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Minnesota West Community and Technical College *
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1290
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Medicine
Date
Jan 9, 2024
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1. A sinus endoscopy with tissue removal from the sphenoid sinus was performed. 31288
2. OB ultrasound, sizes and dates. Single intrauterine pregnancy with fetus in cephalic position. Fetal cardiac motion observed, estimated ultrasound due date is 4/15/xx. 76815
3. OPERATIVE REPORT. Preoperative Diagnosis: Severe bradycardia. Postoperative Diagnosis: Severe bradycardia. Procedure(s) Performed: Dual-chamber pacemaker placement in left subclavian. Guide wire was positioned to the level of the right atrium. Cut down made and tear-away sheath passed over the wire. The ventricular lead was manipulated into the right ventricular apex. The atrial lead was then manipulated into place in the same fashion. The leads and the pacemaker were placed into the newly created pocket and connected and tested. The pocket was closed and patient was stable. Signed. Surgeon Signature. 33208, R00.1
4. A 35-year-old female returns to her PCP to discuss results of an abnormal pap smear. The physician spends a total of 45 minutes discussing with the patient an abnormal pap smear and what options are available. 99215
5. Upper respiratory infection with acute bronchitis. J20.9, J06.9
6. The pleura refers to the: layer of tissue lining the pleural cavity
7. Subcutaneous anal fistulotomy. Metal probe was used to retract the course of the fistula, and a curette was used to remove granulation tissue at the base. 46270
8. Upper GI with barium contrast for abdominal pain, nausea. There is mild esophageal dysmotility, followed by multiple contractions in the distal esophagus. Esophageal mucosa appears normal. No evidence of esophagitis, stomach is negative. No ulcer seen. 74240
9. A patient with uncontrolled low back pain presents and has implantation of a nonprogrammable intrathecal morphine pump. 62361
10. Procedure performed: Direct Laryngoscopy with excision of laryngeal lesion. Laryngoscope was advanced into the larynx. There was a yellow cystic lesion along the left false vocal cord. The scope was advanced just superior to the lesion. Lesion was grasped, and by using straight and upbiting scissors, the entire capsule was excised. 31540
11. A 27-year-old female has menorrhagia and wants permanent sterilization. The patient was placed in Allen stirrups in the operating room. Under anesthesia the cervix was dilated and the hysteroscope was advanced to the endometrium into the uterine cavity. No polyps or fibroids were seen. The NovaSure was used for endometrial ablation. A knife was then used to make an incision in the right lower quadrant
and left lower quadrant with 5 mm trocars inserted under direct visualization with no injury to any abdominal contents. Laparoscopic findings revealed the uterus, ovaries, and fallopian tubes to be normal. The appendix was normal as were the upper quadrants. Because of the patient's history of breast cancer and desire for no further children, it was decided to take out both the tubes and ovaries. 58661, 58563-51
12. The patient is a 42-year-old female who was discovered to have breast cancer on the right side. She was treated with mastectomy followed by chemotherapy and radiation therapy. She now elects to
proceed with reconstruction by single pediculate myocutaneous TRAM flap, which is performed uneventfully. 19367-RT
13. Laceration repair, floor of the mouth. 41250
14. Stones or calculi formations in the gallbladder are termed as. Cholelithiasis
15. A superficial burn, characterized by pain, redness, and swelling is classified as a. first-degree burn
16. Replacement batteries (except J cell) for medically necessary alkaline blood glucose machine owned by patient. A4233
17. OPERATIVE REPORT: Preoperative Diagnosis: Patellar entrapment, right. Postoperative Diagnosis: Patellar entrapment, right. Procedure(s) Performed: Lateral release, right knee. Arthroscope cannula was
introduced, and the anatomy was examined and appears normal. There was a tight lateral retinaculum noted through range of motion of the knee. A longitudinal skin incision was made, incision carried down to the subcutaneous tissue. Nick was made in the lateral patellar retinaculum and lateral patellar release was accomplished. Arthroscopic portal as well as the lateral release incision was closed. Signed. Surgeon Signature. 27425-LT
18. Treatment of molluscum contagiosum by cryotherapy. Patient was given light sedation and the two lesions were exposed. Curettage was attempted, but the lesions were not easily removed; therefore, cryotherapy was used to treat each of the lesions through two freeze/thaw cycles. 17110
19. A 17-year-old presents for his initial visit with complaints of left knee pain after playing football. An expanded problem-focused history and exam were performed with straightforward MDM. 99202
20. What modifier would be appropriate when anesthesia services are performed by the anesthesiologist? AA
21.
What is the CPT code for the decompression of the median nerve found in the space in the wrist on the palmar side? 64721
22. Liver biopsy due to elevated liver enzymes. The area of biopsy site was chosen and a small nick was made on the skin and advanced to the liver capsule. Patient was told to hold her breath, biopsy gun was inserted into the liver, and the obtained biopsy was sent to pathology. 47399
23. Surgical pathology, lymph node biopsy: 88305
24. Anesthesia services for gastric stapling for morbid obesity, 38-year-old normally healthy patient: 00797-P1
25. Circumcision of 1-day-old infant. Base of the penis was cleansed. Incision was made down to the apex. The foreskin was then retracted and the foreskin attachment was cross-clamped and excised with scissors. 54160
26. CAD would be coded as: I25.10
27. Pressurized nebulizer treatment 94640
28. When multiple surgical procedures are performed during the same surgical session, what determines
the appropriate order for reporting those services? Most significant procedure is listed first.
29. OPERATIVE REPORT: Preoperative Diagnosis: End-stage renal disease; infected Ash catheter, dialysis status. Postoperative Diagnosis: End-stage renal disease; infected Ash catheter: Procedure(s) Performed: Left femoral Quinton catheter placement: The patient was brought to Ambulatory Care, placed in the supine position; right groin was prepped and draped in sterile fashion. We attempted to gain access to right femoral vein, but instead placed the needle into the femoral artery. We were using ultrasound, but the artery and vein were very close together. Patient had some edema from the prior catheter. We held pressure and aborted the procedure after one arterial stick. We then shaved and prepped the left groin and attempted to place the catheter in the left groin. Again, we incurred an arterial puncture. Patient developed a small hematoma. We aborted the left femoral approach. We then attempted the right IJ vein. We were able to gain access but could not thread the guidewire due to a thrombus in the vein. We aborted this procedure, then re-evaluated. The swelling in the left groin had diminished. We again did the ultrasound of the groin and we were able to see the vein with the ultrasound. We prepped and draped and were able to percutaneously enter the left femoral vein without puncturing the artery. We placed the guidewire dilator over the guidewire and then placed the catheter over the guidewire. We sutured it in place and flushed it. It flushed easily. Signed. Surgeon Signature. 36556
30. Laminectomy with exploration performed at C1–C2. 63001
31. Repair prosthetic device: L7510
32. Modifier -TA denotes: great toe, Left foot.
33. Anesthesia services for phacoemulsification of cataract, on a normally healthy 72-year-old. 00142-P1,
99100
34. A patient with new onset vertigo presents for vestibular function testing. Recording equipment was placed and patient was placed in a total of four positions. Warm water was introduced into the ear canal on the left side, and nystagmus was observed and recorded. The same procedure was performed on the right ear with same results. 92542
35. A dysrhythmia refers to: abnormal variation in the heart rhythm.
36. A child with chronic otitis media and fluid buildup in both ears was admitted by her otolaryngologist for a bilateral tympanostomy. The procedure was performed with placement of ventilating tubes. The procedure required general anesthetic due to the patient's age. 69436-50
37. Ballooning of a weakened portion of an arterial wall refers to a(n): aneurysm
38. Who codes for an intraoperative cholangiogram? The performing physician
39. Endoscopic transbronchial biopsies six times, RUL: 31628
40. The long bone of the upper leg is called the: femur.
41. The larynx, trachea, bronchial tree, and lungs comprise the: lower respiratory tract
42. Hammertoe repair, right foot, second toe: 28285-T6
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43. Thoracentesis. A Pharmaseal thoracentesis kit was used with aspirating catheter. Patient was prepped in the posterior position and catheter advanced into the intercostal space, two interspaces below the scapula. About 1 liter of cloudy amber fluid was removed. 32554
44. OPERATIVE REPORT Preoperative Diagnosis: Wound, tip of nose. Postoperative Diagnosis: Wound,
tip of nose. Procedure(s) Performed: STSG tip of nose. Nonhealing wound on the tip of the nose. Documented an autologous split-thickness skin graft (STSG) to the tip of nose. A simple debridement of granulated tissues is completed prior to the placement. Using a dermatome, an STSG was harvested from the left thigh. The graft is placed onto the nose defect and secured with sutures. The donor site is examined, which confirms good hemostasis. Signed. Surgeon Signature: 15120
45. Abnormal pap smear: R87.619
46. Benign hypertrophy of prostate: N40.0
47. The right posterior chest was prepped with Betadine and Pharmaseal catheter instilled in the right posterior clavicular line. About 1.2 liters of serosanguineous fluid was removed without difficulty. Once thoracentesis was completed, the patient reported no shortness of breath. 32554-RT 48. A 25-year-old male 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. 11044
49. When a radiology service is performed utilizing IV contrast only, how should it be coded? With contrast
50. Administration of IM Toradol at 8:00 a.m., IM Versed at 8:30 a.m., and IV Levaquin from 9:00 a.m. to 9:45 a.m. 96365, 96372 × 2
51. What is one of the primary advantages of implementing a compliance program? dentification of potential problems before identified by third-party carriers
52. Syndesmotic screw status post pons fracture with left proximal fibular fracture with removal of hardware. 20680
53. A partial medial meniscectomy is performed as well as a lateral meniscectomy. 29880
54. Carbon dioxide, chloride, potassium, sodium. 82374, 82435, 84132, 84295
55. Antibody, candida. 86628
56. Flexible cystourethroscopy with percutaneous cystostomy insertion. A small stab incision was made in the lower midline abdomen for the cystostomy catheter insertion. Flexible cystourethroscopy was performed. Cystostomy trocar was then advanced through the stab incision just above the symphysis pubis and passed all the way through the anterior bladder and into the lumen of the bladder. 12 French cystostomy catheter was advanced through the sheath after removing the trocar, leaving the catheter in place. 51040
57. This Physician Self-Referral Law prohibits a physician from making referrals for certain designated health services payable by Medicare to an entity with which he or she (or an immediate family member) has a financial ownership interest or compensation arrangement, unless an exception applies: Stark Law
58. Laparoscopic radical nephrectomy, right. 50545-RT
59. Anesthesia services for bronchoscopy, diagnostic, on a healthy 35-year-old male. 00520-P1
60. During the global postoperative period, which modifier is reported when the same physician provides a replacement cast application for a distal radial fracture already surgically repaired by the same physician? 58
61. OPERATIVE REPORT. Preoperative Diagnosis: Chronic ethmoid sinusitis, Maxillary sinusitis. Postoperative Diagnosis: Same. Procedure(s) Performed: Endoscopic right anterior ethmoidectomy, bilateral maxillary antrostomy, bilateral frontal sinus exploration. Signed. Surgeon Signature. 31276-50, 31256-50-51, 31254-51-RT, J32.2, J32.0
62. How are repairs to multiple lacerations within the same anatomical group and complexity reported? The sizes are summed together.
63. ERCP. 43260
64. OPERATIVE REPORT. Preoperative Diagnosis: Anemia. Postoperative Diagnosis: Anemia. Procedure(s) Performed: EGD, Colonoscopy. EGD and attempted dx colonoscopy. A gastroscope was inserted and passed into the second portion of the duodenum. Colonoscope was inserted into the rectum, and the scope could not be advanced to the splenic flexure. Therefore, the procedure was terminated. 45330, 43235
65. Anesthesia services for cataract extraction on a 55-year-old male with hypertension. 00142-P2
66. What are the correct codes for diagnostic EGD and percutaneous endoscopic gastrostomy (PEG) tube
placement when two physicians perform the procedure (GI and general surgeon)? 43246-62 GI, 43246-
62 General Surgeon
67. Removal and replacement of new tubes, bilaterally via tympanostomy under general anesthesia. A 3.8 mm speculum was inserted into the left ear, wax removed, and speculum removed. The impacted tube was then removed. A new site was achieved within the same tympanosclerotic plaque, new incision
made and a new tube was placed. The same procedure was repeated to the right ear. 69436-50
68. Left mastectomy for left gynecomastia, skin tag removal. Areola was elevated off the breast and breast tissue was excised. Following completion of the breast procedure, right groin was exposed and draped, and skin tag was excised by shave excision. 19300-LT, 11200-59
69. ER visit, detailed history, detailed exam, low MDM. 99283
70. Repair, 6.0 cm leg, intermediate: 12032
71. If a procedure is performed via synchronous telemedicine, it is designated in CPT with what symbol? *
72. OPERATIVE REPORT. Preoperative Diagnosis: Umbilical hernia. Post operative Diagnosis: Umbilical hernia. Procedure(s) Performed: Repair of Initial umbilical hernia, 12-year-old. An elliptical incision was made around the umbilicus. The incision was carried through subcutaneous tissue, all the way to the fascial layer. The hernia sac was opened and excised along the umbilicus. Limited exploration was done. The peritoneum was closed with #0 Vicryl sutures. The fascia was dissected above and below and closed
in imbricating fashion, pushing the lower edge under the upper edge of the fascia. Mattress sutures were taken from above, a distance from the edge, and the edge was incorporated. INDICATIONS AND/OR FINDINGS: The patient had a large umbilical hernia, measuring 3 cm. Signed. Surgeon Signature.
49593
73. Prostate specimen for radical resection of prostate carcinoma. 88309
74. Left and right mammogram for benign fibrocystic breast disease. 77066
75. IM injection of MMR immunizations including vaccine for a 5-year-old, including appropriate anticipatory counseling provided by the physician to the family. 90460, 90461 X 2, 90707
76. Excision of benign lesion trunk, 2.7 cm with simple closure. none of these codes
77. OFFICE NOTE. Chief Complaint: Epistaxis. History: S: This is a 45-year-old female complaining of epistaxis. She has had it intermittently for a week and a half. It is on the right side today. Diabetes, hypertension, atrial fibrillation, mitral regurgitation, cirrhosis related to alcoholism, coronary artery disease with previous MI, previous CVA, congestive heart failure, and renal insufficiency. Isn't on any blood thinners other than aspirin. On numerous medications that are listed. Exam: O: On exam blood pressure is not bad. Has a little dried scab of blood in the left nostril so I didn't touch that. On the right side had just some oozing from the septum that looked raw. I did put a little epinephrine on a cotton swab in there, left it on for awhile, and removed it, and I used a little silver nitrate to cauterize that side of the septum. Diagnosis/Assessment: Anterior epistaxis. Signed. Surgeon Signature. 30901-RT, Office Visit-25
78. MRI angiography, chest with contrast. 71555
79. When multiple lesions are excised during the same surgical session they are coded as: All lesions are assigned a separate CPT code, and, any with more than a simple closure are assigned additional code(s
80. Chest pain appears to be worsening and is diagnosed as unstable angina. I20.0
81. Limited retroperitoneal ultrasound. 76775
82. A new patient presents for evaluation of coronary artery disease and asthma. Hx extended into the affected systems and other related systems. Past medical, family, and social history are taken. Exam is detailed. MDM is considered high. What E/M level would be assigned in this instance? 99205
83. The practice performs both laparoscopic and open cholecystectomies. An internal review of these procedures coded/billed by the practice indicated that some of the codes were assigned as open procedures, not laparoscopic as performed. In an effort to train staff on the specifics of a laparoscopic cholecystectomy, the practice management team decided to provide additional training. The following documentation was provided: Procedure: Cholecystectomy. A supraumbilical incision was made, a trocar was placed, and a pneumoperitoneum was insufflated. Ports were placed, and the gallbladder was
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identified and dissected free from the attachments with cautery. The gallbladder was brought out through the endobag. What words or phrases in this example are most beneficial for training staff to recognize a laparoscopic cholecystectomy? Supraumbilical incision, trocar(s), pneumoperitoneum, endobag
84. Office visit, established patient, problem-focused history, problem-focused exam, moderate MDM. 99214
85. Patient had a Harrington rod placed posteriorly over L2-L3 at the end of the arthrodesis procedure. What code(s) and modifier(s) would be used to report the spinal instrumentation? 22840
86. Right knee manipulation and injection. After suitable general anesthesia, the patient's knee was gently manipulated. Knee easily flexed to about 85 degrees. It was gentle manipulated further so it flexed to 130 degrees. Full extension was achieved with manipulation. Knee was injected with 80 mg of Kenalog following completion of the manipulation. 27570-RT
87. Tissue destruction or removal by means of high-frequency electrical current is called. ablation.
88. When multiple polypectomies by snare are performed at two different sites during the course of a colonoscopy, what code(s) should be reported? 45385 only
89. Physician performs sling repair for urinary stress incontinency along with A & P repair. Synthetic mesh
was used for both. 57288, 57260-51, 57267-59
90. MRI, elbow joint, right, with and without contrast. 73223
91. A physician performs abdominal hysterectomy for uterine cancer. During the same surgical session, an incidental appendectomy is also performed. 58150
92. Lorazepam, 2 mg. J2060
93. Patient returns to clinic today. She has been doing ice treatments for her knee injury and taking ibuprofen as needed. Knee has improved significantly. No swelling, no tenderness. Will continue conservative measures as needed. MDM was documented as straightforward. 99212
94. Topical tetracaine was applied along with YAG capsulotomy lens for left cataract extraction. Good visualization of posterior capsular opacification was obtained and a total of 41 shots at 2 millijoules were
utilized to open the posterior capsule. 66821-LT
95. A patient is brought from an MVA to the ER with multiple fractured ribs, labored breathing, and complaints of chest pain and palpitations. In the ER, the thoracic surgeon performs a tube thoracostomy with water seal with some relief of the patient's most severe symptoms. 32551
96. Auditory evoked potentials for evoked response testing of central nervous system, for threshold estimation at multiple frequencies. 92652
97. Antinuclear antibody titer. 86039
98. Triglycerides. 84478
99. When colonoscopy with biopsy (CPT code 45380) is performed as well as colonoscopy with polypectomy removed by snare to a different site/polyp (CPT code 45385) during the same surgical session at another site, what code(s) are reported? 45385, 45380-59
100. Services for patient-initiated 30-day spirometry for physician review and interpretation only. 94016