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100
2. What hallux valgus surgery includes a tendon transplant? a. Joplin procedure b. Mayo procedure c. Mitchell procedure d. Keller procedure
A - Joplin procedure
100
12. A patient is given Xylocaine, a local anesthetic, by injection in the thigh above the site to be biopsied. A small bore needle is then introduced into the muscle, about 3 inches deep, and a muscle biopsy is taken. What CPT® code is reported for this service? a. 20205 b. 20206 c. 20225 d. 27324
B - 20206
100
22. A young female patient was taken to the operative suite, and was placed under appropriate anesthesia. She has been suffering from pain and a potential rotator cuff tear of the right shoulder. The right arm was sterilely draped and prepped. Arthroscopic portals were created anteriorly-posteriorly. The joint line was carefully examined. The biceps insertion was noted to be normal. The middle and inferior glenohumeral ligaments were visualized and noted to be normal. The undersurface of the rotator cuff was clearly visualized and also noted to be normal. There was a large anterior spur formation. The burr was introduced through a lateral portal and the anterior lip of the acromion was resected. The undersurface of the clavicle was noted to be quite prominent and part of the impinging process. There was intense bursitis and a bursectomy was performed, allowing for acromial decompression and release. Spurs were removed from the distal clavicle. All instruments were removed, skin incisions were closed and a dressing was applied. The patient was placed in a sling and returned to the recovery room. What CPT® code(s) is/are reported? a. 23130-RT, 23120-51-RT b. 29824-RT, 29826-RT c. 23415-RT d. 29822-RT, 29826-RT
D - 29822-RT, 29826-RT
100
32. The patient has a torn medial meniscus. An arthroscope was placed through the anterolateral portal for the diagnostic procedure. The patellofemoral joint showed grade 2 chondromalacia on the patellar side of the joint only, this was debrided with a 4.0-mm shaver. The medial compartment was also entered and a complex posterior horn tear of the medial meniscus was noted. It was probed to define its borders. A meniscectomy was carried out to a stable rim. What CPT® code(s) is/are reported? a. 29880 b. 29870, 29877-59 c. 29881, 29877-59 d. 29881
D - 29881
100
42. A 31-year-old secretary returns to the office with continued complaints of numbness involving three radial digits of the upper right extremity. Upon examination, she has a positive Tinel’s test of the median nerve in the left wrist. Anti-inflammatory medication has not relieved her pain. Previous electrodiagnostic studies show sensory mononeuropathy. She has clinical findings consistent with carpal tunnel syndrome. She has failed physical therapy and presents for injection of the left carpal canal. The left carpal area is prepped sterilely. A 1.5 inch 25 or 22 gauge needle is inserted radial to the palmaris longus or ulnar to the carpi radialis tendon at an oblique angle of approximately 30 degrees. The needle is advanced a short distance about 1 or 2 cm observing for any complaints of paresthesia or pain in a median nerve distribution. The mixture of 1 cc of 1% lidocaine and 40 mg of Kenalog-10 is injected slowly along the median nerve. The injection area is cleansed and a bandage is applied to the site. What codes are reported? a. 20526, J3301 x 4 b. 20551, J3301 x 4 c. 20526, J3301 d. 20550, J3301
A - 20526, J3301 x 4
200
4. Hallux rigidus is a condition affecting what part of the body? a. Spine b. Ankle c. Foot d. Knee
C - Foot
200
14. A 22-year-old female has a retained Kirschner wire in the left little finger. Using local anesthesia, the left upper extremity was thoroughly cleansed with Betadine. The end portion of the little finger was opened by a transverse incision through the subcutaneous tissue to the bone. The retained Kirschner wire was located within the distal phalanx. It was removed and closed with sutures. What CPT® code is reported? a. 10120-F4 b. 20680-F4 c. 20670-F4 d. 10121-F4
B - 20680-F4
200
24. A 72-year-old female sustained a left radius fracture, resulting in volar angulation, radial shortening and loss of radioulnar inclination. A general anesthetic was administered. A standard dorsal central approach to the wrist was made. The capsule was opened in a T fashion and the malunion site was identified. A series of osteotomes was utilized to open the fracture site and the normal distal radial architecture was restored. The pie-plate was placed on the distal radius utilizing a combination of 2.0 and 1.8 screws and threaded pins for the distal segment and 2.7 screws proximally. Fragments were secured, and Norian SRS was packed into the defect and allowed to harden. With this completed, the wounds were copiously irrigated with normal saline. Soft tissue was closed over the plate and distal radius, and secured with 2-0 Vicryl. What CPT® code is reported? a. 25400-LT b. 25405-LT c. 25607-LT d. 25609-LT
A - 25400-LT
200
34. A 50-year-old male had surgery on his upper leg one day ago to remove an intramuscular tumor and presents with serous drainage from the wound. He was taken back to the operating room for evaluation of a hematoma. His wound was explored down to the rectus femoris muscle, and there was a hematoma, which was very carefully evacuated. The wound was irrigated with antibacterial solution, and the wound was closed in multiple layers. What CPT® and ICD-10-CM codes are reported? a. 10140-79, M96.810 b. 27603-78, T81.4XXA c. 10140-76, T81.9XXA d. 27301-78, M96.831
D - 27301-78, M96.831
200
44. Under general anesthesia, a 45-year-old patient was sterilely prepped. The wrist joint was injected with Marcaine and epinephrine. Three arthroscopic portals were created. The articulating surface between the scaphoid and the lunate clearly showed disruption of the ligamentous structures. We could see soft tissue pouching out into the joint; this was debrided. There was abnormal motion noted within the scapholunate articulation. At this point the C-arm was brought in; arthroscopic instruments were placed in the joint and confirmed the location of the shaver as a probe in the scapholunate ligament. There was a significant gap between the capitate and lunate. K-wire was utilized from the dorsal surface into the lunate, restoring the space. Further examination revealed gross instability between the capitate and lunate. With the wrist in neutral position, a K-wire was passed through the scaphoid, through the capitate and into the hamate. This provided stabilization of the wrist joint. Stitches were placed, and a thumb spica cast was applied. What CPT® code(s) should be reported? a. 29847 b. 29846 c. 29840 d. 29847, 29840-51
A - 29847
300
6. A patient has a greenstick fracture of the right radial shaft. It is treated by surgically placing a bone plate on the distal radial shaft. What ICD-10-CM code is reported? a. S52.90XA b. S52.301B c. S52.311A d. M84.439A
C - S52.311A
300
16. A 27-year-old presents with right-sided thoracic myofascial pain. A 25 gauge 1.5 inch needle on a 10 cc controlled syringe with 0.25% bupivacaine was used. After negative aspiration, 2 cc were injected into each trigger point. A total of four trigger points were injected. A total of 8 cc of bupivacaine was used on the rhomboid major, rhomboid minor, and levator scapular muscles. What CPT® code(s) should be used for this procedure? a. 20550 x 4 b. 20553 c. 20552 d. 20552, 20553-51
B - 20553
300
26. A patient presented with a right ankle fracture. After induction of general anesthesia, the right leg was elevated and draped in the usual manner for surgery. A longitudinal incision was made parallel and posterior to the fibula. It was curved anteriorly to its distal end. The skin flap was developed and retracted anteriorly. The distal fibula fracture was then reduced and held with reduction forceps. A lag screw was inserted from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then applied to the lateral contours of the fibula with cortical and cancellous bone screws. Final radiographs showed restoration of the fibula. The wound was irrigated and closed with suture and staples on the skin. Sterile dressing was applied followed by a posterior splint. What CPT® code is reported? a. 27814-RT b. 27792-RT c. 27823-RT d. 27784-RT
B - 27792-RT
300
36. A 45-year-old presents to the operating room with a right index trigger finger and left shoulder bursitis. The left shoulder was injected with 1 cc of Xylocaine, 1 cc of Celestone, and 1 cc of Marcaine. An incision was made over the A1 pulley in the distal transverse palmar crease, about an inch in length. This incision was taken through skin and subcutaneous tissue. The Al pulley was identified and released in its entirety. The wound was irrigated with antibiotic saline solution. The subcutaneous tissue was injected with Marcaine without epinephrine. The skin was closed with 4-0 Ethilon suture. Clean dressing was applied. What CPT® codes are reported? a. 26055-F6, 20610-76-LT b. 20552-F6, 20605-52-LT c. 26055-F6, 20610-51-LT d. 20553-F6, 20610-51-LT
C - 26055-F6, 20610-51-LT
300
46. The patient is a 17-year-old male who was struck on the elbow by another player’s stick while playing hockey. He is found to have a fracture of the olecranon process. The patient was brought to the OR, anesthetized and intubated. The right upper extremity was prepped with Betadine scrub and draped free in the usual sterile orthopedic manner. The arm was then elevated and exsanguinated and the tourniquet inflated to 250 mm/Hg. A five-inch incision was made with the scalpel on the extensor side of the elbow, beginning distally and proceeding in an oblique fashion up the proximal forearm. Dissection was carried through subcutaneous tissue and fascia, and bleeding controlled with electrocautery. We then subperiostally exposed the proximal ulna and olecranon to visualize the fracture site. The fracture could be seen at the base of the olecranon process. We irrigated the site thoroughly and reduced the fracture fragments without difficulty. Extending the elbow, we inserted two smooth K-wires across the fracture site. Through a drill hole in the proximal ulnar shaft, we threaded an 18 gauge wire through it and wrapped it around the K-wires in a figure-of-eight manner to further stabilize the fixation. Wires were then twisted and placed into soft tissues. The K-wires in the olecranon were advanced slightly after being bent and cut. Sterile dressing was applied and the patient was placed in a splint. What CPT® code is reported? a. 24685-RT b. 24635-RT c. 24675-RT d. 24586-RT
A - 24685-RT
400
8. A patient presents to the ED with back pain and is diagnosed with a lumbar sprain. What ICD-10-CM code is reported? a. S33.5XXA b. S33.8XXA c. M53.3 d. M54.5
A -
400
18. A 63-year-old man sustained a gunshot wound through the right maxillary sinus penetrating through the right neck. CT scan revealed no hard evidence of arterial injury but a bullet was directly in line with the internal jugular vein. He was sent to the operating room for neck exploration to rule out vascular injury and injury to the aero digestive tract. A sternocleidomastoid incision was performed and carried down through the platysma muscle. There was no penetration of the internal jugular vein, but a foreign body was identified resting on the internal jugular vein at approximately the level of the angle of the mandible and removed. The parotid gland was noted to have a blast injury near the tail. This was not surgically repaired or resected. Once all bleeding was controlled, a 10 French round drain was placed in the wound. The wound was copiously irrigated. The platysma muscle was closed and the skin was closed with subcuticular closure. What CPT® code is reported? a. 20525 b. 35201 c. 20100 d. 21899
C - 20100
400
28. This 45-year-old male presents to the operating room with a painful mass of the right upper arm. Upon deep dissection a large mass in the soft tissue of the patient's shoulder was noted. The mass appeared to be benign in nature. With deep blunt dissection and electrocautery, the mass was removed and sent to pathology. What CPT® code is reported? a. 23076-RT b. 23066-RT c. 23075-RT d. 23030-RT
C - 23075-RT
400
38. A patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was performed and included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. What CPT® and ICD-10-CM codes are reported? a. 24579-RT, 29065-51-RT, S42.434B b. 24577-RT, S42.451A c. 24579-RT, S42.451A d. 24575-RT, S42.434B
C - 24579-RT, S42.451A
400
52. In ICD-10-CM, what classification system is used to report open fracture classifications? a. Muller AO Classification of fractures b. PHF Classification of fractures c. Gustilo Classification for open fractures d. Danis-Weber Classification
C - Gustilo Classification for open fractures
500
10. The patient fell and fractured his femoral shaft in three places. He has to have an ORIF of the left femur with an intramedullary nail and interlocking screws (peritrochanterically). The orthopedist also places the leg in a plaster splint prior to leaving the OR. What CPT® code is reported? a. 27245 b. 27507 c. 27513 d. 27506
D - 27506
500
20. A 49-year-old presents with an abscess of the right thumb. The physician incises the abscess and purulent sanguineous fluid is drained. The wound is packed with iodoform packing. What CPT® code is reported? a. 10061-F5 b. 26010-F5 c. 10060-F5 d. 26011-F5
B - 26010-F5
500
30. A 27-year-old triathlete is thrown from his bike on a steep downhill ride. He suffered a severely fractured vertebra at C5. An anterior approach is used to dissect out the bony fragments and strengthen the spine with titanium cages and arthrodesis. The surgeon places the patient supine on the OR table and proceeds with an anterior corpectomy at C5 with discectomy above and below. Titanium cages are placed in the resulting defect and morselized allograft bone is placed in and around the cages. Anterior Synthes plates are placed across C2-C3 and C3-C5, and C5-C6. What CPT® codes should be reported? a. 63081, 22554-51, 22845, 20930 b. 63081, 22554-51, 22846, 22851, 20930 c. 63081, 22554-51, 22845, 20931 d. 63081, 22548-51, 22846, 20931
B - 63081, 22554-51, 22846, 22851, 20930
500
40. A Type I, high velocity open right femur shaft fracture was incurred when a 15-year-old female pedestrian was hit by a car while crossing the street. She was taken to the operating room within four hours of her injury for thorough irrigation and debridement, including excision of devitalized bone. The patient was prepped, draped, and positioned. Intramedullary rodding was carried out with proximal and distal locking screws. What CPT® and ICD-10-CM codes should be reported? a. 27506-RT, 11044-51-RT, S72.361A, V03.90XA b. 27506-RT, 11012-51-RT, S72.301B, V03.90XA c. 27507-RT, 11012-51-RT, S72.321B, V03.90XA d. 27507-RT, 11044-51-RT, S72.301C, V03.90XA VV03.19V
B - 27506-RT, 11012-51-RT, S72.301B, V03.90XA
500
54. Most of the codes in ICD-10-CM Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue have site and laterality designations. What is considered the site? a. The site is always the joint or bone involved. b. The site may be the bone, joint, or muscle involved. c. The site may be the region, bone, or joint involved. d. The site may be the region, bone, joint, or muscle involved.
B - The site may be the bone, joint, or muscle involved. According to ICD-10-CM Guideline I.C.13.a., the site may be the bone, joint, or muscle involved.