Deck 8: Surgery Section: Integumentary System

Question 1

The provider's documentation states the following diagnostic statement: "Patient has a pressure ulcer on the left, upper back that is healing well." The coder would select the following to appropriately code this statement:

A) L89.140, pressure ulcer, left lower back, unstageable
B) L89.121, pressure ulcer, left upper back, stage 1
C) L89.120, pressure ulcer, left upper back, unstageable
D) L89.141, pressure ulcer, left lower back, stage 1

Answer 1

L89.121, pressure ulcer, left upper back, stage 1

Question 2

A patient's pressure ulcer of the right hip is covered by eschar (scar tissue) and the ulcer stage cannot be clinically determined: The coder should assign:

A) L89.200, pressure ulcer of unspecified hip, unstageable
B) L89.211, pressure ulcer of right hip, stage 1 (healing pressure ulcer)
C) L89.219, pressure ulcer of right hip, unspecified stage
D) L89.210, pressure ulcer of right hip, unstageable

Answer 2

L89.210, pressure ulcer of right hip, unstageable

Question 3

How are burns classified in the 16000 to 16036 range in the CPT manual?

A) By percentage of body surface involved and depth of burn
B) By depth
C) By size
D) By category

Answer 3

By percentage of body surface involved and depth of burn

Question 4

The patient returns to the inpatient hospital for a staged treatment of several third-degree burns. Scar tissue has developed over several of the burn sites and is beginning to become painfully contracted. The procedure to release this scar tissue is called:

A) meatotomy
B) escharotomy
C) keratotomy
D) cordotomy

Question 5

The removal of damaged tissue, either by excision or non-excision, is known as:

A) shaving
B) excision
C) grafting
D) debridement

Question 6

In the CPT manual, the Integumentary System subsection is contained in the code range:

A) 11719-12001
B) 11200-19499
C) 10030-19499
D) 11040-11646

Question 7

In the Breast subsection of the Integumentary Surgery subsection, Introduction (19281-19298) includes:

A) implantation of artificial breasts
B) placement of biopsy needles
C) placement of localization devices
D) injections

Question 8

When selecting a code from the "Excision of Benign and Malignant Lesions" (11400-11646) subsection, a coder must calculate the size of a lesion being excised. This size is calculated by:

A) (narrowest margin X 2) + largest diameter of the lesion
B) largest diameter of the lesion X 2
C) (narrowest margin + largest diameter of the lesion) X 2
D) narrowest margin + (largest diameter of the lesion X 2)

Question 9

A subcutaneous mastectomy:

A) includes removal of muscle and tumor
B) includes excision of a tumor and a margin of healthy tissue surrounding the tumor
C) allows the patient to retain the skin, and only the breast tissue below the subcutaneous tissue to the fascia is removed
D) is the removal of the entire breast including the subcutaneous tissue and skin, with or without the nipple

Question 10

When reexcision of a malignant lesion is performed during the postoperative period of the primary excision procedure, it would be appropriate to append modifier:

A) 59
B) 78
C) 79
D) 58

Question 11

To completely code a pressure ulcer, one is necessary to identify :

A) the site only
B) the site and the stage
C) the site and the severity (such as fat layer exposed)
D) the site; laterality, and the stage

Question 12

The basal layer of epidermis:

A) consists of cells devoid of nuclei and filled with keratin
B) contains melanocytes
C) is the middle layer of the skin
D) is the deepest layer of the epidermis

Question 13

The epidermis, dermis, and subcutaneous are types of:

A) glands
B) keratin
C) skin layers
D) follicles

Question 14

When coding for multiple debridement sites of the same depth and condition:

A) do not select a code from the Integumentary subsection when performed on injuries
B) add the surface areas together and select the code(s) to report the service
C) code each site separately by listing a primary code for each
D) only select a code from the Integumentary subsection when performed on infectious wounds and ulcers

Question 15

Inflammation is:

A) a bacterial infection of the cuticle
B) a fungal infection of the nail root that deforms and discolors the nails of the fingers or toes
C) a benign outward growth of skin usually occurring on the neck, axillary, and chest of older persons
D) a localized response to an injury or destruction of tissues

Question 16

The codes in the pilonidal cyst and sinus category are further defined by the presence of ___________ at the site of the cyst:

A) swelling
B) abscess
C) rash
D) infection

Question 17

Multiple burns of the same anatomical site, as identified by the category code, but of different degrees are coded:

A) separately, with codes for the highest degree of burn sequenced last
B) once to the lowest degree of the burn
C) once to the highest degree of the burn
D) separately, with codes for each degree of burn

Question 18

The terms cautery, cryo, and laser are often used to refer to this type of procedure:

A) destruction
B) debridement
C) harvest
D) excision

Question 19

A fissure is also referred to as:

A) scrape, contusion, bruise, scratch
B) redness of skin
C) cicatrix, callus
D) groove or crack

Question 20

The removal by skinning or trimming back overgrowth of cornified epithelial layers is:

A) excision
B) shaving
C) paring
D) debridement

Question 21

The term homograft is often used to describe what type of graft?

A) cryograft
B) autograft
C) xenograft
D) allograft

Question 22

This part of the nail is located beneath the skin of the finger at the proximal end of the nail:

A) cuticle
B) matrix
C) plate
D) bed

Question 23

How many layers does the epidermis consist of?

A) Four
B) One
C) Three
D) Two

Question 24

Which of the following is not a main question that needs to be answered from the medical record before selecting the appropriate codes for incision and drainage procedures?

A) Is this a simple or complex procedure?
B) Is the condition part of the CPT description?
C) Is this an initial or repeat procedure?
D) Is it integumentary or some other body area?

Question 25

The patient record describes the patient as presenting with a pressure ulcer of the right lower back with abrasion, blistering and partial thickness skin loss involving the epidermis. This type of pressure ulcer would be described as being in which of the following stages.

A) Stage 3
B) Stage 2
C) Stage 1
D) Stage 4

Question 26

Cutaneous abscess, furuncle, and carbuncle are coded:

A) by anatomical site of infection and laterality, category L03
B) by anatomical site and severity (depth) of infection and are category L89
C) by anatomical site of infection and laterality, category L02
D) by severity (depth) of infection and are category L89

Question 27

Conditions that lead to diaphoresis include:

A) drug withdrawal, cerebrovascular accident, and hyperthyroidism
B) abdominal pain, drug withdrawal, and hypothyroidism
C) hyperthyroidism, myocardial infarction, and drug withdrawal
D) cerebrovascular accident, hypothyroidism, and abdominal pain

Question 28

In pemphigus the blistering generally occurs _______________while in pemphigoid the bullae (blisters) are ______________.

A) intraepidermally, subepidermal
B) subepidermal, intraepidermally
C) epidermally, subepidermal
D) epidermally, intraepidermal

Question 29

A split-thickness graft includes:

A) epidermal layer only
B) dermis only
C) the epidermis and part of the dermis
D) all layers through the subcutaneous

Question 30

In order to appropriately code non-pressure chronic ulcers, a coder needs to select a minimum of ______ code(s):

A) one
B) two
C) three
D) four

Question 31

All of the following are true about the dermis layer of skin except:

A) it contains nerves, which provide sensory reception of pain, temperature, and pressure to the skin
B) it is the middle layer of the skin
C) it contains no blood vessels, receiving nutrients from the dermis below
D) it is made up of elastin and collagen fibers

Question 32

In ICD-10-CM, Pressure ulcers of the ankle reported with codes from which subcategory:

A) L89.5
B) L89.500
C) L 97.3
D) L89

Question 33

Which of the following is not a subheading in the ICD-10-CM manual in Chapter 12?

A) Other Disorders of Skin and Subcutaneous Tissue
B) Disorders of Skin Appendages
C) Other Diseases of Skin and Subcutaneous Tissue
D) Infections of Skin and Subcutaneous Tissue

Question 34

If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, the coder should assign:

A) two separate codes; one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay
B) two codes for the sites and two codes for the stages
C) one code for the sites and one code for the stages
D) two codes for the sites and one code for the stages

Question 35

The nail plate:

A) acts as a seal between the nail plate and the skin
B) protects toes and fingers
C) produces keratin cells that form the nail plate
D) is the tip of the nail root

Question 36

A patient is brought to the Emergency Department and then admitted inpatient with significant "road burn" wounds from a motorcycle accident. In several stages, the patient receives skin grafts from a compatible donor, another patient in the hospital. This is an example of the use of what type of graft?

A) full-thickness graft
B) xenograft
C) autograft
D) allograft

Question 37

A burn that extends beyond the epidermis and deeper into the dermis, resulting in blistering and significant pain for the patient is:

A) third degree
B) fourth degree
C) second degree
D) first degree

Question 38

In ICD-10-CM, Diseases of the Skin and Subcutaneous Tissue is code range:

A) A00-A99
B) L00-L99
C) D00-D99
D) G00-G99

Question 39

Incision and Drainage of the Integumentary System is considered to be:

A) an intermediate procedure with postoperative periods of 10 to 30 days
B) a major procedure with postoperative periods of 90 days
C) a minor procedure with postoperative periods of 0 days
D) a minor procedure with postoperative periods of 0 to 10 days

Question 40

The destroying of tissue using heat, cold, or chemicals is called:

A) necrosis
B) proliferation
C) destruction
D) cautery

Question 41

Nails have one primary function, which is to:

A) block passage of bacteria to the bloodstream
B) defend against attack
C) produce keratin
D) protect the distal ends of the phalanges

Question 42

Select the correct procedure codes to depict the following surgical case: "Patient presents for removal of 17 skin tags on the neck and ear. 11 tags are removed by ligature; 6 tags are removed by chemical cauterization."
CPT codes: 11200 "Removal of skin tags, multiple fibrocutaneous tags, any area, up to and including 15 lesions"
+11201 "Removal of skin tags, multiple fibrocutaneous tags, any area, each additional 10 lesions, or part thereof (list separately in addition to code for primary procedure)

A) 11200, 11201 X 2
B) 11200, 11201
C) 11200, 11201, 11201
D) 11200 X 2

Question 43

This layer of skin forms a protective covering for the other layers of the integumentary system:

A) dermis
B) keratenous
C) subcutaneous
D) epidermis

Question 44

The provider's documented diagnostic statement reads: "Pressure ulcer, buttock, previously stage IV, currently healed" should be coded as:

A) no code is assigned if the documentation states that the pressure ulcer is completely healed
B) L89.300, pressure ulcer of unspecified buttock, unstageable
C) L89.309, pressure ulcer of unspecified buttock, unspecified stage
D) L89.304, pressure ulcer of unspecified buttock, stage 4

Question 45

A burn that extends beyond the subcutaneous tissue, involving the underlying structures of muscle, tendon, and ligament but not the bone is:

A) fifth degree
B) fourth degree
C) first degree
D) third degree

Question 46

When selecting the appropriate CPT code to describe a wound repair/closure, which of the following questions is not relevant to code selection?

A) What type of closure is being performed?
B) Are there multiple wounds on the same anatomical site?
C) On what anatomical site is this being performed?
D) How did the injury/laceration occur?

Question 47

Scleroderma, keloid scar, and skin tags are all this type of condition:

A) hypertrophic and atrophic conditions
B) corns and callosities
C) unstageable chronic ulcers
D) paronychial conditions

Question 48

A pilonidal cyst is excised and the surgical wound is left open to heal. This is described by:

A) 11770 Excision of pilonidal cyst or sinus; simple
B) 11772 Excision of pilonidal cyst or sinus; complicated
C) 11771 Excision of pilonidal cyst or sinus; extensive
D) 10081 Incision and Drainage of pilonidal cyst, complicated

Question 49

The nail bed:

A) is the tip of the nail root
B) contains nerves and blood vessels
C) produces keratin cells that form the nail plate
D) is the moon-shaped white area located beneath the proximal end of the nail

Question 50

When selecting code(s) to describe multiple lesions being excised from the same anatomical group, the coder should select:

A) multiple codes to describe the size and conditions of each lesion excised, regardless of body area
B) one code describing the largest lesion excised in each body area
C) one code describing the total surface area of all lesions excised in each body area
D) multiple codes to describe the largest and the smallest lesion excised from each body area

Question 51

A bulla, pustule, or vesicle is also known as:

A) macule
B) boil
C) blister
D) chickenpox

Question 52

CPT services/procedures involving trimming, debridement, removal (avulsion), or evacuation of subungual hematomas are found in this subsection:

A) repair (closure)
B) pilonidal cyst
C) nails
D) shaving of epidermal or dermal lesions

Question 53

When selecting a code from "Grafts and Skin Replacement Procedures" (15002-15278), coders must answer all of the following questions except:

A) What is the age of the patient?
B) What is the age of the donor?
C) What type of graft was used?
D) Was the site surgically prepared to receive the graft?

Question 54

The nail matrix:

A) produces keratin cells that form the nail plate
B) is composed of hard keratin
C) acts as a seal between the nail plate and the skin
D) contains nerves and blood vessels

Question 55

The following part of the nail is composed of hard keratin:

A) bed
B) cuticle
C) plate
D) luna

Question 56

Coders will sometimes need to calculate square centimeters (sq cm) to correctly code what type of procedure?

A) burn debridement
B) removal of skin tags
C) breast excision
D) skin grafting

Question 57

A xenograft is a:

A) non-human donor such as a porcine graft
B) graft using all layers through the subcutaneous
C) graft harvested from a patient's own body
D) human skin graft applied from donor to recipient

Question 58

A patient presents with multiple skin lacerations on the lower arm. The physician performs simple repair of a 2.3 cm wound, closes a single layer of skin over a 5.2 cm wound, and closes a 1.2 cm wound with sterile adhesive strips. Using the CPT codes provided below, select the appropriate code(s) for these procedures:
12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.5 cm or less
12002 2.6 cm to 7.5 cm
12004 7.6 cm to 12.5 cm
12005 12.6 cm to 20.0 cm
12006 20.1 cm to 30.0 cm
12007 over 30.0 cm

A) 12002 X 2
B) 12005
C) 12002
D) 12002, 12004

Question 59

The moon-shaped whitish area located beneath the proximal end of the nail is the:

A) matrix
B) plate
C) luna
D) bed

Question 60

An invasion of the body by a pathogenic organism is:

A) bacteria
B) infection
C) inflammation
D) virus

Question 61

Categories L23, L24, and L25 contain codes for the following condition:

A) corns and callosities
B) hypertrophic conditions
C) dermatitis due to substances taken internally
D) contact dermatitis

Question 62

Code ranges 14000-14301 and 15570-15738 describe what type of procedure?

A) Adjacent Tissue Transfers and Flaps
B) Repair (Closure)
C) Nails
D) Pilonidal Cyst

Question 63

Incision and Drainage may be performed for all of the following conditions except:

A) hematoma
B) postoperative wound infection
C) foreign body
D) gangrene

Question 64

A fungal infection of the nail root that deforms and discolors the nails of the fingers or toes is:

A) abscess
B) ingrown nail
C) onychomycosis
D) paronychia

Question 65

How many skin tags does the "Removal of Skin Tags" procedure code 11200 include?

A) 15
B) 10
C) 17
D) 12

Question 66

CPT codes for Paring or Cutting are divided based on:

A) total surface area treated (sq cm)
B) largest lesion treated on each body area (sq cm)
C) number of lesions treated (pared)
D) smallest lesion treated on each body area (sq cm)

Question 67

In Mohs Micrographic Surgery, a physician:

A) excises a partial specimen and submits it to pathology
B) performs the surgical procedure and asks a pathologist to stage the specimen
C) performs the procedure with the assistance of a pathologist
D) acts as surgeon and pathologist throughout the procedure

Question 68

How does one appropriately code for cellulitis and acute lymphangitis?

A) coded by anatomical site
B) coded by anatomical site, with a separate category to identify the infectious agent
C) coded by severity (depth) of infection, with a separate category to identify the anatomical site
D) coded first by underlying organism with a separate category to identify the severity (depth) of infection

Question 69

Retention sutures, debridement, or placement of stents or drains while performing a wound closure necessitate the selection of which level of wound repair?

A) intermediate
B) invasive
C) complex
D) extensive

Question 70

Shaving is known as:

A) trimming, debridement, removal or evacuation
B) sharp removal by transverse incision or horizontal slicing
C) removal of foreign object, damaged tissue, either by excision or non-excision
D) removal by skinning or trimming back overgrowth of cornified epithelial layers

Question 71

In reference to Mohs Micrographic Surgery, a transverse slice of a lesion is known as a:

A) piece
B) specimen
C) slice
D) stage

Question 72

The integumentary system, or skin, is considered to be one organ. Select the correct statement regarding use of laterality modifiers in the Integumentary System subsection:

A) Bilateral modifier 50 and lateral modifiers RT and LT may not be used at any time
B) Bilateral modifier 50 and lateral modifiers RT and LT may be used at the coder's discretion
C) Bilateral modifier 50 and lateral modifiers RT and LT may be used only when documentation states the laterality
D) Bilateral modifier 50 may not be used; lateral modifiers RT and LT may be used only when documentation states the laterality

Question 73

Repair (Closure), simple of wounds is found in the CPT manual in the code range:

A) 12001-12021
B) 15780-16036
C) 12001-16036
D) 13100-13160

Question 74

When multiple related surgical procedures are performed on the same day, in the same session, it is appropriate to report modifier:

A) 58
B) 51
C) 50
D) 59

Question 75

Select the appropriate conversion equation between inches and centimeters:

A) 1 inch = 2.30 cm
B) 1 inch = 3.45 cm
C) 1 inch = 3.21 cm
D) 1 inch = 2.54 cm

Question 76

The word integumentary translates from a Latin word that means:

A) to enclose
B) to cover
C) to wrap
D) to spread

Question 77

Diseases of the Skin and Subcutaneous Tissue is Chapter _____ in ICD-10-CM:

A) 12
B) 9
C) 10
D) 11

Question 78

Sweat is made up of:

A) creatinine, ammonia, urea, water, and sodium
B) water, urea, and sodium
C) water, sodium, and sudoriferous
D) water, sulfur, and ammonia

Question 79

Pemphigus, subcategory L10 is further divided by:

A) type of blistering
B) type of pemphigus, such as drug-induced
C) acute or chronic
D) chronic or acquired

Question 80

Total body surface area is often based on:

A) the rule of nines
B) the age of the patient
C) the degree of burn
D) the type of burn