Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

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

Question 3

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

Accepted Answer

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

Question 4

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

Accepted Answer

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

Question 5

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

Accepted Answer

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

Question 6

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

Accepted Answer

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

Question 7

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

Accepted Answer

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

Question 8

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

Accepted Answer

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

Question 9

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

Accepted Answer

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

Question 10

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

Accepted Answer

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

Question 11

The termsalpingo-oophorectomy refers to:

Accepted Answer

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

Question 12

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

Accepted Answer

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

Question 13

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

Accepted Answer

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

Question 14

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

Accepted Answer

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

Question 15

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

Accepted Answer

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

Question 16

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

Accepted Answer

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

Question 17

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

Accepted Answer

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

Question 18

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

Accepted Answer

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

Question 19

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

Accepted Answer

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

Question 20

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

Accepted Answer

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

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