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質問 # 27
A couple presents to the freestanding fertility clinic to start in vitro fertilization. Under radiologic guidance, an aspiration needle is inserted (by aid of a superimposed guiding-line) puncturing the ovary and preovulatory follicle and withdrawing fluid from the follicle containing the egg.
What is the correct CPT code for this procedure?
- A. 0
- B. 1
- C. 2
- D. 3
正解：A
質問 # 28
A patient is diagnosed with sepsis and associated acute respiratory failure.
What ICD-10-CM code selection is reported?
- A. A41.9, R65.20, J96.00
- B. A41.9
- C. A41.9, J96.00
- D. A41.9, R65.21, J96.00
正解：C
質問 # 29
A 67-year-old male presents with DJD and spondylolisthesis at L4-L5 The patient is placed prone on the operating table and, after induction of general anesthesia, the lower back is sterilely prepped and draped. One incision was made over L1-L5. This was confirmed with a probe under fluoroscopy. Laminectomies are done at vertebral segments L4 and L5 with facetectomies to relieve pressure to the nerve roots. Allograft was packed in the gutters from L1-L5 for a posterior arthrodesis. Pedicle screws were placed at L2, L3, and L4. The construct was copiously irrigated and muscle; fascia and skin were closed in layers.
Select the procedure codes for this scenario.
- A. 63017, 63048, 22612, 22808, 22842 x 3
- B. 63047, 63048, 22612, 22614 x 3, 22842
- C. 63005 x 2, 22612, 22614 x 3, 22842
- D. 63042, 63043, 22808, 22841 x 3
正解：B
質問 # 30
Which one of the following is a commercial or private payer?
- A. Medicare
- B. Blue Cross Blue Shield
- C. Veterans Health Administration (VHA)
- D. Medicaid
正解：B
質問 # 31
A patient with empyema requires a Schede thoracoplasty.
What CPT code is reported for this procedure?
- A. 0
- B. 1
- C. 2
- D. 3
正解：D
質問 # 32
A patient complains of tarry, black stool, and epigastric tightness. An esophagogastroduodenoscopy is recommended to evaluate the source of the bleeding. The endoscope is inserted orally. The esophagus appears normal on scope insertion. No evidence of bleeding in the stomach. The scope is then passed into the duodenum, where a polyp is found and removed with hot biopsy forceps. No evidence of bleeding post procedure.
What CPT code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
質問 # 33
Which statement regarding lesion excision is TRUE?
- A. Lesion excision codes include removal of a lesion, with margins, and intermediate closure when performed
- B. Lesion excision codes are selected by measuring the greatest clinical diameter of a lesion excluding the margins required to complete the excision
- C. Lesion excision codes include removal of a lesion, with margins, and simple (nonlayered) closure when performed
- D. Lesion excision codes include removal of a lesion with margins, and complex closure when performed
正解：C
質問 # 34
View MR 099405
MR 099405
CC: Shortness of breath
HPI: 16-year-old female comes into the ED for shortness of breath for the last two days. She is an asthmatic.
Current medications being used to treat symptoms is Advair, which is not working and breathing is getting worse. Does not feel that Advair has been helping. Patient tried Albuterol for persistent coughing, is not helping. Coughing 10-15 minutes at a time. Patient has used the Albuterol 3x in the last 16 hrs. ED physician admits her to observation status.
ROS: No fever, no headache. No purulent discharge from the eyes. No earache. No nasal discharge or sore throat. No swollen glands in the neck. No palpitations. Dyspnea and cough. Some chest pain. No nausea or vomiting. No abdominal pain, diarrhea, or constipation.
PMH: Asthma
SH: Lives with both parents.
FH: Family hx of asthma, paternal side
ALLERGIES: PCN-200 CAPS. Allergies have been reviewed with child's family and no changes reported.
PE: General appearance: normal, alert. Talks in sentences. Pink lips and cheeks. Oriented. Well developed. Well nourished. Well hydrated.
Eyes: normal. External eye: no hyperemia of the conjunctiva. No discharge from the conjunctiva Ears: general/bilateral. TM: normal. Nose: rhinorrhea. Pharynx/Oropharynx: normal. Neck: normal.
Lymph nodes: normal.
Lungs: before Albuterol neb, mode air entry b/l. No rales, rhonchi or wheezes. After Albuterol neb. improvement of air entry b/l. Respiratory movements were normal. No intercostals inspiratory retraction was observed.
Cardiovascular system: normal. Heart rate and rhythm normal. Heart sounds normal. No murmurs were heard.
GI: abdomen normal with no tenderness or masses. Normal bowel sounds. No hepatosplenomegaly Skin: normal warm and dry. Pink well perfused Musculoskeletal system patient indicates lower to mid back pain when she lies down on her back and when she rolls over. No CVA tenderness.
Assessment: Asthma, acute exacerbation
Plan: Will keep her in observation overnight. Will administer oral steroids and breathing treatment. CXR ordered and to be taken in the morning.
What E/M code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：A
質問 # 35
A 60-year-old male has three-vessel disease and supraventricular tachycardia which has been refractory to other management. He previously had pacemaker placement and stenting of LAD coronary artery stenosis, which has failed to solve the problem. He will undergo CABG with autologous saphenous vein and an extensive modified MAZE procedure to treat the tachycardia.
He is brought to the cardiac OR and placed in the supine position on the OR table. He is prepped and draped, and adequate endotracheal anesthesia is assured. A median sternotomy incision is made and cardiopulmonary bypass is initiated. The endoscope is used to harvest an adequate length of saphenous vein from his left leg. This is uneventful and bleeding is easily controlled. The vein graft is prepared and cut to the appropriate lengths for anastomosis. Two bypasses are performed: one to the circumflex and another to the obtuse marginal. The left internal mammary is then freed up and it is anastomosed to the ramus, the first diagonal, and the LAD. An extensive maze procedure is then performed and the patient is weaned from bypass. At this point, the sternum is closed with wires and the skin is reapproximated with staples. The patient tolerated the procedure without difficulty and was taken to the PACU.
Choose the procedure codes for this surgery.
- A. 33533, 33257-51, 33519-51, 33508-51
- B. 33535, 33259 51, 33519-51, 33508-51
- C. 33533, 33257, 33519, 33508
- D. 33535, 33259, 33519, 33508
正解：C
質問 # 36
View MR 003396
MR 003396
Operative Report
Preoperative Diagnosis: Acute MI, severe left main arteriosclerotic coronary artery disease Postoperative Diagnosis: Acute MI, severe left main arteriosclerotic coronary artery disease Procedure Performed: Placement of an intra-aortic balloon pump (IABP) right common femoral artery Description of Procedure: Patient's right groin was prepped and draped in the usual sterile fashion. Right common femoral artery is found, and an incision is made over the artery exposing it. The artery is opened transversely, and the tip of the balloon catheter was placed in the right common femoral artery. The balloon pump had good waveform. The balloon pump catheter is secured to his skin after local anesthesia of 2 cc of 1% Xylocaine is used to numb the area. The balloon pump is secured with a 0-silk suture. The patient has sterile dressing placed. The patient tolerated the procedure. There were no complications.
What CPT coding is reported for this case?
- A. 0
- B. 1
- C. 2
- D. 3
正解：D
質問 # 37
View MR 099407
MR 099407
Emergency Department Visit
Chief Complaint: VOMITING.
This started just prior to arrival and is still present. He has had nausea and vomiting. No diarrhea, black stools, bloody stools or abdominal pain. Pt is diabetic and has been having elevated blood sugars (320 mg/dL).
REVIEW OF SYSTEMS: Unobtainable due to patient's altered mental status.
PAST HISTORY: Poorly controlled diabetes mellitus, with history of poor compliance.
Medications: See Nurses Notes.
Allergies: PCN.
SOCIAL HISTORY: Nonsmoker. No alcohol use or drug use.
ADDITIONAL NOTES: The nursing notes have been reviewed.
PHYSICAL EXAM
Appearance: Lethargic. Patient in mild distress.
Vital Signs: Have been reviewed-tachycardic.
Eyes: Pupils equal, round and reactive to light.
ENT: Dry mucous membranes present.
Neck: Normal inspection. Neck supple.
CVS: Tachycardia. Heart sounds normal. Pulses normal.
E D. Course: Insulin IV drip per protocol, at 10 units/hr.
Zofran 8 mg 01:33 Jul 13 2008 IVP.
Phenergan 25 mg IVP. 07:52. Discussed case with physician. Dr. X. Reviewed test results. Agreed upon treatment plan. Physician will see patient in hospital.
Total critical care time: 45 min.
Disposition: Admitted to Intensive Care Unit. Condition: stable.
Admit decision based on need for monitoring and IV hydration and medications.
CLINICAL IMPRESSION: Vomiting, diabetic ketoacidosis, probable diabetes insipidus.
What E/M code is reported for this encounter?
- A. 0
- B. 1
- C. 99291, 99292
- D. 2
正解：D
質問 # 38
According to the Repair (Closure) CPT guidelines, what type of repair is reported when a single layer closure includes copious irrigation and extensive cleaning to remove particulate matter?
- A. Simple repair
- B. Complex repair
- C. Simple repair plus a code for irrigation
- D. Intermediate repair
正解：D
質問 # 39
An established patient suffering from migraines without aura, no mention of intractable migraine, and no mention of status migrainosus, is seen by his ophthalmologist who conducts a visual field examination of both eyes. The examination was accomplished plotting four isopters utilizing the Goldmann perimeter testing method. The patient and requesting physician receive the interpretation and report on the same date of service.
What procedure and diagnosis codes are reported for this encounter?
- A. 92082, G43.009
- B. 92082, G43.019
- C. 92081, G43.009
- D. 92083, G43.019
正解：A
質問 # 40
According to the Application of Cast and Strapping CPT guidelines, what is reported when an orthopedic provider performs initial fracture care treatment for a closed scaphoid fracture of the wrist, applies a short arm cast, and the patient will be returning for subsequent fracture care?
- A. 0
- B. 25622, 29075
- C. 29075-22
- D. 1
正解：A
質問 # 41
A patient had surgery a year ago to repair two flexor tendons in his forearm. He is in surgery for a secondary repair for the same two tendons.
Which CPT coding is reported?
- A. 25272 x 2
- B. 0
- C. 25263 x 2
- D. 1
正解：C
質問 # 42
View MR 007400
MR 007400
Radiology Report
Patient: J. Lowe Date of Service: 06/10/XX
Age: 45
MR#: 4589799
Account #: 3216770
Location: ABC Imaging Center
Study: Mammogram bilateral screening, all views, producing direct digital image Reason: Screen Bilateral digital mammography with computer-aided detection (CAD) No previous mammograms are available for comparison.
Clinical history: The patient has a positive family history (mother and sister) of breast cancer.
Mammogram was read with the assistance of GE iCAD (computerized diagnostic) system.
Findings: No dominant speculated mass or suspicious area of clustered pleomorphic microcalcifications is apparent Skin and nipples are seen to be normal. The axilla are unremarkable.
What CPT coding is reported for this case?
- A. 77066-50, Z12.31, Z80.3
- B. 77067, Z12.31, Z80.3
- C. 77067-50, Z80.3, Z12.31
- D. 77066, Z80.3, Z12.31
正解：B
質問 # 43
A physician prescribes carbamazepine to treat a patient with epileptic seizures. After six months, the physician performs a therapeutic drug test to monitor the total level of the drug in the patient.
What CPT and ICD-10-CM coding is used for the six month-evaluation?
- A. 80156, G40.909
- B. 80156, R56.9
- C. 80157, R56.9
- D. 80157, G40.909
正解：A
質問 # 44
A 45-year-old has a dislocated patella in the left knee after a car accident. She taken to the hospital by EMS for surgical treatment. In the surgery suite, the patient is placed under general anesthesia. After being prepped and draped, the surgeon makes an incision above the knee joint in front of the patella. Dissection is carried through soft tissue and reaching the patella in attempt to reduce the dislocation. When the patella is exposed, it is severely damaged due to cartilage breakdown. The tendon is dissected and using a saw the entire patella is freed and removed. The tendon sheath is closed with sutures.
What procedure code is reported for this surgery?
- A. 27566-LT
- B. 27562-LT
- C. 27552-LT
- D. 27556-LT
正解：A
質問 # 45
Patient had polyps removed on a previous colonoscopy. The patient returns three months later for a follow-up examination for another colonoscopy. No new polyps are seen.
What diagnosis coding is reported for the second colonoscopy?
- A. Z09, K63.5
- B. Z86.010, K63.5
- C. K63.5
- D. Z09, Z86.010
正解：A
質問 # 46
A 45-year-old female presents to the ED with chest pain. The provider has an Albumin Cobalt Binding Test to determine if the chest pain is ischemic in nature.
That lab test is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
質問 # 47
Which place of service code is submitted on the claim for a service that is performed in an outpatient surgical floor?
- A. 0
- B. 1
- C. 2
- D. 3
正解：D
質問 # 48
This 27-year-old male has morbid obesity with a BMI of 45 due to a high calorie diet. He has decided to have an open Roux-en-Y gastric bypass. The patient is brought to the operating room and placed in supine position. A midline abdominal incision is made. The stomach is mobilized, and the proximal stomach is divided and stapled creating a small proximal pouch in continuity with the esophagus. A short limb of the proximal bowel of 155 cm is divided. It is brought up and anastomosed to the gastric pouch. The other end of the divided bowel is connected back into the distal small bowel to the short limb's gastric anastomosis to restore intestinal continuity. The abdominal incision is closed.
What are the procedure and diagnosis codes for this encounter?
- A. 43645, E66.8, Z68.42
- B. 43847, E66.9, Z68.42
- C. 43644, E66.01, Z68.43
- D. 43847, E66.01, Z68.42
正解：D
質問 # 49
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