical os was then serially dilated to allow passage of a size 10 curved suction
curette. 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 re- moved from the
cervix. The 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 appar- ent good condition
having tolerated the procedure well.

a. 59812, O03.9 c. 59820, O02.1

b. 59812, O07.4 d. 59856, O02.1

96. DIAGNOSIS: Atrial flutter.

PROCEDURE PERFORMED: Electrical cardioversion.
DESCRIPTION OF PROCEDURE: The patient was sedated with versed and morphine. She was
cardioverted with 50 joules into sinus tachycardia. The patient was given a 20 mg Cardizem IV
push. Her heart rate went down to the 110s, and she was definitely in sinustachycardia.
CONCLUSION Successful electrical cardioversion of atrial flutter into sinus tachycardia.

a. 92961,I49.1 b. 92960,I48.92
c. 92960,92973,I48.92 d. 92960,I49.8

97. PROCEDURE: Bilateral lumbar medial branch block under fluoroscopy for the L3, L4, L5 medial
branches for the L4, L5, L5-S1 facets for diagnostic and therapeuticpurpose.
PROCEDURE: The patient was placed in the prone position on the fluoroscopy table and auto-
mated blood pressure cuff and pulse oxymeter applied. The skin entry points for approaching the
anatomic target points of the bilateral segmental medial branches or dorsal ramus of L3, L4, and
L5

15
 were identified with a 22.5 degree from perpendicular lateral oblique fluoroscopy view and marked.
Following through Chloraprep preparation of the skin a and draping and 1% lidocaine infiltration of
the skin entry points and subcutaneous tissue, a 22 gauge 6 inch spinal needle was placed under
fluoroscopic guidance down on the target point for each respective segment me- dial branch or
dorsal ramus. At each point 1ml consisting of 0.5% bupivacaine and Depo- Medrol was injected. A
total of 80 mg of Depo- Medrol was divided between all six spots. Code theprocedure(s)

a.64483,64484,77003-26 b. 64493-50, 64494-50,64494-50

c. 64493,64494,77003-26 d.64493-50,64494×2, 64495×2

98. 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 forminotomies 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 thisprocedure?

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

c.63015-50 d.63045, 63048 x3

99. OPERATIVE REPORT

Preoperative Diagnosis: Basal Cell Carcinoma
Postoperative Diagnosis: Basal Cell
Carcinoma Location: Mid Parietal
Scalp Procedure: Prior to each surgical stage, the surgical site was tested for anesthesia and re-
anesthetized as needed, after which it was prepped and draped in a sterile fashion. The clini- cally-
apparent tumor was carefully defined and de-bulked prior to the first stage, determining the extent
of the surgical excision. With each stage, a thin layer of tumor-laden tissue was excised with a
narrow margin of normal appearing skin, using the Moh’s fresh tissue technique. A map was
prepared to correspond to the area of skin from which it was excised. The tissue was prepared for
the cryostat and sectioned. Each section was coded, cut and stained for micro- scopic examination.

The entire base and margins of the excised piece of tissue were examined by the surgeon. Areas
noted to be positive on the previous stage (if applicable) were removed with the Moh’s technique
and processed for analysis. No tumor was identified after the final stage of micro- scopically
controlled surgery. The patient tolerated the procedure well without any complication. After
discussion with the patient regarding the various options, the best closure option for each defect
was selected for optimal functional and cosmetic results. Preoperative

Size: 1.5 x 2.9 cm

Postoperative Size: 2.7 x 2.9 cm
Closure: Simple Linear Closure, 3.5cm, scalp
Total # of Moh’s Stages: 2 Stage Sections Positive I-6 blocks II-2 blocks

a.17311, 17315, 17312, 12002

b.17311, 17312, 12002

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 c.17311, 17315, 17312
d.17311, 17312

100. PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduc- tion
and internal fixation of right scaphoid fracture DESCRIPTION OF PROCEDURE: The pa- tient was
brought to the operating room, anesthesia have been administrated. 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 ten- dons 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
Kirchner wire was then used as a guidewire, ex- tending from the proximal pole of the scaphoid
distalward. The guidewire was positioned appro- priately and then measured. A 25mm Acuttrak 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

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