Deck 15: Musculoskeletal System

Question 1

Fracture codes are based on:

A)fracture type
B)treatment type
C)diagnosis
D)patient age

Answer 1

treatment type

Question 2

Insertion of a device into the muscle to measure the pressure within the muscle is monitoring of:

A)interstitial fluid pressure
B)electrical flow
C)microvascular pressure
D)stimulation pressure

Answer 2

interstitial fluid pressure

Question 3

A hip replacement is coded based on the:

A)amount of time the surgery takes
B)time it takes to complete
C)medical reasons for the surgery
D)number of surgeons needed to perform the surgery

Answer 3

medical reasons for the surgery

Question 4

Which term describes a reduction?

A)rotation
B)traction
C)manipulation
D)stabilization

Question 5

Open treatment of a fracture is when the:

A)bone is protruding through the skin
B)physician reduces the fracture
C)fracture site is surgically opened and visualized or opened remotely
D)physician uses an arthroscope

Question 6

Using codes from the wound exploration category requires the coder to assess the extent of the procedure.

Question 7

Which of the following terms describes traction by use of strapping, elastic wraps, or tape?

A)skeletal
B)closed
C)skin
D)multiple method

Question 8

Which of the following is not a fracture treatment?

A)replantation
B)open
C)closed
D)percutaneous

Question 9

A needle biopsy is a way of obtaining a piece of tissue out of the body by excision of the tissue.It can be examined under a microscope by a pathologist.Because this biopsy is performed through the skin, it is called a percutaneous biopsy.

Question 10

The codes for wound exploration can be reported for exploration of any type of wound.

Question 11

Codes for arthrodesis include the bone graft and instrumentation, and these cannot be coded separately.

Question 12

Which of the following flaps describes a bone graft that is taken along with the skin and tissue that overlies the bone?

A)myocutaneous
B)free osteocutaneous
C)dermis/epidermis
D)free

Question 13

The restoration of a fracture or dislocation to its normal anatomic alignment by the application of manually applied force is known as:

A)external fixation
B)manipulation
C)skeletal fixation
D)skeletal traction

Question 14

Which treatment of a fracture requires the fracture to be exposed to view or opened at a remote site for nailing across the fracture?

A)percutaneous
B)open
C)mixed
D)closed

Question 15

An orthopedic surgeon cannot report the service of ultrasonic guidance because this is a radiologic procedure, and only a radiologist can report services represented in the Radiology section.

Question 16

Fast becoming the treatment of choice for many orthopedic surgical procedures is what type of procedure?

A)closed
B)ultrasonic/laser
C)endoscopy/arthroscopy
D)electrical stimulation

Question 17

You cannot report codes for open wound exploration (20100-20103) if the wound is sufficient in size to accomplish the repair and the wound does not need to be enlarged.

Question 18

The application of a cranial halo is a form of:

A)insertional device
B)implantation fixation
C)external fixation
D)internal fixation

Question 19

This type of graft is often taken from the upper thigh area.

A)bone
B)tissue
C)fascia lata
D)paratenon

Question 20

Wound exploration codes have the following service(s) bundled into the codes:

A)exploration and repair
B)exploration, including enlargement; removal of foreign body(ies), repair
C)exploration, including enlargement, repair; necessary grafting
D)exploration, including enlargement; debridement, removal of foreign body(ies), minor vessel ligation, repair

Question 21

Bone grafts for spinal surgery are often coded in conjunction with a surgical procedure.What is the appropriate modifier to apply to the bone graft code?

A)No modifier
B)-51
C)-59
D)-22

Question 22

A patient presents to the orthopedic office complaining of pain in the wrist.Upon examination, the physician determines that the patient has a ganglion cyst.The physician injects the ganglion cyst with Xylocaine to reduce the pain with guidance.What is the correct code?

A)20600
B)20605
C)20611
D)20612

Question 23

Arthrocentesis is:

A)an injection into the joint
B)an aspiration of fluid from the joint
C)a puncture of a joint cavity
D)all of the above

Question 24

The acronym ORIF stands for:

A)open reduction of internal fracture
B)open reduction with internal fixation
C)open release with internal fixation
D)open reduction with imaging fluoroscopy

Question 25

Steven was rollerblading when he hit a bump in the road and fell.As he went down, he tried to break the fall with his hands.He presented to the emergency department with pain and swelling in his left wrist.Radiologic exams were taken of the wrist.It was determined by the physician that he fractured his distal radius.The emergency room physician applied a static short-arm splint to the fractured wrist and referred the patient to the orthopedist on call.Report only the treatment, not the x-ray or ED E/M service.
CPT Code: ____________________

Question 26

Mr.Rappoport has been diagnosed with severe osteoarthritis in the joints of his fingers.The physician performs an interphalangeal joint replacement of the index finger with a prosthetic implant.
CPT Code: ____________________

Question 27

Trigger finger release.
CPT Code: ____________________

Question 28

Arthroscopy is a desirable treatment choice by physicians and patients because the:

A)incisions are smaller
B)risk of infection is decreased
C)recovery time is quicker
D)all of the above

Question 29

Which of the following is not a treatment method for a dislocation?

A)external fixation
B)applying gentle traction
C)rotating limb while applying pressure
D)attaching a weight to the patient

Question 30

A ____ arthroscopy is always included in a surgical arthroscopy.

A)biopsy
B)separate procedure
C)diagnostic
D)debridement

Question 31

What is the difference between the code for a soft tissue abscess in the Musculoskeletal System subsection and the codes for abscess in the Integumentary System subsection?

A)The code in the Musculoskeletal System subsection is used only when the abscess is in the bone.
B)The code in the Musculoskeletal System subsection is associated with deep tissue possibly to the bone.
C)The code in the Musculoskeletal System subsection does not require debridement of the abscess.
D)The code in the Integumentary System subsection may include the bone.

Question 32

Jane was playing volleyball in her high school gymnasium, and during a dive for the ball she fell, landing hard on her right shoulder area.She presented to the orthopedic office in severe pain in the area of her collarbone.Radiologic exams were taken of the area, and it was found that the sternoclavicular joint had been dislocated.The physician applied pressure and moved the bone back into its proper location.Strapping was then applied.Report only the repair, not the x-ray.
CPT Code: ____________________

Question 33

Where is the bimalleolar bone located?

A)wrist
B)shoulder
C)knee
D)ankle

Question 34

____ is the attachment of a spinal fixation device at each end of the area being repaired and at least one other attachment in the area being repaired.

A)Arthrodesis
B)Segmental instrumentation
C)Nonsegmental instrumentation
D)External fixation

Question 35

A bunionectomy is a hallux ____ correction.

A)malleus
B)varus
C)rigidus
D)valgus

Question 36

Steven was able to make an appointment with the orthopedist within a few hours of being seen in the ED for a splint to his left wrist after a fall.The orthopedist reviewed the x-rays from the emergency room and agreed with emergency room physician that the distal radius was fractured.A short-arm fiberglass cast was applied, and the fracture was expected to heal in 6-8 weeks.Report the closed treatment of this fracture.
CPT Code: ____________________

Question 37

The following is NOT a type of bunionectomy.

A)Keller
B)Mitchell
C)Silver
D)Mumford

Question 38

Electrical or ultrasound stimulation is used to:

A)promote healing
B)remove dead tissue
C)reduce joint swelling
D)reduce joint pain

Question 39

A physician applies a cranial halo on a patient with a C-1 fracture.After the fracture is healed, the same physician removes the halo.What is the code for the removal of the halo?

A)20660
B)20661
C)20664
D)99024

Question 40

Surgical and fracture repair codes in the musculoskeletal subsection:

A)include the application and removal of all casts, splints, and strapping
B)include the application and removal of the initial casts, splints, or strapping applied by the treating physician
C)include the application and removal applied by an urgent care/emergency room physician when the urgent care/emergency room physician is not providing the fracture care
D)do not include casts, splints, or strapping, therefore allowing the physician to charge separately for these services

Question 41

Open treatment of a hip fracture of proximal neck with prosthetic femoral hip replacement.
CPT Code: ____________________

Question 42

Location: Inpatient Hospital
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Left knee medial meniscus tear.
POSTOPERATIVE DIAGNOSIS: Left knee medial meniscus tear.
PROCEDURE PERFORMED: Left knee arthroscopic partial medial meniscectomy.
ANESTHESIA: Spinal.
ESTIMATED BLOOD LOSS: Minimal, no drains.
This 41-year-old female suffering with left knee pain was taken to surgery.After appropriate level of anesthesia achieved, the left knee was prepped and draped in orthopedic manner.We made two portals in the knee, one medial and the other lateral to the patellar tendon.Sharp dissection was carried through skin; blunt dissection was carried into the joint space.On examination of the knee, there was a sort of a bucket-handle type tear of the posterior horn of the medial meniscus, in the avascular area, but it was very complex.We went ahead and debrided this back to stable tissue, again in the avascular area.Remainder of the meniscus was probed and felt to be intact.The anterior cruciate ligament was probed, felt to be intact, lateral meniscus probed and felt to be intact.No loose bodies were appreciated in the suprapatellar pouch, medial or lateral gutters.The articular surface was generally in good condition except for the patellofemoral joint.The patella had some areas of Grade 3 chondromalacia especially centrally.We went ahead and irrigated the wound copiously.We injected 20 cc of 0.25% Marcaine through the joint space and portal sites.We dressed the wound with interrupted nylon sutures.The patient tolerated the procedure well and left the operating room in good condition.
CPT Code: ____________________

Question 43

____________________ is the application of pulling force to hold a bone in correct alignment.

Question 44

Arthroscopic medial meniscus repair.
CPT Code: ____________________

Question 45

Total hip replacement for the treatment of severe osteoarthritis.
CPT Code: ____________________

Question 46

Location: Inpatient Hospital
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Fracture/subluxation of neck, C6-7.
POSTOPERATIVE DIAGNOSIS: Fracture/subluxation of neck, C6-7.
PROCEDURE PERFORMED: Placement of halo.
ANESTHESIA: General.
PROCEDURE: Under general anesthesia, the patient's head was prepped.The halo was applied.The pins were secured.The vest was secured.
The patient was monitored with sensory-evoked potentials.There were no changes throughout the case.Films were done postop which showed the alignment was acceptable at C6-7.
CPT Code: ____________________

Question 47

Closed treatment of hip dislocation, status post hip arthroplasty, without anesthesia.
CPT Code: ____________________

Question 48

Scar revision of amputation site lower right arm (ulna and radius).
CPT Code and modifier: ____________________

Question 49

Total knee replacement (arthroplasty) for the treatment of severe osteoarthritis.
CPT Code: ____________________

Question 50

Sally presents to the physician's office with pain in the toes of her left foot.The physician took x-rays of her foot and toes and it was determined that she had fractures in her second, third, and fourth digit on her left foot.Strapping was applied (closed treatment).Select all possible correct CPT Code answers.

A)28510, 28511
B)28510, 28510-51 x 2
C)28510-T1, 28510-T2, 28510-T3
D)28510 x 3
E)
28510-T1 x 3
F)28510-T3

Question 51

Closed treatment of second and third metatarsal fractures of the left foot, with manipulation.Select all possible CPT Code answers.

A)28475, 28476
B)28475 x 2
C)28475-T1 x 2
D)28475-T1, 28475-51-T2
E)28475, 28475-51
F)28475-T3
G)28475-T2, 28475-T1

Question 52

Jackie had been complaining of pain in her knee for several months.The orthopedist suspected a torn medial and lateral meniscus and ordered a diagnostic arthroscopy.During the diagnostic arthroscopy it was found that Jackie had a torn medial and lateral meniscus.The physician repaired both these during the same operative session through the scope.
CPT Code: ____________________

Question 53

Select the five graft types represented in the musculoskeletal subsection.

A)bone graft
B)spinal graft
C)tissue graft
D)joint graft
E)Marrow graft
F)fascia lata graft
G)cartilage graft
H)tendon graft

Question 54

Select all of the following that are the use of a needle and a syringe to withdraw fluid.

A)aspiration
B)removal
C)adjustment
D)centesis

Question 55

Surgical arthroscopy of the shoulder, rotator cuff repair.
CPT Code: ____________________

Question 56

Arthrocentesis is aspiration of a joint, and the codes used to report the service are in the range of ____________________.(Make sure to include a dash with no spaces in your code range.XXXXX-XXXXX)