Deck 27: Coding and Surgical Procedures

Question 1

Mrs. Jones is in the operating room today for repair of a nontraumatic tear of the rotator cuff of the right shoulder. The physician performs an arthroscopy subacromial decompression with an open repair of the rotator cuff. Select the appropriate ICD-10-CM and CPT code(s):

A) M75.101, 29826
B) M75.101, 23412, 29827-59
C) M75.121, 23412, 29827
D) M75.101, 29821

Answer 1

M75.101, 23412, 29827-59

Question 2

Tommy was climbing the tree in front of his house, fell, and sustained a greenstick fracture of the ulna of his left arm. The orthopedic surgeon performed a closed manipulation and applied a short arm cast. Select the appropriate ICD-10-CM and CPT code(s):

A) S52.202A, 25530, 29075
B) S52.212A, 25500
C) S52.212A, 25535
D) S52.212A, 25505

Answer 2

S52.212A, 25535

Question 3

The patient underwent partial excision of the posterior C7 and L1 and L2 vertebrae to remove intrinsic bony lesions. Two surgeons worked simultaneously as primary surgeons to remove the lesions. Surgeon A removed the lesion at C7, and surgeon B removed the lesions at L1 and L2. Code the services of surgeon B with the appropriate ICD-10-CM and CPT code(s):

A) M84.88, 22100-59, 22102, 22103
B) M84.88, 22100-62, 22102, 22103-62
C) M84.9, 22102-62
D) M84.88, 22102-62, 22103-62

Answer 3

M84.88, 22102-62, 22103-62

Question 4

Mrs. Jones, an established patient, is seen by the rheumatologist for repeated pain in her left knee due to osteoarthritis. Today she presents with pain and swelling. The rheumatologist performs an arthrocentesis of the left knee followed by injection of Dexa-Methasone sodium phosphate, 5 mg. No E/M service is performed. Select the appropriate ICD-10-CM and CPT code(s):

A) M17.12, 20610, J1100 5u
B) M17.12, 20610, 99212-25, J1100 5u
C) M17.12, 20605, 99212-25
D) M17.32, 20605, J1100 5u, 99212-25

Question 5

Mr. Jones is a patient with recurrent stage IV colon carcinoma of the sigmoid colon. He had previously undergone a laparoscopic low anterior resection (LAR). He was brought to the operating room today and under general anesthesia underwent a laparoscopic lysis of adhesions. The small bowel loops were found to be adherent to the anterior abdominal wall and also near the colostomy. These adhesions were lysed. There was one loop of small bowel that was adherent to the anterior abdominal wall of the RLQ, and this adhesion was not disturbed. Select the appropriate ICD-10-CM and CPT code(s):

A) C18.7, K66.0, 44180
B) K66.0, C18.7, 44180
C) K66.0, C18.7, 44340
D) C18.7, K66.0, 44340

Question 6

Jeremy presented to the ED complaining of severe odynophagia after eating chicken wings. Upon initial x-rays, no perforation of the esophagus was noted. The gastrointestinal specialist was called, and the patient was taken to the endoscopy suite. There, with the patient under moderate sedation, the gastroenterologist performed an esophagoscopy and removed a small chicken bone lodged in the esophagus above the diaphragm. Select the appropriate ICD-10-CM and CPT code(s):

A) T18.128A, 43247
B) T18.9xA, 43215
C) T18.9xA, 43200
D) T18.128A, 43215

Question 7

Mrs. Jones presented with pain in the right upper quadrant. Upon a CT of the abdomen and an ultrasound of the gallbladder, a diagnosis of cholelithiasis and acute cholecystitis was confirmed, and the patient was taken to the operating room. The patient underwent a laparoscopic cholecystectomy with a normal intraoperative cholangiogram to remove the gallstones. Select the appropriate ICD-10-CM and CPT code(s):

A) K80.00, 47579
B) K80.01, 47562
C) K80.00, 47563
D) K80.10, 47570

Question 8

A 45-year-old male with pancreatic cancer presents with a distended abdomen. The ultrasound reveals fluid in the peritoneal cavity. The patient undergoes a therapeutic paracentesis with ultrasound imaging guidance to drain the fluid. Select the appropriate ICD-10-CM and CPT code(s):

A) C25.9, 49082
B) C25.8, 49083
C) C25.9, 49083
D) C25.3, 49082

Question 9

Pre-op diagnosis: Left lung abscess
Post-op diagnosis: Same
Procedure performed: Left upper lobectomy with decortication and drainage
Indications: The patient is a 56-year-old female with evidence of a left upper-lobe abscess seen on the MRI. She was admitted with tension pneumothorax, which was treated with double-lumen intubation and a chest tube.
Procedure: The patient was brought to the operating room and placed in the supine position, with general intubation from the double-lumen tube. The patient was rolled onto the right lateral decubitus position, with left side up. A posterior lateral thoracotomy was performed. Adhesions were taken down sharply and bluntly and with cautery. Following this a standard artery first left upper lobectomy was carried out utilizing 0 silk and hemoclips. The left upper pulmonary vein was secured with a single application of the stapling machine. The posterior fissure was created with multiple applications of the automatic stapling machine and the bronchus secured with a single application of the bronchus stapling machine. Following this the wound was drained with three 24-French strium chest tubes and hemostasis obtained with spray Tisseel and surgical gauze. The bronchus was sealed with bio glue and the wound closed in layers. A sterile compression dressing was applied, and the patient was returned to the surgical intensive care unit after the double-lumen tube was changed to a single-lumen tube. The patient received 3 units of packed cells intraoperatively to maintain hemostasis. Sponge count and needle count correct × 2. Large abscess in the left upper lobe accounted for approximately 70% of the left upper-lobe parenchyma.
Select the appropriate ICD-10-CM and CPT code(s):

A) J85.2, 32503
B) J85.2, J93.83, 32320, 32480-LT
C) J85.2, 32480-LT
D) J85.2, J93.83, 32482-LT

Question 10

Procedure performed: Fiber-optic bronchoscopy, bronchial biopsy, bronchial washings, and bronchial brushings
Preprocedure diagnosis: Abnormal chest x-ray
Postprocedure diagnosis: Inflammation in all lobes, pneumonia; with pleural placquing? consistent with possible candidiasis
The patient was already on a ventilator, so the bronchoscope tube was introduced through the ET tube. We saw 2.5 cm above the carina of the trachea, which was red and swollen as was the carina. The right lung: All entrances were patent, but they were all swollen and red, with increased secretions. The left lung was even more involved, with more swelling and more edema and had bloody secretions, especially at the left base. This area from the carina all the way down to the smaller airways on the left side had shown white placquing consistent with possible candidiasis. These areas were brushed, washed, and biopsied. A biopsy specimen was also sent for tissue culture, as well as two biopsy specimens sent for pathology. Sheath brushings were also performed. The patient tolerated the procedure well and was sent back to the ICU.
Select the appropriate ICD-10-CM and CPT code(s):

A) R93.0, J18.9, 31625
B) R93.0, J18.9, B37.9, 31625
C) J18.9, 31625, 31623-51
D) J18.9, B37.9, 31625

Question 11

Preoperative diagnosis: Respiratory insufficiency
Postoperative diagnosis: Respiratory insufficiency
Operation: Tracheostomy with division of thyroid isthmus
Estimated blood loss: Less than 10 mL
Fluids: Crystalloid
Complications: None
Technique: The patient was brought to the operating room and placed in the supine position. He was given general anesthesia through his existing oral intubation tube. The anterior neck was prepped and draped in the usual sterile fashion. Lidocaine 1% with 1:100,000 epinephrine was infiltrated into the skin at the lower neck.
A transverse incision was made at the cricoid ring level through skin and subcutaneous fat. The platysmal layer was traversed, and then the strap muscles were separated in the midline. The thyroid isthmus was ligated and divided with #2-0 silk ligatures. An inferiorly based tracheostomy flap was created using the second and third tracheal rings and sewn into place with a #3-0 chromic stitch to the inferior dermis margin.
Hemostasis was achieved using suction cautery. At this point, the oral intubation tube was withdrawn, and a #8 Shiley low-pressure cuffed tube was passed into the newly created trach site. The trach ties were tied securely into place, and the cuff was inflated to a comfortable pressure. The patient then received further ventilation through the newly placed trach tube. The patient was then allowed to awaken from general anesthesia and was taken back to the ICU in stable condition.
Select the appropriate ICD-10-CM and CPT code(s):

A) R06.9, 31605
B) R06.89, 31605, 60200
C) R06.89, 31600
D) R06.89, 31502, 60200

Question 12

Preoperative diagnosis: Left perihilar mass
Postoperative diagnosis: Left perihilar mass, mucosal abnormality in the posterior subsegment of the left upper lobe
Procedure performed: Bronchoscopy, transbronchial lung biopsy and bronchial lung biopsy, brushing and washing
Assistant: None
Anesthesia: MAC
Description of procedure: With the patient in the supine position, under monitored anesthesia care, the scope was introduced through the mouth, and the larynx and the laryngeal area were inspected. All of them were normal. The scope was then inserted through the trachea into the carina, which was sharp and clear. There was a moderate amount of thick-thin secretions that were suctioned through both right and left main bronchi. The scope was then directed into the right main bronchus, and then the right upper-lobe bronchus with its subsegments was inspected. All of them were normal. Right middle-lobe and right lower-lobe bronchi with their subsegments were also inspected and were normal. The scope was then directed into the left side, where the left main bronchus was normal. Left lower-lobe and middle-lobe bronchi with their subsegments were normal. The left upper-lobe bronchus, anterosuperior segment, showed an anterior subsegment to have a bulging in one of its subbronchi. Under fluoroscopy, biopsy forceps were inserted, and several pieces of lung tissue were obtained from the area of the left perihilar lesion. Then brushing was done in the same area. Washing was also done in the same area. Then, in a separate container, several pieces of bronchial tissue were taken from the area that was bulging, anterosuperior subsegment of the left upper-lobe bronchus. All specimens were submitted for cytology, pathology, and/or culture. The patient tolerated the procedure well, with no apparent complications. Chest x-ray is pending.
Select the appropriate ICD-10-CM and CPT code(s):

A) R91.8, C34.90, 31628, 31620
B) R91.8, 31628, 31623-51
C) R91.8, 31628, 00635
D) R91.8, C34.90, 31629

Question 13

Procedure: Permanent pacemaker implantation
Indication for the procedure: Sick sinus syndrome with decreased mentation and confusion
Description of the procedure: After a detailed description of the procedure, indications, and potential risks of permanent pacemaker implantation was given to the patient as well as the patient's daughter, informed consent was obtained. The patient was transferred to the cardiac catheterization lab. A left subclavian area was prepared and draped in the usual sterile manner, and the left subclavian vein was accessed by Seldinger technique. A guidewire was placed. The left subclavian vein was accessed, and a separate guidewire was also placed.
Following this, a deep subcutaneous pacemaker pocket was created using the blunt dissection technique without any excessive bleeding.
Following this, a French-7 introducer sheath was advanced over the guidewire, and the guidewire was removed. A Medtronic bipolar endocardial lead, model #5054 and serial #LEH025605V, was advanced under fluoroscopic guidance, and the tip of the pacemaker lead was positioned in the right ventricular apex.
Following this, the French-9.5 introducer sheath was advanced over a separate guidewire under fluoroscopic guidance, and the guidewire was removed.
Through this sheath, a bipolar atrial screw-in lead by Medtronic, model #4568, was selected. It was positioned in the right atrial appendage, and the lead was screwed in.
Following this, the stimulation thresholds were obtained for the atrial lead. The amplitude was millivolts (mv) of resistance of 549 ohms, with pulse rate of 0.5 ms.
Following the ventricular stimulation, threshold perimeters were obtained, including R-wave entry of 4.6 mv with resistance of 1,427 ohms, with a pulse wave of 0.5 ms. Minimum-stimulation threshold voltage was 0.4 volt for the ventricular lead, and minimal-stimulation voltage was 2 volts for the atrial lead.
Select the appropriate ICD-10-CM and CPT code(s):

A) I49.5, 33207
B) I49.5, 33202, 33212
C) I49.8, 33210
D) I49.5, 33208

Question 14

Preoperative diagnosis: Carcinoma of the lung with right neck metastasis
Postoperative diagnosis: Carcinoma of the lung with right neck metastasis
Operative procedures: Cervical esophagoscopy, microlaryngoscopy, and biopsy
Procedure and findings: With the patient under general anesthesia, the 10I 14 × 23 Roberts esophagoscope was passed. It was noticed that the left piriform sinus was of normal appearance. There was edema of the free tip of the epiglottis. The scope was advanced through the left piriform sinus into the cervical esophagus, and the cervical esophagus and postcricoid area were essentially normal. Also, the upper cervical esophagus was normal. The scope was slowly withdrawn through the right piriform sinus. It was noticed that there was a tumor involving the anterior wall of the right piriform sinus, extending approximately 1 cm below the pharyngeal epiglottic fold. This tumor then also involved the lateral hypopharyngeal wall to a minor degree. The scope was removed.
The Dedo microlaryngoscope was passed. It was now noticed that the above findings were further defined. It was noticed that there was an exit through the tumor involving the vallecula on the right side going into the base of the tongue for a distance of approximately 0.5 cm. This tumor was quite exophytic, and it extended laterally above the pharyngeal epiglottic fold, extending, therefore, approximately 0.75 cm to the lateral hypopharyngeal wall. It also involved heavily the medial wall of the right piriform sinus without crossing over onto the laryngeal surface of the epiglottic fold. The vocal cords were of normal appearance. The right vocal cord was fixed in the midline. Inferiorly the tumor extended onto the medial wall of the piriform sinus just about 0.5 cm below the level of the right vocal cord. The scope was suspended. These findings were confirmed, and under 10 × magnification, several biopsies were obtained. The scope was removed. The neck was carefully palpated. The endoscopy had been preceded by a tracheostomy. The patient was initially prepared with Betadine solution and draped in the usual manner. A horizontal incision was made approximately 2 cm above the sternal notch and carried through the subcutaneous tissue down to the strap muscles. The strap muscles were divided in the midline. The cricoid cartilage was identified, the trach ties were tied securely into place, and the cuff was inflated to a comfortable pressure. The patient then received further ventilation through the newly placed trach tube. The patient tolerated all procedures well.
Select the appropriate ICD-10-CM and CPT code(s):

A) C79.89, C34.10, 31536, 43200-59, 31600-59
B) C34.11, C79.89, 43200, 31541
C) C34.11, C79.2, 31541, 43200
D) C34.11, C79.2, 43202

Question 15

Arteriogram: Left Renal Artery Stenosis
Procedure in detail: The procedure, indications, possible complications of an abdominal aortogram, and possible renal arteriogram were discussed with the patient. The patient agreed to have the procedure done and signed the consent.
Under sterile technique with fluoroscopy control, a vascular sheath was introduced in the right common femoral artery using the Seldinger technique. Through this sheath, a 5-French pigtail catheter was introduced and placed at the proximal abdominal aorta. Flush aortogram followed, and a digital subtraction study of the abdominal aorta, by placing the catheter close to the renal artery origin, was performed.
Evidence of mild atheromatous plaque disease involving the infrarenal abdominal aorta, causing focal dilation, is seen. No significant stenosis is noted at the aortic bifurcation.
The celiac axis, including the splenic artery, gastroduodenal artery, and hepatic artery, is normal.
On the right side, the renal artery is normal in caliber, without any significant stenosis. Segmental arteries are normal. Contrast nephrogram is also uniform.
On the left side, there is segmental narrowing at the origin of the left renal artery. The narrowed segment is approximately 2 cm in length, with the narrowing more than 50% to 60% seen. No significant distal stenotic dilation of the renal artery is seen. Segmental arteries of the left renal artery are normal. Nephrogram of the left kidney is also normal.
Since the digital subtraction study was done with stenosis analysis, left renal artery stenosis is in the range of 50% to 65%. Hence, a selective renal arteriogram was not performed.
Impression: A 2-cm stenotic segment involving the origin of the left renal artery with stenosis in the range of 50% to 65% is noted. Segmental arteries of the left kidney are normal. Nephrogram of the left kidney is also normal.
Select the appropriate ICD-10-CM and CPT code(s):

A) I70.1, 36246-LT
B) I70, 36245 x2
C) I71.1, 36245-50
D) I70.1, 36252

Question 16

Preoperative diagnoses:
1)Sick sinus syndrome, status post-pacemaker insertion.
2)Infected pacemaker with exposed wires.
3)Coronary artery disease with history of coronary artery bypass graft.
4)Essential hypertension.
Postoperative diagnoses:
1)Sick sinus syndrome, status post-pacemaker insertion.
2)Infected pacemaker with exposed wires.
3)Coronary artery disease with history of coronary artery bypass graft.
4)Essential hypertension.
Operations performed:
1)Explant of pacemaker generator and two wires under fluoroscopic guidance and xenon laser.
2)Pocket revision.
3)Intraoperative transesophageal echocardiography with interpretation.
Select the appropriate ICD-10-CM and CPT code(s):

A) Z95.0, I49.5, T82.7S, I25.709, I10, 33233, 33222, 93318
B) T82.7xxS, I49.5, Z95.0, I25.810, I10, 33233, 33222, 93318
C) I49.5, T82.7xxD, I25.709, I10, 33233, 33222, 93318
D) T82.7xxS, I49.5, I25.709, Z95.0, I10, 33233, 33222, 93318

Question 17

Upon orders from Dr. Clyos, a portable x-ray machine was transported to the city nursing home for chest x-rays of a patient with possible tuberculosis. The diagnosis was nodular lesions and patchy infiltrates in the upper lobes. Select the appropriate ICD-10-CM and CPT code(s):

A) A41.9, 71045
B) Z03.89, 71046
C) O12.80, Z03.89, 71045
D) A15.9, Z03.89, 71045

Question 18

CT Scan of the Chest and Adrenals
History: Left pulmonary nodule on chest x-ray
Technique: Helical transaxial images, 7 mm, of the chest were obtained after the administration of oral and intravenous contrast.
Findings: The patient's chest x-rays from February 24 and 25 were reviewed. There is an ill-defined opacity suggested in the left midlung zones on those studies, including oblique views.
Within the left lower lobe laterally, there is an approximately 2-cm area of parenchymal density that has the appearance of interstitial changes without findings of a significant nodule or mass. This finding can relate to scarring. There is no other nodule, mass, or effusion. Within the mediastinum, there is no evidence of adenopathy seen. The heart and great vessels are normal in appearance. There is a suggestion of minimal pericardial thickening anteriorly that is not specific. Osseous structures show degenerative changes with osteophyte formation at multiple levels in the thoracic spine.
Visualized upper abdominal structures, including liver, spleen, kidneys, pancreas, aorta, and para-aortic retroperitoneum, show no specific finding. The adrenal glands are not enlarged.
Impression: There is a small focal area of increased parenchymal density that has an interstitial pattern. There is no significant nodule or mass. This is suggestive of scarring. There is no nodule, mass, effusion, or adenopathy seen. Consider chest x-ray follow-up of this lesion to assess stability.
Select the appropriate ICD-10-CM and CPT code(s):

A) J98.3, 71250
B) J98.4, 71250, 71260
C) J98.4, 71270
D) J98.4, 71260

Question 19

CT Scan of the Abdomen and Pelvis
History: Malignant testicular neoplasm
Technique: Axial CT images of the abdomen and pelvis were obtained with intravenous and oral contrast.
Findings: Images of the lung bases are normal. Images of the abdomen show the liver, spleen, gallbladder, pancreas, and adrenal glands to be normal. No mass is seen. There is no evidence of cholelithiasis. A retroaortic left renal vein is seen. No obvious mass or enlarged lymph nodes are noted in the retroperitoneum. Mesenteric structures appear normal. A prominent inferior vena cava is seen. Gas is identified in the left inguinal structures, likely representing previous left orchidectomy and removal of the inguinal ring. No enlarged lymph node is identified in the pelvis.
Impression: Left retroaortic renal vein is seen. No adenopathy is noted within the abdomen or pelvis. No enlarged lymph node is seen; no mass is identified.
Select the appropriate ICD-10-CM and CPT code(s):

A) Z85.47, 74177 x2
B) Z85.47, 74160, 74150
C) Z85.47, 74150, 74175
D) Z85.47, 74178

Question 20

Examination: Gastric-emptying study
Reason for the examination: This is a study of elimination for gastroparesis, abdominal cramping, and pain.
Interpretation: One millicurie of technetium-99m sulfur colloid was given through a gastrostomy tube in saline. The normal half-time of clearance of liquid material from the stomach is 12 minutes. The patient's clearance is 50 minutes, which is a fourfold increase in time and is compatible with a marked delay in gastric emptying.
Select the appropriate ICD-10-CM and CPT code(s):

A) K31.89, R10.84, 78262
B) K31.819, 78264
C) K31.84, 78264
D) K31.84, R10.84, 78264

Question 21

Thoracic Aortogram with Cerebral Angiography
History: The patient is an 82-year-old man with a thoracic aneurysm and carotid stenosis.
Procedure: A 20-minute consultation was utilized explaining the risks, benefits, and alternatives of angiography. All the patient's questions were answered, and he had given informed consent prior to the procedure. The patient was premedicated with IM Demerol and Phenergan. Buffered lidocaine was used for local anesthesia. Sedation was not required.
A 5-French pigtail catheter was advanced into the aorta via the right femoral artery with the standard Seldinger technique. With the tip of the catheter in the ascending aorta, an aortogram with digital subtraction technique was obtained in the left anterior projection. AP frontal view of the intracranial circulation was also obtained from an arch injection. The catheter was then exchanged over a guidewire for a 5-French Simmons II catheter. The carotid artery and left vertebral artery were selectively catheterized and injected with contrast for digital subtraction filming. In the right common carotid, it was initially difficult to get a stable catheter position, and various combinations of guidewires and a Simmons III catheter were used to obtain selective catheterization. After all images were reviewed, the catheter was removed, and direct pressure was applied to the puncture site until complete hemostasis was achieved.
Total contrast load was 132 cc of Isovue. Fluoroscopy time was 41.5 minutes.
Findings: The ascending aortic arch is dilated and has a more normal diameter just after the left subclavian catheter, and then the descending thoracic aorta enlarges again. There is no evidence of intimal dissection. The origins from the arch are patent. The right carotid bifurcation is slightly irregular; however, no hemodynamically significant stenosis is observed in the right internal carotid. The right external carotid is open. The left external carotid is completely occluded. The left internal carotid has 75% reduction of its cross-sectional area near its origin. On selective injections, it is interesting to note that the right anterior cerebral artery does not fill from the right carotid injection, but both anterior cerebral arteries fill from the left carotid injection. Vertebral arteries are patent. The left vertebral artery is larger. No obvious intracranial abnormality is observed.
Impression: There is 75% stenosis of the left internal carotid. Complete occlusion of the left external carotid. Very mild irregularity of the right internal carotid. Widely patent right external carotid. Both vertebral arteries are patent.
Select the appropriate ICD-10-CM codes.

A) I65.22, I71.2
B) I65.22, I71.4
C) I65.22, I71.3
D) I65.22, I71.1

Question 22

History: A 62-year-old woman (height, 1.7 m; weight, 61 kg) was scheduled for resection of a sigmoid colon carcinoma. Her medical history revealed hypothyroidism, vitamin B12 deficiency, and stiff person syndrome. This syndrome started with low back pain, which rendered her unable to walk. She was experiencing stiffness, involuntary jerks, and painful cramps. Neurologic examination revealed extreme hypertonia of the body and proximal legs, with intercurrent, painful spasms. Reflexes were symmetrical without Babinski signs. Laboratory findings showed positive glutamic acid decarboxylase (GAD) and negative amphiphysin antibodies. The patient was successfully treated with baclofen and diazepam. Subsequently, prednisone as immunosuppressive therapy was started. The stiffness diminished, and the patient was able to walk unaided. The neurologic examination was unremarkable, except for a slight stiffness in the legs. Her medication at admission was prednisone 20 mg once a day, baclofen 12.5 mg twice a day (daily dose = 25 mg), diazepam 7.5 mg twice a day (daily dose = 15 mg), levothyroxine 25 ?g once a day, and vitamin B12 injections. Her medical history included urologic and gynecologic surgery under general anesthesia before she experienced SPS.
Procedure: No premedication was given. Anesthesia was induced with propofol (2.5 mg/kg) and sufentanil (0.25 ?g/kg). After the administration of atracurium (0.6 mg/kg), the trachea was intubated, and anesthesia was continued with isoflurane (0.6-1.0 vol %) and oxygen/air for the duration of the procedure. Cefuroxime 1,500 mg, clindamycin 600 mg, and dexamethasone 10 mg were administered IV. In the following 2 hours, additional atracurium (35 mg), sufentanil (10 ?g), and morphine (8 mg) were administered. At the end of the procedure, which was uneventful, neuromuscular monitoring showed four strong twitches. Although the patient was responsive, she could not open her eyes, grasp with either hand, or generate tidal volumes beyond 200 mL. Neostigmine 2 mg (0.03 mg/kg) and glycopyrrolate 0.2 mg did not alter the clinical signs of muscle weakness.
The patient was sedated with propofol and further mechanically ventilated in the recovery room. After 1 hour, the sedation was stopped and mechanical ventilation was terminated. At that time, baclofen 12.5 mg was administered into the gastric tube. Two hours later she was in a good clinical condition, and her trachea was extubated.
Select the appropriate ICD-10-CM and CPT code(s):

A) C18.7, E09.3, G25.82, 00790
B) C18.7, E03.9, E53.8, G25.82, 00790
C) C18.7, E09.3, G25.82, 00790.
D) C17.8, E03.9, D51.9, G25.82, 00790.

Question 23

History: A 73-year-old 81-kg male with a history of non-Hodgkin's lymphoma and moderate in situ adenocarcinoma of the prostate presents for transurethral resection of the prostate (TURP). The preoperative evaluation reveals a history of smoking (60 pack-years), normal ejection fraction and heart valves, and normal chest x-ray and EKG. No other significant findings.
Procedure: He was taken to the operating room and monitored as per routine for cystoscopy and TURP. After appropriate preoxygenation, general anesthesia was uneventfully induced with fentanyl, propofol, and rocuronium. The patient was intubated, ventilated, and placed in the lithotomy position. The operative procedure was started without difficulty. After 90 minutes, the patient's temperature had dropped from 35.9°C at the beginning of the case to 32.9°C. Blood was sent to the lab due to the length of the surgery. The patient's vital signs were stable. Shortly thereafter the following values were sent back from the laboratory to the operating room: NA 109 mEq/L, K 4.7 mEq/L, CL 83 mEq/L, Glucose 83 mg/dl, Hct 34. The anesthesiologist informed the surgeon about the findings, and the surgery was then stopped. The patient was transferred to the surgical intensive care unit (SICU).
At arrival in the SICU: The patient was still intubated and sedated. The body temperature was 33.5°C. The laboratory measurements revealed NA 107 mEq/L, K 5.7 mEq/L, CL 79 mEq/L, CO2 109 mEq/L, ammonia level of 60 mmol/L, and serum osmolarity of 273. A radial arterial catheter and a central venous catheter were inserted, and rewarming with hot air (Bair Hugger) was initiated.
Select the appropriate ICD-10-CM and CPT code(s):

A) C85.83, D07.5, 00910
B) C85.83, D07.5, 00914, 99100
C) C85.8, D07.5, 00912-53
D) D07.5, Z85.72, 00914-53, 99100

Question 24

Preprocedure diagnosis: Lumbar radiculopathy
Postprocedure diagnosis: Lumbar radiculopathy
Procedure performed: Lumbar epidural steroid injection
Anesthesia given: Local
Indications for procedure: This 53-year-old female presents with symptoms consistent with a lumbar radiculopathy. Previous epidural steroid injections have resulted in significant improvement of her pain. This is the second in a series of three of those injections.
Description of procedure: The patient was placed in the left lateral decubitus position. The L4-5 interspace was identified with deep palpation. Local infiltration was carried out with 3 cc of 1% lidocaine. The area was prepped and draped in the usual sterile fashion. An 18-gauge Tuohy needle was advanced to the epidural space with the loss-of-resistance technique. Then a mixture of Depo-Medrol 80 mg, normal saline 10 cc, and lidocaine 1% at 5 cc was injected. No complications were encountered, and the patient was returned to the outpatient surgery department in stable condition.
Plan: To repeat this procedure in two weeks
Select the appropriate ICD-10-CM and CPT code(s):

A) M54.13, 62320
B) M54.5, 62322
C) M54.16, 62322
D) M54.16, 62320

Question 25

Preoperative diagnosis: Left hip pain and bilateral chest and back pain
Postoperative diagnosis: Left hip pain and bilateral chest and back pain
Procedures: Bilateral lumbar paravertebral sympathetic nerve block under ultrasound guidance.
Left hip greater trochanter bursa injection.
Procedure in detail: All questions were answered. His back was palpated to try to elicit areas of discomfort. This was quite difficult to do, since he said he hurt all over. Of note is that we had looked at his legs, and on his right leg he had an area of excoriation or erythema that was unusual for him, and he stated that his pain seemed to correlate with his edema and erythema of his legs. With this in mind, we turned our attention first to his left hip pain and asked him to move his left hip to where we could elicit a point of maximum tenderness. Point of maximum tenderness was elicited over what appeared to be the greater trochanter of the left hip area itself. We then injected what appeared to be the bursa of the left hip with 10 cc of 0.25% Marcaine with 20 mg of Depo-Medrol. He was then placed in a prone position with a pillow supporting his upper abdomen. In light of his symptoms down his legs, we felt that a lumbar paravertebral sympathetic nerve block was indicated at this time. We identified the spinous process of L2. The midpoint of the spinous process of L2 was marked. A line perpendicular to the spinous process of L2 was then drawn on his skin, and a point that was 1¾ inches from the midline was then marked. The skin at this point was anesthetized with 1.5% lidocaine using a 25-gauge B-bevel needle. This was then followed with a 22-gauge 3½-inch needle that was advanced under a slightly cephalic medial direction, approximately 85 degrees off midline. Under fluoroscopic guidance, the needle was advanced. On the first attempt on the left, we encountered the transverse process of L2. The needle was repositioned left of cephalic, and we were able to bypass the transverse process. The needle was advanced until we encountered the vertebral body of L2 under ultrasound guidance. We then obtained a lateral view and found that indeed we were at the level of the midbody of L2. With this needle felt to be adequately placed, we then injected 6 cc of 0.25% Marcaine with 20 mg of Depo-Medrol. The needle was left in place, and the stylet was replaced.
We then turned our attention to the right-hand side because of the excoriation on his legs and the edema that he said he experiences with increased levels of his pain. The skin was once again marked 1¾ inches from the midline at the midlevel of the spinous process of L2. The skin was anesthetized with 1.5% lidocaine. This was then followed with a 22-gauge 3½-inch spinal needle that was advanced under fluoroscopic guidance. Of note, we made three or four passes in the attempt to approximate the needle next to the vertebral body of L2. Interesting to note is that in order to obtain the maximum view of the spinous process of L2, we were approximately 5 degrees to the right in terms of off midline. Once the 22-gauge 3½-inch spinal needle was placed on the right after several attempts, he did not complain of any paresthesias at this time. We then took a lateral view and found that our needle was not as deep as it should be. We then withdrew the needle, and on ultrasound guidance, using a lateral view, the needle was advanced until it was felt that we were at the appropriate depth. An AP view was then retaken, and we were found to be not at the body of L2 in terms of next to it. The needle was then removed and repositioned in a slightly medial fashion, and it was felt that we encountered bone. We then turned to the lateral view once again and found that we were at this time at the midbody of L2. This was felt to be adequately placed after three attempts. Then 6 cc of 0.25% Marcaine with 20 mg of Depo-Medrol was injected. The needle stylet was then replaced, and we then waited approximately 4 minutes for the Marcaine to set.
We then removed the needles of both the right and the left sides, respectively, and pressure was applied at the skin to prevent any bleeding. He was then placed in the supine position and was discharged home in satisfactory condition. He was instructed to call if he had any changes in edema of his legs.
Select the appropriate ICD-10-CM and CPT code(s):

A) M25.52, R07.9, M54.5, 64520
B) M25.552, R07.9, M54.5, 20610, 0216T-50
C) M25.552, R07.89, M54.5, 0213T
D) M25.552, R07.9, M54.5, 64520-50

Question 26

A 43-year-old male came into the doctor's office to have a hemorrhoidopexy by stapling for his second-degree hemorrhoids. He was very uneasy since he had never had this procedure before. Dr. Hanson administered an IV of Versed, for the anxiety. The procedure is not really painful, so there was no need for a full anesthetic or painkiller. Myrtle Pape, a certified registered nurse anesthetist (CRNA), sat with the patient throughout the procedure to ensure his safety and comfort level. The procedure was complete in one stage, taking 30 minutes.Select the appropriate ICD-10-CM and CPT code(s):

A) K64.1, 46947, 99152, 99153
B) K64.9, 46947
C) K64.1, 46947, 99152 x2
D) K64.9, 46947, 99151, 99153

Question 27

Dr. Willow is called in to administer general anesthesia to a 3-month-old female patient diagnosed with congenital tracheal stenosis. Dr. Gordon performs a surgical repair of her trachea. The patient is released to the recovery room staff in good condition. Select the appropriate ICD-10-CM and CPT code(s) for Dr. Willow:

A) J39.8, 00326, 99100
B) Q32.1, 00326
C) Q32.1, 00320, 99100
D) J39.8, 00320

Question 28

Esther Nelson, a 79-year-old female, came to see Dr. Talbot for a right total-knee arthroplasty due to osteoarthritis of right knee. Dr. Clearwater administered the general anesthesia for the procedure. Esther is in otherwise good health. Select the appropriate ICD-10-CM and CPT code(s) for Dr. Clearwater:

A) M17.11, 01402-P1, 99100
B) M25.9, 01400, 99100
C) M25.9, 01402, 99100
D) M25.569, 01400-P1, 99100

Question 29

Jerry, an established patient, is seen today for evacuation of a subungual hematoma of his left index finger, sustained while hanging a picture. The physician performs a problem-focused history and problem-focused examination to evaluate the extent of the damage and determines that evacuation of the hematoma is needed. He then evacuates the subungual hematoma. Select the appropriate ICD-10-CM and CPT code(s):

A) S60.122A, 11740, 99212-25
B) S60.122, 11750-25
C) S60.112, 11740, 99212
D) S60.121, 11740

Question 30

Sally was seen today for repair of four lacerations following a fall on some broken glass. The physician evaluated and performed simple repair on the following: a 6-cm laceration on the right forearm, a 2.5-cm laceration on the right forearm, a 0.5-cm laceration on the left hand, and a 20-cm laceration on the left upper arm. Select the appropriate ICD-10-CM and CPT code(s):

A) S41.102A, S51.801A, S61.402A, 12006, 12002-RT
B) S41.109A, S51.801A, S61.402A, 12004-RT, 12006-LT
C) S41.102A, S51.801A, S61.402A, 12006
D) S41.102A, S51.821A, S61.402A, 12002-RT, 12006-LT

Question 31

Preoperative diagnosis: Morbid obesity
Postoperative diagnoisis: Morbid obesity
Procedure performed: Abdominal panniculectomy
Estimated blood loss: Throughout the procedure, approximately 20 Ml
Anesthesia: General endotracheal anesthesia
Indications for procedure: This is a 49-year-old female who previously underwent gastric bypass surgery and has lost 120 pounds, leaving a large lower pannus of the abdomen. This pannus needs to be resected. The nonoperative versus operative management options were discussed with the patient. The operative risks included bleeding, infection, hematoma, chance for further surgery as well as pain, and a resulting scar. The patient accepted the risks and consented to surgery.
Procedure in detail: The patient was placed under general endotracheal anesthesia. The patient was draped in the proper manner, and the lower abdominal pannus was identified. It was preoperatively marked prior to going to the OR. The lower incision was made from the superior iliac crest with the middle being the pubic tubercle. That lower incision was then made. The pass was then elevated at the level of the anterior abdominal fascia and was elevated superiorly to the level of the inferior umbilicus. Then incisions were made on the umbilicus to the superior iliac crest, and the skin and subcutaneous pannus was passed off table as a specimen. The wound was then made hemostatic with the use of electrocautery. JP drains were placed. The abdominal skin flap was then brought to the inferior skin flap and sutured in place with 2-0 Vicryl sutures at the dermal level. The drains were then secured, and then the skin was closed with running 3-0 Monocryl suture. The wound was further dressed with Steri-strips, gauze, and abdominal binder. The patient tolerated the procedure well. All needle and instrument counts at the end of the procedure were correct, and the patient was taken to PACU in good condition.
Select the appropriate ICD-10-CM and CPT code(s):

A) E66.0, 15830
B) E65.0, E66.01, 15830
C) E66.01, 15830
D) E66.01, 15830, 13100, 13101

Question 32

A patient presents to his physician today complaining of pain in the left gluteal area. The physician gathers an expanded problem-focused history and performs an expanded problem-focused examination and decision making of straightforward complexity, determining that the cause of the pain is an infected sebaceous cyst in this area. An incision and drainage of the cyst is performed. Select the appropriate ICD-10-CM and CPT code(s):

A) L72.3, 10060, 99213-25
B) L05.01, 10060, 99212
C) L72.1, 10081, 99212-25
D) L05.01, 10080, 99213

Question 33

Mrs. Mustin undergoes insertion of a left custom breast prosthesis 3 months after a mastectomy for breast cancer. The patient needed to undergo radiation to that area prior to the insertion of the prosthesis. Select the appropriate ICD-10-CM and CPT code(s):

A) C50.912, 19430
B) Z85.3, 19342, 19396
C) C50.912, 19430, 19396
D) Z85.3, 19342

Question 34

A patient is sent to the radiology department with an indication of abdominal pain. A KUB is ordered. The coder inputs data that is then transferred to line 21 of the CMS-1500 form, showing ICD-10-CM code R10.11, and line 24 field C showing CPT 74018. Which of the following has the coder demonstrated?

A) None of these
B) Linkage
C) Medical necessity
D) Medical necessity and linkage

Question 35

Mr. Jones, a new patient with a history of prostate cancer 6 years ago, presented today with pain in his lower back and weakness in his extremities. He brought films from x-rays taken earlier in the week and his previous records from his internal medicine physician. The physician takes a comprehensive PMFSH and ROS and performs a comprehensive examination. Based on review of the records and his findings, the physician's diagnosis is metastatic prostate cancer to the sacral vertebrae. The physician discussed treatment options with the patient including risks and benefits. Select the appropriate ICD-10-CM and CPT code(s):

A) C79.51, Z85.46, 99205
B) Z85.46, 99204
C) C79.51, C61, 99204
D) C61, C79.51, 99205

Question 36

Jeremy is seen at the clinic today by his regular physician for a rash on his arm that developed while camping in the woods this past weekend. After the problem-focused history and examination the physician determines that the problem was caused by poison oak, and Jeremy is diagnosed with allergic contact dermatitis and prescribed corticosteroid skin cream to reduce the inflammation. Select the appropriate ICD-10-CM and CPT code(s):

A) L24.7, 99212
B) L23.7, 99211
C) L23.7, 99212
D) L24.7, 99211

Question 37

Patient Infant Male Crowley
I was present, at the request of the delivering physician, at the vaginal delivery at 5:07 p.m. of a male infant 29 weeks' gestation with a spontaneous cry. At the 1-minute mark the Apgar was 5, the decreases were in tone, grimace, and color. An Apgar of 8 was reached at the 5-minute mark, with decreases continued in grimace and tone. The infant was taken to NICU for further management. Upon examination, decreased breath sounds and increased work to breathe were noted. The infant was intubated with difficulty. The patient did tolerate this well.
An umbilical artery catheter was placed without difficulty, and labs were ordered. A chest x-ray and abdominal films were done. Both UAC and the endotracheal tube are in proper placement. The OG has been advanced; the lung fields do show significant granularity. Blood gas is 8.32, PCO2 of 50, PO2 of 102 on a setting of 22/4 rate of 60, and 80% FiO2.
PE: Patient currently is intubated. His weight is 1,706 grams; OFC is 30.5; length is 39.6 cm. Heart rate is in the 120s to 130s. Respiratory rate is 60 on the ventilator; O2 saturation is in the mid-90s. Blood pressure in right arm is 67/34, with a mean of 46, and in right leg is 67/32, with a mean of 44.
Plan: Observation for sepsis
Maternal hypermagnesemia.
Admission to the NICU, continued mechanical ventilation.
Select the appropriate ICD-10-CM and CPT code(s):

A) Z38.00, P22.0, P07.16, P07.32, 99464, 99468
B) P22.0, P07.17, P07.32, P71.8, P00.2, Z38.02, 99468, 99464
C) Z38.00, P22.0, P07.17, P07.32, P00.2, 99468
D) P22.0, P07.15, P07.32, P71.8, P00.2, Z38.01, 99468

Question 38

A 76 year old female is admitted for IV antibiotic therapy to treat pneumonia due to pseudomonas bacteria and a level 3 initial inpatient visit was provided. On days 2 and 3, the patient had not yet responded to treatment as noted after an expanded problem-focused exam and history. On day 4, the patient showed significant improvement and the physician recorded a problem-focused history and exam. On day 5, the patient was discharged to home and the physician spent 30 minutes in discharge day management. Select the appropriate CPT codes for the physician visits from the admit to the discharge.

A) 99223, 99232, 99231, 99231, 99238
B) 99222, 99232, 99231, 99238
C) 99223, 99232, 99232, 99231, 99238
D) 99223, 99232, 99232, 99232, 99238

Question 39

Dr. Black, a cardiologist, today is seeing Mrs. Smythe, a 72-year-old Medicare patient, at the request of her internist regarding her chronic atrial fibrillation. After a comprehensive history, comprehensive cardiology-specific examination, and decision making of moderate complexity, Dr. Black prescribes some adjustments to her medications and sends a letter to her internist with his findings and suggested follow-up. Select the appropriate CPT and ICD-10-CM codes.

A) I48.1, 99245
B) I48.2, 99204
C) I48.2, 99244
D) I48.9, 99205

Question 40

Dr. Green works for a house-call physician service. She was called to evaluate a new patient, an 88-year-old bedridden woman who has developed a painful rash on her posterior left side of the trunk, extending from C6 to C7 around the right side and ending midline on the anterior trunk just below the sternum. The physician performs a detailed history and a detailed examination and medical decision making is of low complexity. She diagnoses the patient with shingles. Select the appropriate codes.

A) R21, 99204
B) B02.9, 99343
C) B02.9, 99342
D) B02.9, 99203

Question 41

Dr. Mathis has been called to the ICU to provide care for a 37-year-old male patient who has received second-degree burns over 50% of his body. Dr. Mathis provides support from 1 p.m. to 3 p.m. After leaving the unit to do his rounds, Dr. Mathis is called back around 5 p.m., and he provides critical care support to the patient until 6 p.m. Select the appropriate CPT codes.

A) 99291 x3
B) 99291, 99292 x5
C) 99291 x2, 99292
D) 99291, 99292 x4

Question 42

A 50-year-old male patient presents to the office today for his annual preventive visit. During the visit, Dr. Jones becomes concerned about the patient's hypertension and believes that this needs some evaluation and management beyond the preventive visit. Dr. Jones changes the patient's medications and orders lab work. Which modifier would be reported to the payer in order to be reimbursed for both the preventive visit and the office visit?

A) 24
B) 51
C) 76
D) 25

Question 43

June was admitted to the hospital with atrial fibrillation by her PCP, and cardiology was consulted at the time of admission. On the next day, the cardiologist made rounds and checked on Mary's progress. An expanded problem-focused interval history was obtained, and an expanded problem-focused exam was performed. Mary has been on IV therapy and is showing improvement. Select the code for the cardiologist encounter on the second day.

A) 99232
B) 99213
C) 99253
D) 99233

Question 44

An abnormal hump caused by increased convexity of the thoracic spine is called:

A) Osteopenia
B) Scoliosis
C) Lordosis
D) Kyphosis

Question 45

Which term pertains to the heart muscle?

A) Myocardium
B) Carditis
C) Presbyopia
D) Peritoneal

Question 46

The area between the lungs that contains the heart, aorta, venae cavae, esophagus, and trachea is the:

A) Upper abdominal
B) Mediastinum
C) Thoracic cavity
D) Pleural cavity

Question 47

One of the largest veins in the body is the:

A) Renal vein
B) Biliary duct
C) Jugular vein
D) Vena cava

Question 48

The medical term for air in the pleural cavity is:

A) Visceral pleuritis
B) Pneumoperitoneum
C) Pneumothorax
D) Hemothorax

Question 49

S: A 46-year-old male who was in a car accident presents for a prosthetic spectacle.
O: HEENT is unremarkable. Monofocal measurements are taken, and data for the creation of an appropriate prosthesis are recorded.
A: Aphakia, left eye.
P: Return in 10 days for a final fitting.
Select the appropriate ICD-10-CM and CPT code(s):

A) H27.01, 92340
B) H27.01, 92352
C) H27.02, 92352
D) H27.02, V82.2xxA, 92354

Question 50

Procedure performed: Left-sided heart catheterization, selective coronary angiography, and left ventriculography
Indication: Chest pain and abnormal Cardiolite stress test
RESULTS
Hemodynamics: The left ventricular pressure before the LV-gram was 117/1 with an LVEDP of 4; after the LV-gram it was111/4 with an LVEDP of 10. The aortic pressure on pullback was 111/17.
Left ventriculography: The left ventriculography showed that the left ventricle was of normal size. There were no significant segmental wall motion abnormalities. The overall left ventricular systolic function was normal, with an ejection fraction of better than 60%.
Selective coronary angiography:
A. Right coronary artery: The right coronary artery is a medium- to large-size dominant artery that has about 80% to 90% proximal/mideccentric stenosis. The rest of the artery has only mild surface irregularities.
B. Left main coronary artery: The left main has mild distal narrowing.
C. Left circumflex artery: The left circumflex artery is a medium-size, nondominant artery. It gives rise to a very high first obtuse marginal/intermedius, which is a bifurcation medium-size artery that has only mild surface irregularities. The second obtuse marginal is also a medium-size artery that has about 20% to 25% proximal narrowing. After that second obtuse marginal, the circumflex artery is a small-size artery that has about 20% to 30% narrowing, a small aneurismal segment.
D. Left anterior descending coronary artery: The left anterior descending artery is a medium-size artery that is mildly calcified. It gives rise to a very tiny first diagonal that has mild diffuse atherosclerotic disease. Right at the origin on the second diagonal, the LAD has about 30% narrowing. The rest of the artery is free of significant obstructive disease. The second diagonal is also a small-caliber artery that has no significant obstructive disease.
Conclusion: Severe single-vessel atherosclerotic heart disease
Select the appropriate ICD-10-CM and CPT code(s):

A) R07.9, R94.39, 93545, 78635.
B) I25.110, 93458
C) R94.30, I25.110, 93458
D) R07.9, R94.30, 93454, 78635

Question 51

Bilateral Doppler Study: Carotid Arteries
Indications: Status post-carotid endarterectomy imaging. The patient states that he was told that the right carotid artery is blocked. The right internal carotid artery is not identified, probably completely blocked.
Velocity measurements on the right side:
Common carotid artery: 58.9 cm/sec
Right external carotid: 142 cm/sec
Right vertebral: 44 cm/sec and showing antegrade flow
Velocity measurements on the left side:
Common carotid artery: 35 cm/sec
Carotid bulb: 60 cm/sec
Internal carotid: 52 cm/sec
External carotid: 236 cm/sec
Left vertebral: 55 cm/sec
Status postendarterectomy changes are noted in the left internal carotid and the bulb. There is evidence of ectasia. On the right, the common carotid artery shows ectasia.
Judging from the velocity measurements, the right internal carotid artery has a stenosis in the range of 50% to 79%.
The left internal carotid artery has a stenosis in the range of 16% to 49%. The left external carotid artery is in the range of 50% to 79%.
Impression: The right internal carotid artery is completely occluded. Status postendarterectomy changes in the left internal carotid and the bulb are noted. No significant occlusive disease is seen in the left internal carotid artery. Both vertebral arteries are showing antegrade flow.
Select the appropriate ICD-10-CM and CPT code(s):

A) Z09, 93880
B) I65.22, Z98.89, 0126T
C) Z09, 93882
D) I65.21, Z98.890, 93880

Question 52

Holter Monitor Report
History: This is a 36-year-old male referred for evaluation of syncope episodes and dizziness. He also has a history of depression and anxiety.
A Holter monitor was placed on April 2 for 24 hours. Recording revealed sinus rhythm with three VPCs and three isolated APCs. There were no SVTs, no VTs, and no pauses. The patient had multiple complaints of dizziness, anxiety, panic, and feeling near syncopal. Rhythms at these times documented normal sinus rhythm at rates between 80 and 104 beats per minute. No significant arrhythmias.
Impression: Normal Holter
Select the appropriate ICD-10-CM and CPT code(s):

A) R55, R42.2, 93225
B) R55, R42, 93224
C) R55, R42, 93226
D) R55, R42, 93227

Question 53

A 55-year-old female was having a problem with menopause. Because of the reported concerns about hormone replacement therapy, she decided to try acupuncture. After discussing her symptoms and discussing a treatment plan, Dr. Kind inserted several needles; the needles were removed 20 minutes later. Dr. Kind reviewed the follow-up plan and made an appointment for the patient's next visit. Dr. Kind spent 30 minutes in total face-to-face with Charlene. Select the appropriate ICD-10-CM and CPT code(s):

A) N95.1, 97810, 97811
B) N95.1, 97810, 97811 x3
C) N95.1, 97810, 97811 x2
D) N95.1, 97810, 97813, 97814 x2

Question 54

This is a new 35-year-old male who is experiencing a piercing ringing sound in his left ear that began 6 months ago. The ringing interferes with his daily life, and he has problems sleeping. The patient is taken to a testing suite for a bilateral tinnitus assessment; pitch frequency matching loudness and masking procedures are included. The findings of the testing indicate a positive determination of tinnitus, acute tinnitus. Follow-up masking therapy scheduled. Select the appropriate ICD-10-CM and CPT code(s):

A) H93.1, 92625, 92562
B) H93.12, 92625
C) H93.12, 92625-52
D) H93.1, 92558

Question 55

A 36-year-old female who was the driver in a car accident presented with whiplash for chiropractic manipulative treatment of her cervical spine. The chiropractor provided a complete history and examination prior to the treatment plan of one visit a week for 2 months, at which point her status will be reevaluated. Today the first manipulation was performed. Select the appropriate ICD-10-CM and CPT code(s):

A) S13.4xxA, V49.40xA, 99213, 98940
B) S13.4xxA, V49.40xA, 98940
C) S13.4xxA, 98940
D) S13.4xxA, 99213, 98940

Question 56

A 75-year-old female recently underwent a stroke assessment of her aphasia. The following assessments were performed using Boston diagnostic aphasia examination: expressive and receptive speech, language function, language comprehensive, speed production ability, reading, spelling, and writing skills. Total time 60 minutes. Select the appropriate ICD-10-CM and CPT code(s):

A) I69.920, 96105
B) R47.01, 96105
C) R47.01, 92502
D) I69.920, 92511

Question 57

Preoperative diagnosis: Left hydrocele
Postoperative diagnosis: Left hydrocele
Procedure performed: Left hydrocelectomy
Procedure description: The initial incision was made, and the left hydrocele was delivered out of the wound and incised. The hydrocele was emptied of about 500 mL and then incised completely. About 90% of the hydrocele sac was removed with the Bovie. The hydrocele sac was involuted and sewn to itself using running 3-0 Vicryl in the manner of Jaboulay. The testicle was replaced in the left scrotum, and the patient tolerated the procedure well.
Select the appropriate ICD-10-CM and CPT code(s):

A) N43.3, 55040-LT
B) N43.2, 55000-LT
C) N43.3, 55060-LT
D) N43.0, 55041-LT

Question 58

The patient is seen in the OB/GYN office for follow-up postpartum. She had been seen by her previous physician throughout her pregnancy, but has relocated since the normal vaginal delivery of her daughter 6 weeks ago. Select the appropriate ICD-10-CM and CPT code(s):

A) Z39.2, 59430
B) Z39.0, 59426
C) Z39.2, 59400
D) Z39.2, 59514

Question 59

A 28-year-old patient was seen today for her annual physical exam by her OB/GYN. After discussion with the physician, the patient expressed her decision to have her IUD removed as she and her husband are ready to begin a family. This procedure was performed at this visit. Select the appropriate ICD-10-CM and CPT code(s):

A) Z00.12, Z30.432, 99295-25, 58301
B) Z00.00, Z30.432, 99294-25, 58301
C) Z00.01, Z30.432, 99394-25, 58301
D) Z00.00, Z30.432, 99395-25, 58301

Question 60

Mary was seen today for a surgical hysteroscopy with lysis of intrauterine adhesions. Select the appropriate ICD-10-CM and CPT code(s):

A) N85.9, 58560
B) N85.6, 58559
C) N85.6, 58555
D) N85.8, 58558

Question 61

A patient underwent fine-needle aspiration without imaging guidance of a thyroid cyst. Select the appropriate ICD-10-CM and CPT code(s):

A) E04.1, 60200
B) E04.0, 60100
C) E04.1, 10021
D) E04.1, 10005

Question 62

Preoperative diagnosis: Right subdural hematoma
Postoperative diagnosis: Right subdural hematoma
Procedure performed: Right temporoparietal craniotomy for evacuation of subdural hematoma
Anesthesia: General endotracheal
Complications: None
Conditions: Stable
Indications for procedure: Mr. Green is a 45-year-old male with a known history of alcoholism. He reported falling today, with loss of consciousness for about 20 minutes. Upon arrival at the ED, he was minimally responsive, with some spontaneous movement on the right side. He was intubated and taken to CT, which demonstrated a large right temporal subdural hematoma with 2.5-cm midline shift and effacement of the right lateral ventricle.
Description of procedure: The patient was brought to the OR already intubated. General anesthesia was induced. He was given Ancef for preoperative prophylactic IV antibiotics. Lacri-Lube was placed in both eyes, which were then taped shut. A Foley was placed. The patient was positioned supine on the operating room table with the right side elevated with a gel roll. The head was secured in the three-point Mayfield head-holder with the right side up. All pressure points were inspected and padded adequately. The patient's scalp was clipped, prepped, and draped in standard sterile surgical fashion. Local anesthetic was infiltrated along the line of the planned skin incision. A right temporoparietal inverted-question-mark incision was performed with a #10 blade down to the level of the periosteum. The scalp flap, along with the muscle and periosteum, was elevated and reflected anteriorly and held in place with fishhooks. Raney clips were applied to the skin edges. Using the high-speed Midas Rex drill with the perforator bit, burr holes were placed in the temporoparietal region, and they were connected with the B1 and footplate. The bone flap was elevated from the dura and set aside. The underlying brain appeared to be tense. The dura was opened with a 15-blade, and a large amount of subdural hematoma was immediately released. The subdural space was copiously irrigated, and hemostasis was achieved.
Select the appropriate ICD-10-CM and CPT code(s):

A) S06.5x3A, 61314
B) S06.5x4A, 61314
C) S06.5x1A, 61314
D) S06.5x2A, 61314

Question 63

George presented with chronic intractable pain of unknown origin in his left leg. The neurologist used stereotaxis to create a lesion in the spinal cord in order to attempt to block the pain and provide sustainable relief. Select the appropriate ICD-10-CM and CPT code(s):

A) M79.605, 63620
B) M79.602, 65222
C) M79.605, 63600
D) M79.604, 65220

Question 64

The patient was seen for complaints of persistent cluster headaches and blurring vision. As part of the workup, a lumbar puncture was performed, the pressure of the spinal fluid was measured, and some fluid was removed for analysis. Select the appropriate ICD-10-CM and CPT code(s):

A) G44.001, 62270
B) G44.001, 62272
C) G44.009, 62270
D) G44.009, 62272

Question 65

Sam, a welder, was seen today by the ophthalmologist for removal of a welding flash from his left eye. The flash had caused a nonperforating tear in the cornea. The ophthalmologist removed the flash and repaired the cornea. Select the appropriate ICD-10-CM and CPT code(s):

A) T15.02A, 65222, 65275
B) T15.02XS, 65220
C) T15.02XD, 65220, 65275
D) T15.02XA, 65275

Question 66

A patient underwent tympanoplasty with a mastoidectomy and ossicular chain reconstruction for removal of a cholesteatoma of the right ear Select the appropriate ICD-10-CM and CPT code(s):

A) H71.92, 69637
B) H71.91, 69642
C) H71.92, 69643
D) H71.91, 69641

Question 67

Section: Kidney (left): Adenocarcinoma
MACROSCOPIC
Specimen type: Radical nephrectomy
Laterality: Left
Tumor site: Upper pole
Focality: Unifocal
Tumor size: Greatest dimension is 7.2 cm.
Macroscopic extent of tumor: Tumor extends into major veins.
MICROSCOPIC
Histologic type: Clear cell (conventional) renal carcinoma
Histologic grade: Furhman Nuclear Grade 2
PATHOLOGIC STAGING (pTN)
Primary tumor (pT): pT3
Regional lymph nodes (pN): Nx
Number of lymph nodes examined: 0
Number of lymph nodes involved: 0
Margins: Renal vein margin positive
Adrenal gland: Unevolved
Venous (large vessel) invasion (V) (excluding renal vein and inferior vena cava): Negative
Lymphatic (small vessel) invasion (L): Present
Additional pathologic findings: Chronic glomerulonephritis present in noninvolved renal parenchyma
Clinical history: A 76-year-old male with a left renal mass in the upper pole; hematuria
Gross description section: Received in formalin, labeled "left kidney," is a 12.2- × 7.1- × 2.5-cm kidney with unremarkable perirenal fat present at the upper pole (suture oriented, per requisition). A 2.3 cm in length segment of ureter exits from the hilum. The renal vein appears occluded. The cut sections demonstrate a 7.2- × 1.5- × 1.5-cm brown-orange circumscribed tumor with sharp borders present in the upper pole. Gerota's fascia appears uninvolved. The tumor extends into the renal vein; the venous margin appears positive for tumor.
Microscopic section: Microscopic examination was performed.
Select the appropriate ICD-10-CM and CPT code(s):

A) C64.9, 88307-LT
B) C64.9, N08, 88307-LT
C) C64.2, N03.9, 88307
D) C64.8, 88307

Question 68

History: The patient is a 79-year-old male with dyspepsia and weight loss. A recent supraclavicular lymph node biopsy revealed signet-ring cell adenocarcinoma.
Specimen site: Stomach
Gross description: Received in formalin is a 10.0- × 6.5- × 3.2-cm segment of stomach, with a palpable firm 4.0- × 2.2-cm mass on the designated lesser curvature. The external surface of the specimen is unremarkable and inked black. The cut surfaces demonstrate the mass and adjacent firm areas of nodularity. The remainder of the gastric mucosa is unremarkable. Six lymph node candidates and representative sections of the stomach are submitted.
Microscopic description: Microscopic examination was performed. See synoptic report. The uninvolved stomach shows chronic inactive gastritis with intestinal metaplasia.
Diagnosis: Stomach (proximal): Invasive adenocarcinoma
Comment: Signet-ring cell carcinomas are not typically graded but are high-grade and would correspond to grade 3.
Select the appropriate ICD-10-CM and CPT code(s):

A) C16.9, K30, R63.4, 88309
B) C16.9, 88309, 88307 x6
C) C16.9, K30, 88309 x2
D) C16.5, 88309, 88307

Question 69

Specimen site: Cervical biopsy
Pre-operative Diagnosis: Severe squamous dysplasia, consistent with CIN III (high-grade dysplasia)
Gross description: Cervical biopsy: One fragment of gray-white tissue, measuring 0.5 centimeters in diameter. Totally submitted with a request for levels. Submitted request for stains.
Microscopic description: Sections of the cervical biopsy show high-grade dysplasia, consistent with CIN III. No evidence of invasive malignancy is present.
Select the appropriate ICD-10-CM and CPT code(s):

A) D06.9, 88305, 88312
B) N87.9, 88305, 88312
C) N87.0, 88305
D) D06.9, 88305

Question 70

Specimen site: Right medial cheek
Specimen site: Left dorsal hand
Gross description: Right medial cheek: The specimen is one gray-white fragment measuring 0.3 × 0.2 cm. Totally submitted in one cassette with a request for levels labeled "A."
Left dorsal hand: The specimen is one gray-white fragment measuring 0.3 × 0.3 cm. Totally submitted in one cassette with a request for levels labeled "B."
Microscopic description: The right medial cheek shows atypical keratinocytes within the entire thickness of the epidermis extending to the stratum corneum. The lesion appears to have been excised. The dermis shows elastosis.
The dorsal hand shows hyperkeratosis. The epidermis is mildly acanthotic. There is extensive dermal elastosis.
Final diagnoses:
1) Right medial cheek, biopsy:
? Squamous cell carcinoma in-situ. (See comment.)
2) Left dorsal hand, biopsy:
? Dermal elastosis.
? No malignant changes seen.
Comment: The lesion from the cheek appears to reside within the confines of the histologic section. The skin lesion shows no invasive malignancy.
Select the appropriate ICD-10-CM and CPT code(s):

A) C41.10, L85.0, 88305, 88305
B) C41.10, L87.2, 88304 x2
C) D04.39, L87.2, 88305 x2
D) C41.10, L85.0, 88305

Question 71

Specimen site: Gastric biopsy
Gross description: Gastric biopsy: Received in formalin, the specimen consists of two fragments of gray-brown mucosa, each measuring approximately 0.3 centimeter in diameter. Totally submitted for routine and special stains and additional levels.
Microscopic description: Sections show benign-appearing gastric mucosa with acute and chronic inflammatory cells within the lamina propria. The surface and pit-lining epithelium are also infiltrated with neutrophils. There is no dysplasia or malignancy. Special stains for H. pylori are positive.
Final diagnosis:
Gastric biopsy:
? Chronic active gastritis.
? Warthin-Starry stain positive for H. pylori.
? Negative for intestinal metaplasia, dysplasia, or malignancy.
Select the appropriate ICD-10-CM and CPT code(s):

A) K29.50, B96.81, 88305, 88312
B) K29.40, B96.81, 88305x2, 88312 x2
C) K29.40, B96.81, 88305
D) K29.40, B96.81, 88305 x2

Question 72

History: 76-year-old female with colonic mass
Diagnosis: Invasive adenocarcinoma, 3.4 × 3.0 cm, involving muscularis propria
All margins negative.
No lymphatic invasion.
No metastatic tumor identified.
Gross description: Received fresh is a right colon, 32 cm in length. Upon opening of the specimen, there is a 3.4- × 3.0-cm nodular mass. 36 lymph nodes were retrieved. Representative sections are submitted.
Microscopic description: Microscopic examination performed
Select the appropriate ICD-10-CM and CPT code(s):

A) C18.6, 88309
B) C18.7, 88309
C) C18.2, 88309
D) C18.9, 88308

Question 73

Diagnosis: Stomach (distal): Invasive adenocarcinoma
Gross description: Received in formalin two specimens, 9.0- × 5.5- × 4.3- cm and 2.0- × 1.5- × 3.4-cm segments of the stomach, with a palpable firm 3.0- × 2.5-cm mass on the designated lesser curvature of the larger specimen. The external surfaces of the specimens are unremarkable and inked black. The curved surfaces demonstrate the mass and adjacent firm areas of nodularity. The remainder of the gastric mucosa is unremarkable.
Microscopic description: Microscopic examination was performed. See synoptic report.
Select the appropriate ICD-10-CM and CPT code(s):

A) C19.5, 88309, 88302
B) C16.6, 88307, 88309
C) C16.5, 88309 x2
D) C16.5, 88307

Question 74

History: A 62-year-old woman (height, 1.7 m; weight, 61 kg) was scheduled for resection of a sigmoid colon carcinoma. Her medical history revealed hypothyroidism, vitamin B12 deficiency, and stiff person syndrome. This syndrome started with low back pain, which rendered her unable to walk. She was experiencing stiffness, involuntary jerks, and painful cramps. Neurologic examination revealed extreme hypertonia of the body and proximal legs, with intercurrent, painful spasms. Reflexes were symmetrical without Babinski signs. Laboratory findings showed positive glutamic acid decarboxylase (GAD) and negative amphiphysin antibodies. The patient was successfully treated with baclofen and diazepam. Subsequently, prednisone as immunosuppressive therapy was started. The stiffness diminished, and the patient was able to walk unaided. The neurologic examination was unremarkable, except for a slight stiffness in the legs. Her medication at admission was prednisone 20 mg once a day, baclofen 12.5 mg twice a day (daily dose = 25 mg), diazepam 7.5 mg twice a day (daily dose = 15 mg), levothyroxine 25 ?g once a day, and vitamin B12 injections. Her medical history included urologic and gynecologic surgery under general anesthesia before she experienced SPS.
Procedure: No premedication was given. Anesthesia was induced with propofol (2.5 mg/kg) and sufentanil (0.25 ?g/kg). After the administration of atracurium (0.6 mg/kg), the trachea was intubated, and anesthesia was continued with isoflurane (0.6-1.0 vol %) and oxygen/air for the duration of the procedure. Cefuroxime 1,500 mg, clindamycin 600 mg, and dexamethasone 10 mg were administered IV. In the following 2 hours, additional atracurium (35 mg), sufentanil (10 ?g), and morphine (8 mg) were administered. At the end of the procedure, which was uneventful, neuromuscular monitoring showed four strong twitches. Although the patient was responsive, she could not open her eyes, grasp with either hand, or generate tidal volumes beyond 200 mL. Neostigmine 2 mg (0.03 mg/kg) and glycopyrrolate 0.2 mg did not alter the clinical signs of muscle weakness.
The patient was sedated with propofol and further mechanically ventilated in the recovery room. After 1 hour, the sedation was stopped and mechanical ventilation was terminated. At that time, baclofen 12.5 mg was administered into the gastric tube. Two hours later she was in a good clinical condition, and her trachea was extubated.
Select the appropriate ICD-10-CM and CPT code(s):

A) C18.7, E09.3, G25.82, 00790
B) C18.7, E03.9, E53.8, G25.82, 00790.
C) C18.7, E09.3, G25.82, 00790.
D) C17.8, E03.9, D51.9, G25.82, 00790

Question 75

History: A 73-year-old 81-kg male with a history of non-Hodgkin's lymphoma and moderate in situ adenocarcinoma of the prostate presents for transurethral resection of the prostate (TURP). The preoperative evaluation reveals a history of smoking (60 pack-years), normal ejection fraction and heart valves, and normal chest x-ray and EKG. No other significant findings.
Procedure: He was taken to the operating room and monitored as per routine for cystoscopy and TURP. After appropriate preoxygenation, general anesthesia was uneventfully induced with fentanyl, propofol, and rocuronium. The patient was intubated, ventilated, and placed in the lithotomy position. The operative procedure was started without difficulty. After 90 minutes, the patient's temperature had dropped from 35.9°C at the beginning of the case to 32.9°C. Blood was sent to the lab due to the length of the surgery. The patient's vital signs were stable. Shortly thereafter the following values were sent back from the laboratory to the operating room: NA 109 mEq/L, K 4.7 mEq/L, CL 83 mEq/L, Glucose 83 mg/dl, Hct 34. The anesthesiologist informed the surgeon about the findings, and the surgery was then stopped. The patient was transferred to the surgical intensive care unit (SICU).
At arrival in the SICU: The patient was still intubated and sedated. The body temperature was 33.5°C. The laboratory measurements revealed NA 107 mEq/L, K 5.7 mEq/L, CL 79 mEq/L, CO2 109 mEq/L, ammonia level of 60 mmol/L, and serum osmolarity of 273. A radial arterial catheter and a central venous catheter were inserted, and rewarming with hot air (Bair Hugger) was initiated.
Select the appropriate ICD-10-CM and CPT code(s):

A) C85.83, D07.5, 00910
B) C85.83, D07.5, 00914, 99100
C) C85.8, D07.5, 00912-53
D) D07.5, Z85.72, 00914-53, 99100

Question 76

Preprocedure diagnosis: Lumbar radiculopathy
Postprocedure diagnosis: Lumbar radiculopathy
Procedure performed: Lumbar epidural steroid injection
Anesthesia given: Local
Indications for procedure: This 53-year-old female presents with symptoms consistent with a lumbar radiculopathy. Previous epidural steroid injections have resulted in significant improvement of her pain. This is the second in a series of three of those injections.
Description of procedure: The patient was placed in the left lateral decubitus position. The L4-5 interspace was identified with deep palpation. Local infiltration was carried out with 3 cc of 1% lidocaine. The area was prepped and draped in the usual sterile fashion. An 18-gauge Tuohy needle was advanced to the epidural space with the loss-of-resistance technique. Then a mixture of Depo-Medrol 80 mg, normal saline 10 cc, and lidocaine 1% at 5 cc was injected. No complications were encountered, and the patient was returned to the outpatient surgery department in stable condition.
Plan: To repeat this procedure in two weeks
Select the appropriate ICD-10-CM and CPT code(s):

A) M54.13, 62320
B) M54.5, 62322
C) M54.16, 62320
D) M54.16, 62322

Question 77

Preoperative diagnosis: Left hip pain and bilateral chest and back pain
Postoperative diagnosis: Left hip pain and bilateral chest and back pain
Procedures: Bilateral lumbar paravertebral sympathetic nerve block under ultrasound guidance.
Left hip greater trochanter bursa injection.
Procedure in detail: All questions were answered. His back was palpated to try to elicit areas of discomfort. This was quite difficult to do, since he said he hurt all over. Of note is that we had looked at his legs, and on his right leg he had an area of excoriation or erythema that was unusual for him, and he stated that his pain seemed to correlate with his edema and erythema of his legs. With this in mind, we turned our attention first to his left hip pain and asked him to move his left hip to where we could elicit a point of maximum tenderness. Point of maximum tenderness was elicited over what appeared to be the greater trochanter of the left hip area itself. We then injected what appeared to be the bursa of the left hip with 10 cc of 0.25% Marcaine with 20 mg of Depo-Medrol. He was then placed in a prone position with a pillow supporting his upper abdomen. In light of his symptoms down his legs, we felt that a lumbar paravertebral sympathetic nerve block was indicated at this time. We identified the spinous process of L2. The midpoint of the spinous process of L2 was marked. A line perpendicular to the spinous process of L2 was then drawn on his skin, and a point that was 1¾ inches from the midline was then marked. The skin at this point was anesthetized with 1.5% lidocaine using a 25-gauge B-bevel needle. This was then followed with a 22-gauge 3½-inch needle that was advanced under a slightly cephalic medial direction, approximately 85 degrees off midline. Under fluoroscopic guidance, the needle was advanced. On the first attempt on the left, we encountered the transverse process of L2. The needle was repositioned left of cephalic, and we were able to bypass the transverse process. The needle was advanced until we encountered the vertebral body of L2 under ultrasound guidance. We then obtained a lateral view and found that indeed we were at the level of the midbody of L2. With this needle felt to be adequately placed, we then injected 6 cc of 0.25% Marcaine with 20 mg of Depo-Medrol. The needle was left in place, and the stylet was replaced.
We then turned our attention to the right-hand side because of the excoriation on his legs and the edema that he said he experiences with increased levels of his pain. The skin was once again marked 1¾ inches from the midline at the midlevel of the spinous process of L2. The skin was anesthetized with 1.5% lidocaine. This was then followed with a 22-gauge 3½-inch spinal needle that was advanced under fluoroscopic guidance. Of note, we made three or four passes in the attempt to approximate the needle next to the vertebral body of L2. Interesting to note is that in order to obtain the maximum view of the spinous process of L2, we were approximately 5 degrees to the right in terms of off midline. Once the 22-gauge 3½-inch spinal needle was placed on the right after several attempts, he did not complain of any paresthesias at this time. We then took a lateral view and found that our needle was not as deep as it should be. We then withdrew the needle, and on ultrasound guidance, using a lateral view, the needle was advanced until it was felt that we were at the appropriate depth. An AP view was then retaken, and we were found to be not at the body of L2 in terms of next to it. The needle was then removed and repositioned in a slightly medial fashion, and it was felt that we encountered bone. We then turned to the lateral view once again and found that we were at this time at the midbody of L2. This was felt to be adequately placed after three attempts. Then 6 cc of 0.25% Marcaine with 20 mg of Depo-Medrol was injected. The needle stylet was then replaced, and we then waited approximately 4 minutes for the Marcaine to set.
We then removed the needles of both the right and the left sides, respectively, and pressure was applied at the skin to prevent any bleeding. He was then placed in the supine position and was discharged home in satisfactory condition. He was instructed to call if he had any changes in edema of his legs.
Select the appropriate ICD-10-CM and CPT code(s):

A) M25.552, R07.9, M54.5, 64520-50
B) M25.52, R07.9, M54.5, 64520
C) M25.552, R07.89, M54.5, 0213T
D) M25.552, R07.9, M54.5, 20610, 0216T-50

Question 78

A 43-year-old male came into the doctor's office to have a hemorrhoidopexy by stapling for his second-degree hemorrhoids. He was very uneasy since he had never had this procedure before. Dr. Hanson administered an IV of Versed, for the anxiety. The procedure is not really painful, so there was no need for a full anesthetic or painkiller. Myrtle Pape, a certified registered nurse anesthetist (CRNA), sat with the patient throughout the procedure to ensure his safety and comfort level. The procedure was complete in one stage, taking 30 minutes.Select the appropriate ICD-10-CM and CPT code(s):

A) K64.9, 46947
B) K64.1, 46947, 99152 x2
C) K64.9, 46947, 99151, 99153
D) K64.1, 46947, 99152, 99153

Question 79

Dr. Willow is called in to administer general anesthesia to a 3-month-old female patient diagnosed with congenital tracheal stenosis. Dr. Gordon performs a surgical repair of her trachea. The patient is released to the recovery room staff in good condition. Select the appropriate ICD-10-CM and CPT code(s) for Dr. Willow:

A) J39.8, 00320
B) J39.8, 00326, 99100
C) Q32.1, 00326
D) Q32.1, 00320, 99100

Question 80

Esther Nelson, a 79-year-old female, came to see Dr. Talbot for a right total-knee arthroplasty due to osteoarthritis of right knee. Dr. Clearwater administered the general anesthesia for the procedure. Esther is in otherwise good health. Select the appropriate ICD-10-CM and CPT code(s) for Dr. Clearwater:

A) M25.9, 01400, 99100
B) M17.11, 01402-P1, 99100
C) M25.569, 01400-P1, 99100
D) M25.9, 01402, 99100