Deck 26: Coding for Surgical Procedures on Digestive, Urinary, Male and Female Reproductive Systems, Maternity Care, Nervous System, and Eyes, Ears, and Endocrine System

Question 1

The medical term that can be used for pain in the head is:

A) Neuralgia
B) Agraphia
C) Cephalgia.
D) Paraplegia

Answer 1

Cephalgia.

Question 2

The nervous system is divided into two major systems. Which system includes the brain and the spinal cord?

A) Autonomic nervous system
B) Peripheral nervous system
C) Somatic nervous system
D) Central nervous system

Answer 2

Central nervous system

Question 3

Operation: LEEP procedure
Diagnosis: Cervical polyp
Procedure: With the patient in the supine position, general anesthesia was administered. The patient was put in the dorsal lithotomy position and prepped and draped for dilation and curettage in a routine fashion.
An insulated posterior weighted retractor was put in. Using the LEEP tenaculum, we were able to grasp the anterior lip of the cervix with a large wire loop at 35 cutting, 30 coagulation. The cervical polyp on the posterior lip of the cervix was excised.
Then changing to a 40 of coagulation and 4 cutting, the base of the polyp was electrocoagulated, which controlled all the bleeding and then it was closed with figure-of-eight 3-0 Vicryl sutures.
Rechecking the cervix, no bleeding was noted. The patient was laid flat on the table, awakened, and moved to the recovery room bed and sent to the recovery room in satisfactory condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 57452, N88.1
B) 57455, N88.1
C) 57461, N84.1
D) 57460, N84.1

Answer 3

57460, N84.1

Question 4

The patient is a female transgender patient who has undergone hormonal therapy, along with other services, to prepare her for her sex change to a male. The patient is counseled on the adverse effects of surgery, as well as complications that may occur. The patient signs the consent for surgery and is taken to the operating room, prepped for surgery, and placed under general anesthesia. The patient successfully comes through surgery. Select the appropriate CPT code:

A) 55899
B) 55980
C) 55970
D) 55920

Question 5

A 25-year-old male patient presents for outpatient surgery today on penile genital warts that previously were treated with medication and have not subsided. The patient is having the genital warts removed using a cryosurgery technique. What are the correct CPT and ICD-10-CM codes?

A) 54060, A63.0
B) 54055, B07.9
C) 54056, A63.0
D) 54050, B07.8

Question 6

When multiple surgeons perform the complete skull base procedure (approach procedure, definitive procedure, reconstruction/repair), each surgeon reports only the code for the specific procedure each performed. If one surgeon performs all of the procedures, then all the applicable codes are reported and a modifier is added to the secondary procedure code(s). Which modifier is added?

A) 51
B) 62
C) No modifier is needed.
D) 59

Question 7

A 39-year-old female presents with an ectopic pregnancy. Due to previous abdominal surgeries, the surgeon is unable to perform a laparoscopic fallopian tube removal and must use an open procedure to successfully perform the removal. The physician elects to surgically treat this patient by using an open approach to her abdomen to remove her left fallopian tube and ovary, along with the products of conception. Select the appropriate CPT and ICD-10-CM codes:

A) 59120, O00.80
B) 59121-LT, O98.513
C) 59150, O98.519
D) 59120-LT, O00.90

Question 8

Preoperative diagnosis: Bladder tumor, 3.4 cm
Postoperative diagnosis: Bladder tumor, 4.2 cm
Procedure: The patient was placed in the lithotomy position after receiving IV sedation. He was prepped and draped. A 21-French cystoscope was passed into the bladder; a previous CT scan of the bladder indicated a tumor of approximately 3.4 cm. After inspection of the bladder with the cystoscope, the findings were consistent with a bladder tumor but the size was inconsistent; the actual finding was a size of 4.2 cm. A biopsy was taken, and laser surgery was performed with fulguration on the removal of the tumor. The patient tolerated the procedure well.
Code only the procedure:

A) 52341
B) 52235
C) 52000
D) 52334

Question 9

Select the appropriate CPT and ICD-10-CM codes to report the removal of 35 percent of the left thyroid lobe through an isthmusectomy. The patient's diagnosis is benign thyroid neoplasm.

A) 60225, D49.7
B) 60240, D34
C) 60212, D49.7
D) 60210, D34

Question 10

Which of the following terms refers to an abnormal accumulation of fluid in the peritoneal cavity that is often a complication of a malignancy?

A) Peritonitis
B) Crohn's disease
C) Volvulus
D) Ascites

Question 11

A patient is seen in the outpatient clinic for a colonoscopy due to a family history of colon cancer. The patient has no personal history of gastrointestinal disease and is currently without signs and symptoms. The colonoscopy revealed a colonic polyp that was removed by hot biopsy forceps. What should the CPT and diagnosis codes for this case be?

A) 45384, K63.5, Z12.11, Z80.0
B) G0105, K63.5, Z12.11, Z80.0
C) G0105, Z12.11, Z80.0, K63.5
D) 45384, Z12.11, Z80.0, K63.5

Question 12

To accurately identify that a procedure was performed on the second lumbar vertebra, which of the following would be documented in the operative report?

A) C2
B) C2-3
C) L2
D) L2-3

Question 13

A 55-year-old male patient is coming to the hospital for an outpatient service for a prostate biopsy. The patient has a family history of prostate cancer, had recent blood work showing elevated PSA levels, and has problems urinating. The patient presents and is placed under anesthesia and prepped and draped. Ultrasonic guidance is used for needle placement, and a needle biopsy is taken. The biopsy is sent to pathology, and the patient is awaiting the results. Select the appropriate CPT and ICD-10-CM codes:

A) 55700, 76942, R97.20, Z80.42
B) 55706, R97.20, Z80.42
C) 55705, 76942, R97.20, Z85.46
D) 55706, R97.20

Question 14

There are two main types of glaucoma. Which type of glaucoma describes when fluid does not flow through the orbicular meshwork properly?

A) Open angle
B) Congential
C) Traumatic
D) Closed angle

Question 15

Preoperative diagnosis: Right eustachian tube dysfunction
Postoperative diagnosis: Right eustachian tube dysfunction
Anesthesia: General mask
Name of operation: Eustachian tube catheterization
Procedure: The patient was taken to the operating room and placed in the supine position. After general anesthesia was given, the operating microscope was brought in for full use throughout the case. The right tympanic membrane was approached using a transnasal approach. An anterior-inferior radial incision was made in the right tympanic membrane. Suction revealed a substantial amount of mucopurulent drainage. A Sheehy pressure equalization tube was placed in the site. Floxin drops were added. The patient tolerated the procedure well and returned to the recovery room awake and in stable condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 69405, H69.80
B) 69799, H69.80
C) 69400, H69.81
D) 69799, H69.81

Question 16

An endoscopy procedure was started on a patient who was scheduled and prepped for a total colonoscopy. The physician was unable to advance the scope beyond the splenic flexure due to unforeseen circumstances. Which of the following modifiers is appended to the colonoscopy code?

A) None; the procedure would be billed without a modifier.
B) None; the procedure would not be billed.
C) 52
D) 53

Question 17

A 35-year-old patient is brought to the operating room for an outpatient surgery for a hiatal hernia repair. The surgeon is able to repair the hernia laparoscopically by placing sutures in the crus diaphragmatic muscles below the esophagus and bringing them together to close the hiatal hernia. The anterior and posterior walls of the fundus are wrapped and stitched around the esophagus to complete the procedure. Select the appropriate CPT and ICD-10-CM codes for this procedure:

A) 43279, Q40.1
B) 43280, K44.0
C) 43281, K44.1
D) 43281, K44.9

Question 18

Postoperative diagnosis: Ovarian cyst, right
Anesthesia: General
Name of operation: Open drainage of cyst
Procedure: The patient was taken to the operating room and prepped and draped in the usual manner, and adequate anesthesia was induced. An infraumbilical incision was made, and abdominal entrance was made. Gas was entered into the abdomen at 2 liters. The abdomen was visualized. The cyst was noted on the right, a 4-cm ovarian cyst. This was needled, and a hole was cut in it with the scissors. Hemostasis was intact. The instruments were removed. The patient was awakened and taken to the recovery room in good condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 58822, N83.201
B) 58800, N83.201
C) 58820, N83.201
D) 58805, N83.201

Question 19

Operative Report
Preoperative diagnosis: Internal hemorrhoids
Postoperative diagnosis: Internal hemorrhoids, anal fistula
Procedure performed: Hemorroidectomy and repair of anal fistula
Operative note: The patient presented today for an inpatient procedure to repair an anal fistula and remove internal hemorrhoids. The patient was put under general anesthesia, prepped, and draped. The physician entered the anus using an endoscope to determine placement of internal hemorrhoids and, upon entering, identified an intersphincteric anal fistula that had occurred since the last visit by the patient. The procedure was initiated, and removal of two columns of internal hemorrhoids was performed using rubber band ligation. Once that procedure was performed, an endoscopic repair of the anal fistula took place, using fibrin glue to seal the fistula. With this accomplished, the patient was awakened from anesthesia and taken to an inpatient room for an overnight stay.
Select the appropriate CPT and ICD-10-CM codes:

A) 46258, K64.4, K60.4
B) 46262, K64.8, K60.3
C) 46221, 46706-59, K64.8, K60.3
D) 46255, K64.5, K60.2

Question 20

A 23-year-old patient, is seen by Dr. Johnson for a cough with wheezing and green-colored mucus for the past four days, as well as four days of external bleeding hemorrhoids and diarrhea. Dr. Johnson gives her Augmentin for acute viral bronchitis, instructions on the care of external hemorrhoids, and a diet plan to assist with the diarrhea. What diagnoses should Dr. Johnson use for this encounter?

A) R19.7, J20.8, K64.4
B) J20.8, K64.4, R19.7
C) J21.0, R19.7, K64.4
D) K64.4, J20.8, R19.7

Question 21

An elderly gentleman has worsening bilateral hydronephrosis. He did not have much of a postvoid residual on bladder scan. He is taken to the OR to have a bilateral cystoscopy and retrograde pyelogram. The results come back as gross prostatic hyperplasia. Select the appropriate CPT and ICD-10-CM codes:

A) 52005-50, N40.0, N13.30
B) 52005, N40.0, N13.3
C) 52000, N42.83
D) 52000-50, N13.30, N40.0

Question 22

The termsalpingo-oophorectomy refers to:

A) The removal of the fallopian tube
B) The removal of the fallopian tube and the ovary
C) The removal of a fertilized egg
D) Cutting into the fallopian tube and ovary for a surgical procedure

Question 23

Preoperative diagnosis: (1) Cholelithiasis, (2) acute cholecystitis
Postoperative diagnosis: (1) Cholelithiasis, (2) acute cholecystitis
Name of operation: Laparoscopic cholecystectomy
Anesthesia: General
Findings: The gallbladder was thickened and showed evidence of chronic cholecystitis. There was a great deal of inflammatory reaction around the cystic duct. The cystic duct was slightly larger. There were nine stones impacted in the cystic duct. The gallbladder contained numerous stones, which were small. With the stones impacted in the cystic duct, it was felt that probably none were within the common duct. Other than rather marked obesity, no other significant findings were noted on limited exploration of the abdomen.
Procedure: Under general anesthesia after routine prepping and draping, the abdomen was insufflated with the Veress needle and the standard four trocars were inserted uneventfully. Inspection was made for any entry problems, and none were encountered.
After limited exploration, the gallbladder was then retracted superiorly and laterally, and the cystic duct was dissected out. This was done with some difficulty due to the fibrosis around the cystic duct, but care was taken to avoid injury to the duct and to the common duct. In this manner, the cystic duct and cystic artery were dissected out. Care was taken to be sure that the duct that was identified went into the gallbladder and was the cystic duct. The cystic duct and cystic artery were then doubly clipped and divided, taking care to avoid injury to the common duct. The gallbladder was then dissected free from the gallbladder bed. Again, the gallbladder was somewhat adherent to the gallbladder bed due to previous inflammatory reaction. The gallbladder was dissected free from the gallbladder bed utilizing the endo shears and the cautery to control bleeding. The gallbladder was extracted through the operating trocar site, and the trocar was reinserted. Inspection was made of the gallbladder bed. One or two bleeding areas were fulgurated, and bleeding was well controlled.
Select the appropriate CPT and ICD-10-CM codes:

A) 47600, K80.21, K80.51
B) 47564, K80.00
C) 47570, K80.21
D) 47562, K80.00

Question 24

The patient is a 35-year-old female who has been having prolonged and heavy bleeding during menstruation. After other testing, the patient opted to have an elective uterine ablation using NovaSure.
Procedure: After the patient was put under general anesthesia, the patient was placed in the dorsolithotomy position, after which the perineum and the vagina were prepped, the bladder was straight catheterized, and the patient was draped. After a bimanual exam was performed, a speculum was placed and the cavity integrity assessment performed. The NovaSure system uses a small amount of CO2 to verify cavity integrity prior to performing the procedure. The NovaSure thermal endometrial ablation procedure then delivered radiofrequency energy until tissue impedance reached 50 ohms; the electrode array was retracted for easy removal, leaving the uterine lining desiccated down to the superficial myometrium. The patient was awakened from anesthesia and sent home to recover.
Select the appropriate CPT and ICD-10-CM codes:

A) 58356, N92.0
B) 58541, N92.3
C) 58356, N92.0.
D) 58353, N92.0

Question 25

Postoperative diagnosis: Ovarian cyst, right
Anesthesia: General
Name of operation: Open drainage of cyst
Procedure: The patient was taken to the operating room and prepped and draped in the usual manner, and adequate anesthesia was induced. An infraumbilical incision was made, and abdominal entrance was made. Gas was entered into the abdomen at 2 liters. The abdomen was visualized. The cyst was noted on the right, a 4-cm ovarian cyst. This was needled, and a hole was cut in it with the scissors. Hemostasis was intact. The instruments were removed. The patient was awakened and taken to the recovery room in good condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 58800, N83.201
B) 58822, N83.201
C) 58805, N83.201
D) 58820, N83.201

Question 26

Preoperative diagnosis: Bladder tumor, 3.4 cm
Postoperative diagnosis: Bladder tumor, 4.2 cm
Procedure: The patient was placed in the lithotomy position after receiving IV sedation. He was prepped and draped. A 21-French cystoscope was passed into the bladder; a previous CT scan of the bladder indicated a tumor of approximately 3.4 cm. After inspection of the bladder with the cystoscope, the findings were consistent with a bladder tumor but the size was inconsistent; the actual finding was a size of 4.2 cm. A biopsy was taken, and laser surgery was performed with fulguration on the removal of the tumor. The patient tolerated the procedure well.
Code only the procedure:

A) 52235
B) 52341
C) 52000
D) 52334

Question 27

A 23-year-old patient, is seen by Dr. Johnson for a cough with wheezing and green-colored mucus for the past four days, as well as four days of external bleeding hemorrhoids and diarrhea. Dr. Johnson gives her Augmentin for acute viral bronchitis, instructions on the care of external hemorrhoids, and a diet plan to assist with the diarrhea. What diagnoses should Dr. Johnson use for this encounter?

A) J21.0, R19.7, K64.4
B) K64.4, J20.8, R19.7
C) R19.7, J20.8, K64.4
D) J20.8, K64.4, R19.7

Question 28

A patient is seen in the outpatient clinic for a colonoscopy due to a family history of colon cancer. The patient has no personal history of gastrointestinal disease and is currently without signs and symptoms. The colonoscopy revealed a colonic polyp that was removed by hot biopsy forceps. What should the CPT and diagnosis codes for this case be?

A) 45384, K63.5, Z12.11, Z80.0
B) G0105, Z12.11, Z80.0, K63.5
C) 45384, Z12.11, Z80.0, K63.5
D) G0105, K63.5, Z12.11, Z80.0

Question 29

Preoperative diagnosis: Right eustachian tube dysfunction
Postoperative diagnosis: Right eustachian tube dysfunction
Anesthesia: General mask
Name of operation: Eustachian tube catheterization
Procedure: The patient was taken to the operating room and placed in the supine position. After general anesthesia was given, the operating microscope was brought in for full use throughout the case. The right tympanic membrane was approached using a transnasal approach. An anterior-inferior radial incision was made in the right tympanic membrane. Suction revealed a substantial amount of mucopurulent drainage. A Sheehy pressure equalization tube was placed in the site. Floxin drops were added. The patient tolerated the procedure well and returned to the recovery room awake and in stable condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 69799, H69.80
B) 69400, H69.81
C) 69405, H69.80
D) 69799, H69.81

Question 30

The patient is a 35-year-old female who has been having prolonged and heavy bleeding during menstruation. After other testing, the patient opted to have an elective uterine ablation using NovaSure.
Procedure: After the patient was put under general anesthesia, the patient was placed in the dorsolithotomy position, after which the perineum and the vagina were prepped, the bladder was straight catheterized, and the patient was draped. After a bimanual exam was performed, a speculum was placed and the cavity integrity assessment performed. The NovaSure system uses a small amount of CO2 to verify cavity integrity prior to performing the procedure. The NovaSure thermal endometrial ablation procedure then delivered radiofrequency energy until tissue impedance reached 50 ohms; the electrode array was retracted for easy removal, leaving the uterine lining desiccated down to the superficial myometrium. The patient was awakened from anesthesia and sent home to recover.
Select the appropriate CPT and ICD-10-CM codes:

A) 58353, N92.0
B) 58541, N92.3
C) 58356, N92.0.
D) 58356, N92.0

Question 31

When multiple surgeons perform the complete skull base procedure (approach procedure, definitive procedure, reconstruction/repair), each surgeon reports only the code for the specific procedure each performed. If one surgeon performs all of the procedures, then all the applicable codes are reported and a modifier is added to the secondary procedure code(s). Which modifier is added?

A) 59
B) 62
C) 51
D) No modifier is needed.

Question 32

Operation: LEEP procedure
Diagnosis: Cervical polyp
Procedure: With the patient in the supine position, general anesthesia was administered. The patient was put in the dorsal lithotomy position and prepped and draped for dilation and curettage in a routine fashion.
An insulated posterior weighted retractor was put in. Using the LEEP tenaculum, we were able to grasp the anterior lip of the cervix with a large wire loop at 35 cutting, 30 coagulation. The cervical polyp on the posterior lip of the cervix was excised.
Then changing to a 40 of coagulation and 4 cutting, the base of the polyp was electrocoagulated, which controlled all the bleeding and then it was closed with figure-of-eight 3-0 Vicryl sutures.
Rechecking the cervix, no bleeding was noted. The patient was laid flat on the table, awakened, and moved to the recovery room bed and sent to the recovery room in satisfactory condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 57460, N84.1
B) 57455, N88.1
C) 57461, N84.1
D) 57452, N88.1

Question 33

The termsalpingo-oophorectomy refers to:

A) The removal of the fallopian tube
B) The removal of the fallopian tube and the ovary
C) The removal of a fertilized egg
D) Cutting into the fallopian tube and ovary for a surgical procedure

Question 34

To accurately identify that a procedure was performed on the second lumbar vertebra, which of the following would be documented in the operative report?

A) L2-3
B) C2
C) C2-3
D) L2

Question 35

An elderly gentleman has worsening bilateral hydronephrosis. He did not have much of a postvoid residual on bladder scan. He is taken to the OR to have a bilateral cystoscopy and retrograde pyelogram. The results come back as gross prostatic hyperplasia. Select the appropriate CPT and ICD-10-CM codes:

A) 52000-50, N13.30, N40.0
B) 52005-50, N40.0, N13.30
C) 52000, N42.83
D) 52005, N40.0, N13.3

Question 36

A 39-year-old female presents with an ectopic pregnancy. Due to previous abdominal surgeries, the surgeon is unable to perform a laparoscopic fallopian tube removal and must use an open procedure to successfully perform the removal. The physician elects to surgically treat this patient by using an open approach to her abdomen to remove her left fallopian tube and ovary, along with the products of conception. Select the appropriate CPT and ICD-10-CM codes:

A) 59120-LT, O00.90
B) 59150, O98.519
C) 59120, O00.80
D) 59121-LT, O98.513

Question 37

Which of the following terms refers to an abnormal accumulation of fluid in the peritoneal cavity that is often a complication of a malignancy?

A) Ascites
B) Volvulus
C) Crohn's disease
D) Peritonitis

Question 38

A 25-year-old male patient presents for outpatient surgery today on penile genital warts that previously were treated with medication and have not subsided. The patient is having the genital warts removed using a cryosurgery technique. What are the correct CPT and ICD-10-CM codes?

A) 54050, B07.8
B) 54056, A63.0
C) 54055, B07.9
D) 54060, A63.0

Question 39

Which of the following is the gland that secretes a factor that causes T cells to mature and is larger in infants?

A) Lymph
B) Adrenal
C) Thymus
D) Spleen

Question 40

A 35-year-old patient is brought to the operating room for an outpatient surgery for a hiatal hernia repair. The surgeon is able to repair the hernia laparoscopically by placing sutures in the crus diaphragmatic muscles below the esophagus and bringing them together to close the hiatal hernia. The anterior and posterior walls of the fundus are wrapped and stitched around the esophagus to complete the procedure. Select the appropriate CPT and ICD-10-CM codes for this procedure:

A) 43281, K44.1
B) 43280, K44.0
C) 43281, K44.9
D) 43279, Q40.1

Question 41

There are two main types of glaucoma. Which type of glaucoma describes when fluid does not flow through the orbicular meshwork properly?

A) Closed angle
B) Traumatic
C) Open angle
D) Congential

Question 42

The patient is a female transgender patient who has undergone hormonal therapy, along with other services, to prepare her for her sex change to a male. The patient is counseled on the adverse effects of surgery, as well as complications that may occur. The patient signs the consent for surgery and is taken to the operating room, prepped for surgery, and placed under general anesthesia. The patient successfully comes through surgery. Select the appropriate CPT code:

A) 55899
B) 55980
C) 55920
D) 55970

Question 43

Select the appropriate CPT and ICD-10-CM codes to report the removal of 35 percent of the left thyroid lobe through an isthmusectomy. The patient's diagnosis is benign thyroid neoplasm.

A) 60240, D34
B) 60210, D34
C) 60225, D49.7
D) 60212, D49.7

Question 44

A 55-year-old male patient is coming to the hospital for an outpatient service for a prostate biopsy. The patient has a family history of prostate cancer, had recent blood work showing elevated PSA levels, and has problems urinating. The patient presents and is placed under anesthesia and prepped and draped. Ultrasonic guidance is used for needle placement, and a needle biopsy is taken. The biopsy is sent to pathology, and the patient is awaiting the results. Select the appropriate CPT and ICD-10-CM codes:

A) 55705, 76942, R97.20, Z85.46
B) 55706, R97.20
C) 55706, R97.20, Z80.42
D) 55700, 76942, R97.20, Z80.42

Question 45

Preoperative diagnosis: (1) Cholelithiasis, (2) acute cholecystitis
Postoperative diagnosis: (1) Cholelithiasis, (2) acute cholecystitis
Name of operation: Laparoscopic cholecystectomy
Anesthesia: General
Findings: The gallbladder was thickened and showed evidence of chronic cholecystitis. There was a great deal of inflammatory reaction around the cystic duct. The cystic duct was slightly larger. There were nine stones impacted in the cystic duct. The gallbladder contained numerous stones, which were small. With the stones impacted in the cystic duct, it was felt that probably none were within the common duct. Other than rather marked obesity, no other significant findings were noted on limited exploration of the abdomen.
Procedure: Under general anesthesia after routine prepping and draping, the abdomen was insufflated with the Veress needle and the standard four trocars were inserted uneventfully. Inspection was made for any entry problems, and none were encountered.
After limited exploration, the gallbladder was then retracted superiorly and laterally, and the cystic duct was dissected out. This was done with some difficulty due to the fibrosis around the cystic duct, but care was taken to avoid injury to the duct and to the common duct. In this manner, the cystic duct and cystic artery were dissected out. Care was taken to be sure that the duct that was identified went into the gallbladder and was the cystic duct. The cystic duct and cystic artery were then doubly clipped and divided, taking care to avoid injury to the common duct. The gallbladder was then dissected free from the gallbladder bed. Again, the gallbladder was somewhat adherent to the gallbladder bed due to previous inflammatory reaction. The gallbladder was dissected free from the gallbladder bed utilizing the endo shears and the cautery to control bleeding. The gallbladder was extracted through the operating trocar site, and the trocar was reinserted. Inspection was made of the gallbladder bed. One or two bleeding areas were fulgurated, and bleeding was well controlled.
Select the appropriate CPT and ICD-10-CM codes:

A) 47564, K80.00
B) 47570, K80.21
C) 47562, K80.00
D) 47600, K80.21, K80.51

Question 46

An endoscopy procedure was started on a patient who was scheduled and prepped for a total colonoscopy. The physician was unable to advance the scope beyond the splenic flexure due to unforeseen circumstances. Which of the following modifiers is appended to the colonoscopy code?

A) None; the procedure would not be billed.
B) 52
C) 53
D) None; the procedure would be billed without a modifier.

Question 47

The nervous system is divided into two major systems. Which system includes the brain and the spinal cord?

A) Somatic nervous system
B) Peripheral nervous system
C) Central nervous system
D) Autonomic nervous system

Question 48

The medical term that can be used for pain in the head is:

A) Agraphia
B) Paraplegia
C) Cephalgia
D) Neuralgia

Question 49

Operative Report
Preoperative diagnosis: Internal hemorrhoids
Postoperative diagnosis: Internal hemorrhoids, anal fistula
Procedure performed: Hemorroidectomy and repair of anal fistula
Operative note: The patient presented today for an inpatient procedure to repair an anal fistula and remove internal hemorrhoids. The patient was put under general anesthesia, prepped, and draped. The physician entered the anus using an endoscope to determine placement of internal hemorrhoids and, upon entering, identified an intersphincteric anal fistula that had occurred since the last visit by the patient. The procedure was initiated, and removal of two columns of internal hemorrhoids was performed using rubber band ligation. Once that procedure was performed, an endoscopic repair of the anal fistula took place, using fibrin glue to seal the fistula. With this accomplished, the patient was awakened from anesthesia and taken to an inpatient room for an overnight stay.
Select the appropriate CPT and ICD-10-CM codes:

A) 46255, K64.5, K60.2
B) 46258, K64.4, K60.4
C) 46221, 46706-59, K64.8, K60.3
D) 46262, K64.8, K60.3

Question 50

The nervous system is divided into two major systems. Which system includes the brain and the spinal cord?

A) Somatic nervous system
B) Central nervous system
C) Peripheral nervous system
D) Autonomic nervous system

Question 51

Select the appropriate CPT and ICD-10-CM codes to report the removal of 35 percent of the left thyroid lobe through an isthmusectomy. The patient's diagnosis is benign thyroid neoplasm.

A) 60212, D49.7
B) 60210, D34
C) 60240, D34
D) 60225, D49.7

Question 52

A 35-year-old patient is brought to the operating room for an outpatient surgery for a hiatal hernia repair. The surgeon is able to repair the hernia laparoscopically by placing sutures in the crus diaphragmatic muscles below the esophagus and bringing them together to close the hiatal hernia. The anterior and posterior walls of the fundus are wrapped and stitched around the esophagus to complete the procedure. Select the appropriate CPT and ICD-10-CM codes for this procedure:

A) 43280, K44.0
B) 43281, K44.1
C) 43279, Q40.1
D) 43281, K44.9

Question 53

A 25-year-old male patient presents for outpatient surgery today on penile genital warts that previously were treated with medication and have not subsided. The patient is having the genital warts removed using a cryosurgery technique. What are the correct CPT and ICD-10-CM codes?

A) 54055, B07.9
B) 54056, A63.0
C) 54060, A63.0
D) 54050, B07.8

Question 54

Preoperative diagnosis: Bladder tumor, 3.4 cm
Postoperative diagnosis: Bladder tumor, 4.2 cm
Procedure: The patient was placed in the lithotomy position after receiving IV sedation. He was prepped and draped. A 21-French cystoscope was passed into the bladder; a previous CT scan of the bladder indicated a tumor of approximately 3.4 cm. After inspection of the bladder with the cystoscope, the findings were consistent with a bladder tumor but the size was inconsistent; the actual finding was a size of 4.2 cm. A biopsy was taken, and laser surgery was performed with fulguration on the removal of the tumor. The patient tolerated the procedure well.
Code only the procedure:

A) 52334
B) 52000
C) 52341
D) 52235

Question 55

There are two main types of glaucoma. Which type of glaucoma describes when fluid does not flow through the orbicular meshwork properly?

A) Traumatic
B) Closed angle
C) Open angle
D) Congential

Question 56

A 39-year-old female presents with an ectopic pregnancy. Due to previous abdominal surgeries, the surgeon is unable to perform a laparoscopic fallopian tube removal and must use an open procedure to successfully perform the removal. The physician elects to surgically treat this patient by using an open approach to her abdomen to remove her left fallopian tube and ovary, along with the products of conception. Select the appropriate CPT and ICD-10-CM codes:

A) 59120, O00.80
B) 59120-LT, O00.90
C) 59150, O98.519
D) 59121-LT, O98.513

Question 57

A 55-year-old male patient is coming to the hospital for an outpatient service for a prostate biopsy. The patient has a family history of prostate cancer, had recent blood work showing elevated PSA levels, and has problems urinating. The patient presents and is placed under anesthesia and prepped and draped. Ultrasonic guidance is used for needle placement, and a needle biopsy is taken. The biopsy is sent to pathology, and the patient is awaiting the results. Select the appropriate CPT and ICD-10-CM codes:

A) 55706, R97.20, Z80.42
B) 55706, R97.20
C) 55700, 76942, R97.20, Z80.42
D) 55705, 76942, R97.20, Z85.46

Question 58

An endoscopy procedure was started on a patient who was scheduled and prepped for a total colonoscopy. The physician was unable to advance the scope beyond the splenic flexure due to unforeseen circumstances. Which of the following modifiers is appended to the colonoscopy code?

A) None; the procedure would be billed without a modifier.
B) 53
C) 52
D) None; the procedure would not be billed.

Question 59

An elderly gentleman has worsening bilateral hydronephrosis. He did not have much of a postvoid residual on bladder scan. He is taken to the OR to have a bilateral cystoscopy and retrograde pyelogram. The results come back as gross prostatic hyperplasia. Select the appropriate CPT and ICD-10-CM codes:

A) 52000, N42.83
B) 52005-50, N40.0, N13.30
C) 52000-50, N13.30, N40.0
D) 52005, N40.0, N13.3

Question 60

The patient is a female transgender patient who has undergone hormonal therapy, along with other services, to prepare her for her sex change to a male. The patient is counseled on the adverse effects of surgery, as well as complications that may occur. The patient signs the consent for surgery and is taken to the operating room, prepped for surgery, and placed under general anesthesia. The patient successfully comes through surgery. Select the appropriate CPT code:

A) 55920
B) 55980
C) 55899
D) 55970

Question 61

The patient is a 35-year-old female who has been having prolonged and heavy bleeding during menstruation. After other testing, the patient opted to have an elective uterine ablation using NovaSure.
Procedure: After the patient was put under general anesthesia, the patient was placed in the dorsolithotomy position, after which the perineum and the vagina were prepped, the bladder was straight catheterized, and the patient was draped. After a bimanual exam was performed, a speculum was placed and the cavity integrity assessment performed. The NovaSure system uses a small amount of CO2 to verify cavity integrity prior to performing the procedure. The NovaSure thermal endometrial ablation procedure then delivered radiofrequency energy until tissue impedance reached 50 ohms; the electrode array was retracted for easy removal, leaving the uterine lining desiccated down to the superficial myometrium. The patient was awakened from anesthesia and sent home to recover.
Select the appropriate CPT and ICD-10-CM codes:

A) 58541, N92.3
B) 58353, N92.0
C) 58356, N92.0.
D) 58356, N92.0

Question 62

Operation: LEEP procedure
Diagnosis: Cervical polyp
Procedure: With the patient in the supine position, general anesthesia was administered. The patient was put in the dorsal lithotomy position and prepped and draped for dilation and curettage in a routine fashion.
An insulated posterior weighted retractor was put in. Using the LEEP tenaculum, we were able to grasp the anterior lip of the cervix with a large wire loop at 35 cutting, 30 coagulation. The cervical polyp on the posterior lip of the cervix was excised.
Then changing to a 40 of coagulation and 4 cutting, the base of the polyp was electrocoagulated, which controlled all the bleeding and then it was closed with figure-of-eight 3-0 Vicryl sutures.
Rechecking the cervix, no bleeding was noted. The patient was laid flat on the table, awakened, and moved to the recovery room bed and sent to the recovery room in satisfactory condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 57452, N88.1
B) 57455, N88.1
C) 57461, N84.1
D) 57460, N84.1

Question 63

The medical term that can be used for pain in the head is:

A) Agraphia
B) Cephalgia
C) Paraplegia
D) Neuralgia

Question 64

Preoperative diagnosis: Right eustachian tube dysfunction
Postoperative diagnosis: Right eustachian tube dysfunction
Anesthesia: General mask
Name of operation: Eustachian tube catheterization
Procedure: The patient was taken to the operating room and placed in the supine position. After general anesthesia was given, the operating microscope was brought in for full use throughout the case. The right tympanic membrane was approached using a transnasal approach. An anterior-inferior radial incision was made in the right tympanic membrane. Suction revealed a substantial amount of mucopurulent drainage. A Sheehy pressure equalization tube was placed in the site. Floxin drops were added. The patient tolerated the procedure well and returned to the recovery room awake and in stable condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 69799, H69.81
B) 69405, H69.80
C) 69400, H69.81
D) 69799, H69.80

Question 65

Postoperative diagnosis: Ovarian cyst, right
Anesthesia: General
Name of operation: Open drainage of cyst
Procedure: The patient was taken to the operating room and prepped and draped in the usual manner, and adequate anesthesia was induced. An infraumbilical incision was made, and abdominal entrance was made. Gas was entered into the abdomen at 2 liters. The abdomen was visualized. The cyst was noted on the right, a 4-cm ovarian cyst. This was needled, and a hole was cut in it with the scissors. Hemostasis was intact. The instruments were removed. The patient was awakened and taken to the recovery room in good condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 58800, N83.201
B) 58805, N83.201
C) 58822, N83.201
D) 58820, N83.201

Question 66

The termsalpingo-oophorectomy refers to:

A) Cutting into the fallopian tube and ovary for a surgical procedure
B) The removal of a fertilized egg
C) The removal of the fallopian tube and the ovary
D) The removal of the fallopian tube

Question 67

When multiple surgeons perform the complete skull base procedure (approach procedure, definitive procedure, reconstruction/repair), each surgeon reports only the code for the specific procedure each performed. If one surgeon performs all of the procedures, then all the applicable codes are reported and a modifier is added to the secondary procedure code(s). Which modifier is added?

A) No modifier is needed.
B) 62
C) 59
D) 51

Question 68

A patient is seen in the outpatient clinic for a colonoscopy due to a family history of colon cancer. The patient has no personal history of gastrointestinal disease and is currently without signs and symptoms. The colonoscopy revealed a colonic polyp that was removed by hot biopsy forceps. What should the CPT and diagnosis codes for this case be?

A) 45384, Z12.11, Z80.0, K63.5
B) G0105, K63.5, Z12.11, Z80.0
C) G0105, Z12.11, Z80.0, K63.5
D) 45384, K63.5, Z12.11, Z80.0

Question 69

Which of the following terms refers to an abnormal accumulation of fluid in the peritoneal cavity that is often a complication of a malignancy?

A) Ascites
B) Volvulus
C) Peritonitis
D) Crohn's disease

Question 70

A 23-year-old patient, is seen by Dr. Johnson for a cough with wheezing and green-colored mucus for the past four days, as well as four days of external bleeding hemorrhoids and diarrhea. Dr. Johnson gives her Augmentin for acute viral bronchitis, instructions on the care of external hemorrhoids, and a diet plan to assist with the diarrhea. What diagnoses should Dr. Johnson use for this encounter?

A) K64.4, J20.8, R19.7
B) R19.7, J20.8, K64.4
C) J21.0, R19.7, K64.4
D) J20.8, K64.4, R19.7

Question 71

Which of the following is the gland that secretes a factor that causes T cells to mature and is larger in infants?

A) Thymus
B) Spleen
C) Adrenal
D) Lymph

Question 72

Preoperative diagnosis: (1) Cholelithiasis, (2) acute cholecystitis
Postoperative diagnosis: (1) Cholelithiasis, (2) acute cholecystitis
Name of operation: Laparoscopic cholecystectomy
Anesthesia: General
Findings: The gallbladder was thickened and showed evidence of chronic cholecystitis. There was a great deal of inflammatory reaction around the cystic duct. The cystic duct was slightly larger. There were nine stones impacted in the cystic duct. The gallbladder contained numerous stones, which were small. With the stones impacted in the cystic duct, it was felt that probably none were within the common duct. Other than rather marked obesity, no other significant findings were noted on limited exploration of the abdomen.
Procedure: Under general anesthesia after routine prepping and draping, the abdomen was insufflated with the Veress needle and the standard four trocars were inserted uneventfully. Inspection was made for any entry problems, and none were encountered.
After limited exploration, the gallbladder was then retracted superiorly and laterally, and the cystic duct was dissected out. This was done with some difficulty due to the fibrosis around the cystic duct, but care was taken to avoid injury to the duct and to the common duct. In this manner, the cystic duct and cystic artery were dissected out. Care was taken to be sure that the duct that was identified went into the gallbladder and was the cystic duct. The cystic duct and cystic artery were then doubly clipped and divided, taking care to avoid injury to the common duct. The gallbladder was then dissected free from the gallbladder bed. Again, the gallbladder was somewhat adherent to the gallbladder bed due to previous inflammatory reaction. The gallbladder was dissected free from the gallbladder bed utilizing the endo shears and the cautery to control bleeding. The gallbladder was extracted through the operating trocar site, and the trocar was reinserted. Inspection was made of the gallbladder bed. One or two bleeding areas were fulgurated, and bleeding was well controlled.
Select the appropriate CPT and ICD-10-CM codes:

A) 47570, K80.21
B) 47564, K80.00
C) 47600, K80.21, K80.51
D) 47562, K80.00

Question 73

Operative Report
Preoperative diagnosis: Internal hemorrhoids
Postoperative diagnosis: Internal hemorrhoids, anal fistula
Procedure performed: Hemorroidectomy and repair of anal fistula
Operative note: The patient presented today for an inpatient procedure to repair an anal fistula and remove internal hemorrhoids. The patient was put under general anesthesia, prepped, and draped. The physician entered the anus using an endoscope to determine placement of internal hemorrhoids and, upon entering, identified an intersphincteric anal fistula that had occurred since the last visit by the patient. The procedure was initiated, and removal of two columns of internal hemorrhoids was performed using rubber band ligation. Once that procedure was performed, an endoscopic repair of the anal fistula took place, using fibrin glue to seal the fistula. With this accomplished, the patient was awakened from anesthesia and taken to an inpatient room for an overnight stay.
Select the appropriate CPT and ICD-10-CM codes:

A) 46255, K64.5, K60.2
B) 46258, K64.4, K60.4
C) 46262, K64.8, K60.3
D) 46221, 46706-59, K64.8, K60.3

Question 74

The termsalpingo-oophorectomy refers to:

A) The removal of a fertilized egg
B) The removal of the fallopian tube
C) Cutting into the fallopian tube and ovary for a surgical procedure
D) The removal of the fallopian tube and the ovary

Question 75

Postoperative diagnosis: Ovarian cyst, right
Anesthesia: General
Name of operation: Open drainage of cyst
Procedure: The patient was taken to the operating room and prepped and draped in the usual manner, and adequate anesthesia was induced. An infraumbilical incision was made, and abdominal entrance was made. Gas was entered into the abdomen at 2 liters. The abdomen was visualized. The cyst was noted on the right, a 4-cm ovarian cyst. This was needled, and a hole was cut in it with the scissors. Hemostasis was intact. The instruments were removed. The patient was awakened and taken to the recovery room in good condition.
Select the appropriate CPT and ICD-10-CM codes:

A) 58820, N83.201
B) 58822, N83.201
C) 58805, N83.201
D) 58800, N83.201

Question 76

A 25-year-old male patient presents for outpatient surgery today on penile genital warts that previously were treated with medication and have not subsided. The patient is having the genital warts removed using a cryosurgery technique. What are the correct CPT and ICD-10-CM codes?

A) 54050, B07.8
B) 54056, A63.0
C) 54060, A63.0
D) 54055, B07.9

Question 77

Preoperative diagnosis: Bladder tumor, 3.4 cm
Postoperative diagnosis: Bladder tumor, 4.2 cm
Procedure: The patient was placed in the lithotomy position after receiving IV sedation. He was prepped and draped. A 21-French cystoscope was passed into the bladder; a previous CT scan of the bladder indicated a tumor of approximately 3.4 cm. After inspection of the bladder with the cystoscope, the findings were consistent with a bladder tumor but the size was inconsistent; the actual finding was a size of 4.2 cm. A biopsy was taken, and laser surgery was performed with fulguration on the removal of the tumor. The patient tolerated the procedure well.
Code only the procedure:

A) 52341
B) 52000
C) 52334
D) 52235

Question 78

An elderly gentleman has worsening bilateral hydronephrosis. He did not have much of a postvoid residual on bladder scan. He is taken to the OR to have a bilateral cystoscopy and retrograde pyelogram. The results come back as gross prostatic hyperplasia. Select the appropriate CPT and ICD-10-CM codes:

A) 52005-50, N40.0, N13.30
B) 52005, N40.0, N13.3
C) 52000-50, N13.30, N40.0
D) 52000, N42.83

Question 79

A 35-year-old patient is brought to the operating room for an outpatient surgery for a hiatal hernia repair. The surgeon is able to repair the hernia laparoscopically by placing sutures in the crus diaphragmatic muscles below the esophagus and bringing them together to close the hiatal hernia. The anterior and posterior walls of the fundus are wrapped and stitched around the esophagus to complete the procedure. Select the appropriate CPT and ICD-10-CM codes for this procedure:

A) 43281, K44.1
B) 43281, K44.9
C) 43280, K44.0
D) 43279, Q40.1

Question 80

Operative Report
Preoperative diagnosis: Internal hemorrhoids
Postoperative diagnosis: Internal hemorrhoids, anal fistula
Procedure performed: Hemorroidectomy and repair of anal fistula
Operative note: The patient presented today for an inpatient procedure to repair an anal fistula and remove internal hemorrhoids. The patient was put under general anesthesia, prepped, and draped. The physician entered the anus using an endoscope to determine placement of internal hemorrhoids and, upon entering, identified an intersphincteric anal fistula that had occurred since the last visit by the patient. The procedure was initiated, and removal of two columns of internal hemorrhoids was performed using rubber band ligation. Once that procedure was performed, an endoscopic repair of the anal fistula took place, using fibrin glue to seal the fistula. With this accomplished, the patient was awakened from anesthesia and taken to an inpatient room for an overnight stay.
Select the appropriate CPT and ICD-10-CM codes:

A) 46262, K64.8, K60.3
B) 46221, 46706-59, K64.8, K60.3
C) 46255, K64.5, K60.2
D) 46258, K64.4, K60.4