Mock - 5 esMOCK 1.46 year -old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck.AQ.5 cm margin was drawn out and a 15 blade scalpel was used for full excision of an8cm lesion. Layered closure was performed after the removal. The specimen was sent for permanent histopathology examination. What are the CPT code(s) for this procedure? vi Baing A.11626 B.11626, 12004-51 oe, C.11626, 12044-51 D.11626, 13132-51, 13133 2.53 year-old male is in the dermatologist’s office for removed of 2 lesions located on his lip and nose. Lesions were identified and marked, The lower lip lesions of 4mm in size was shaved to the level ofthe superficial dermis. Utilizing a 3 mm punch, a biopsy was taken of the left supra tip nasal area. What are the CPT codes for three procedures? A.11104, 11105 B.11310, 11104-59 C.17000, 17003 D.11440, 11004-59 3.76 year -old has dermatochalasis on bilateral upper eyelids. A blepharoplasty will be performed on the eyelids. A Lower incision line was marked at approximately 5mm above the lid margin along the crease. Then using a Pinch test with forceps the amount of skin to be resected was determined and marked - An elliptical incision was performed on the left eyelid and the skin was excised. In a similar fashion the same procedure was performed on the right eye. The rounds were closed with sutures. The correct CPT code(s)is/are? A.15822, 15823-51 _B.15823-50 C.15822-50 D.15820-LT, 15820-RT 4.Patient has a basal cell carcinoma on his upper back .A map was prepared to correspond to the area of skin where the excisions of the tumor will be performed using Mohs micrographic surgery technique. Therewere three tissue blocks that were prepared for cryostat, sectioned and removed in the first stage. Then a second stage had six tissue blocks which were also cut and stained for microscopic examination. The entire base and margins of the excise pieces of tissue were examined by the surgeon. NO tumor was identified after the final stage of the microscopically controlled surgery .What procedure codes are reported? A.17313, 17314, 17314 B.17313, 17315 C.17260, 17313, 17314 D.17313, 17314, 17315 5.45 years old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of subcutaneous tissue, totaling a primary defect of 1.8cm . Electrocautery was used for hemostasis .An adjacent tissue transfer of 3sq cm was taken from the nasolabial fold and was advanced into the primary defect .Which CPT code is (are) reported? ‘A.14060 B.11642, 14060 C.11642,1 5115 D.15574 6.24 year -old patient had an abscess on her vulva which burst .She had developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed andirrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT code is:MOCK 7.52-year-old female has a mass growing on her right flank for several layers. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimetres. This wasexcised primarily bluntly with a few attachments divided with electrocautery. What CPT and ICD-10-CM codes are reported? A. 21932,D17.39 —_B. 21935,D17.1 €.21931,D17.1 D.21925,D17.9 8.An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemi epiphysiodesis done. On each knee ,the C-arm was used to localize the growth plate. With the growthplate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix figure-of- eight plate was placed and checked with X-ray .We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-OVicryl and 3-OMonocryl.What procedure code is reported? A.27470-50 —_B.27475-50 C.27477-50 D.27485-50 9, The patient is 66 years-old female who presents with Dupuytren’s disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren’s disease right ring digit and palm. An extensile Bruner incision was then made beginning inthe proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmer fascia extending distally over the flexor tendons of the ring finger. The fascia attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code(s) is (are) used? A.26123-RT, 26125-F7 B.26121-RT C.26035-RT D.26040-RT 10, This is a 32-year-old female who presents today with sacroiliitis. On the physical exam there was painon palpation of the left and right sacroiliac joint and fluoroscopic guidance was done for the needle positioning. Then 80 mg of Depo-Medrol and ImLof bupivacaine at 0.5% was injected into the left and right sacroiliac joint with a 22 gauge needle. The correct CPT(s) is (are): A.20611 B.27096-50, 77012 €.27096-50 D.27096, 27096-51, 77012 11.42 year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the glenchumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes, about5% of the humerus just adjacent to the rotator cuff insertion of supra spinatus. The biceps was inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The rotator in Terval was very thick and contracted. Adhesions were destroyed with electrocautery and the Bovie. The superior glenohumeral ligament, the middle glenohumeral ligament and the tendinous portion of subscapularis were released. The arthroscope was placed anteriorly, adhesions were destroyed and the shaver was usedto debride some of the posterior capsule and the posterior capsule was released in its posterosuperior andthen poster inferior aspect. What CPT codes are (are) reported? A.23450-LT B.23466-LT C.29805-LT, 29806-51-LT D.29825-LT 12. After adequate anaesthesia was obtained the patient was turned prone in a kneeling position on the spinal table. a lower middle lumbar midline lumbar incision was made and soft tissuesMOCK and augmented with structural autogenous bone from the iliac crest. The posterior instrumentation of 5.5 mm diameter titanium rod was then cut to the appropriate length and bent to confirm to the normal lordotic curve .It was then slid immediately onto the bone screws and at each level compression was carried out as each of the two bolts were tightened so thatthe interbody fusions would be snug and as tight as possible. Select the appropriate CPT codes for this visit? A.22612, 22614*2, 22842, 20938, 20930 B.22533, 22534*2,22842 C.22630, 22632*2, 22842, 20938, 20930 D.22554,22632*2,22842 BSding 13. The patient is a 67 year-old gentleman with metastatic colon cancer recently operated on for a brain metastatis ,now for placement of an infuse-A-port for continued chemotherapy. The left subclavian vein was located with a needle and guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this .After tunneling the introducer was placed over the guide wire and power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneouspocket and everything sat very nicely fluoroscopically .It was secured to the underlying soft tissue with 2-0 silk stitch. What CPT code (s) is (are) reported for this procedure? A.36556, 7001-26 B.36558 C.36561, 77001-26 D.36571 14.A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This was estimated tobe 800cc in size and had an appearance of fluid on the CT scan. A needle is used to puncture through thechest tissues and enter the pleural cavity to insert a guide wire under ultrasound guidance. A pigtail catheter is then inserted at the length of the guide wire and secured by stitches .The catheter will remainin the chest and is connected to drainage system to drain the accumulated fluid. The CPT code is: A.32557 B.32555 C.32556 D.32550 1s. The patient is a 59 year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. Heis taken to the operating room for re-do left carotid endarterectomy. The left neck was prepared and the previous incision was carefully reopened. Using sharp dissection ,the common carotid artery and its branches were dissected free. The patient was systematically heparinized and after a few minutes ,clamps were applied to the common carotid artery andits branches. A longitudinal artriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastoc balloon ~shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima were removed and the endartectomized surfaces irrigated with heparinized saline. An oval Dacron patch was then sewn into placewith running 6-0 Prolene. Which CPT codes(s) is/are reported? A.35301 B.35301, 35390 C.35302 D.35311, 35390 16, Patient has lung cancer in his upper right and middle lobes. Patient is in the operating suite to have a video ~assisted thorascopic surgery(VATS).A 10-mm zero degree thorascope is inserted in the right pleuralcavity through a port site placed in the ninth and seventh intercostal spaces .Lung was deflated. The tumoris in the right pleural. Both lobes were removed thorascopically .Port site closed. A chest tube placed to suction and patient was sent to recoveryMOCK A.32482 B.32484 C.32670 D.32671 17. The patient is a 58 year -old white male, one moth status post pneumonectomy. He had a post pneumonectomy empyema treated with a tunneled cuffed pleural catheter which has been draining the cavity for one month with clear drainage .He has had no evidence of a block or pleural fistula. Therefore aplanned return to surgery results in the removal of the catheter. The correct CPT code is : A.32440-78 B.32035-58 C.32036-79 D.32552-58 18, The patient is a 51 year-old gentleman who has end-stage renal disease .He was in the OR yesterday fora revision of his AV graft . The next day the patient had complications of the graft failing. The patient was back to the operating room where an open thrombectomy was performed on both sides getting good backbleeding, good inflow. Select the appropriate code for performing the procedure in a post-operative period: A.36831-76 B.36831 C.36831-78 D.36831-58 19, A70 year-old female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant andone in the left lower quadrant and the laparoscopic was inserted. Dissection was carried down to the area of the hernia where a small defect was clearly visualized. There was some omentum, which was adhered tothe hernia, and this was delivered back into the peritoneal cavity. The mesh was taken on to the defect. What procedure code(s) is/are reported? ‘A. 49560, 49568 B.49652 C.49653 D.49652, 49568 20, The patient is a 50 year-old gentleman who presented to the emergency room with signs and symptoms os acute appendicitis with possible rupture. He has been brought to the operating room .An infraumbilical incision was made which a 5-mm Versa Step trocar was inserted .A S-mm Odegreelaparoscope was introduced. A second 5- mm trocar was placed suprapubically and a 12mm trocarin the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture noted. The base of the appendix was then divided and placed into an Endo-catch bag and the 12 mm defect was brought out. Select the appropriate code for this procedure: Sains noe A.44970 B.44950 C.44960 D.44979 21, An 82 year-old female had a CAT scan which revealed evidence of a proximal small bowel obstruction. She was taken to the operating room where an elliptical abdominal incision was made, excising the skin and subcutaneous tissue. There were extensive adhesions along the entire length of the small bowel: the omentum and bowel were stuck up to the anterior abdominal wall. Time consuming, tedious and spendingan extra hour to lysis the adhesions to free up the entire length of the gastrointestinal tract from the ligament to Treitz to the ileocolic anastomosis. The correct CPT code A.44005 B.44180-22 C.44005-22 D.44180-59 22.55 year -old patient was admitted with massive gastric dilation .The endoscope was inserted with a catheter placement. The endoscope is passed through the cricopharyngeal muscle area without difficulty. Esophagus is normal, some chronic reflux changes at the esophago gastricMOCK dissolved .Endoscope could not be engaged due to high grade narrowing in the pyloric channel, the duodenum was not examined .It seems to be a high grade outlet obstruction with a superimposed volvulus .A repeat examination is not planned at this time. Whatcode should be used for this procedure? A.43246-52 B.43241-52 .43235 D.43191. 23.The patient is a 78 year-old white female with morbid obesity that presented with small bowel obstruction. She had surgery approximately one week ago and underwent exploration, which required a small bowel resection of the terminal ileum and anastomosis leaving her with a large inferior ventral hernia. Two days ago she started having drainage from her wound which has become serious; She is nowbeing taken back to the operating room. Reopening the original incision with a scalpel, the intestine was examined and the anastomosis was reopened, excised at both ends and further excision of intestine, Thefresh ends were created to perform another end-to-end anastomosis . The correct procedure code is: A.44120-78 B.44126-79 ¢.44120-76 D.44202-58 24.15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was digitalized .Nosignificant adenoid tissue was felt. The tonsils were then removed bilaterally by dissection. The uvula was ahuge size because of edema, apart of this then removed and the raw surface oversewn with 3-0 chromic catgut. Which CPT code(s) is /are reported? 42821 B.42825, 42104-51 ing os, C.42826, 42106-51 D.42842 25.45 year-old male is going to donate his kidney to his son. Operating ports where placed in standard position and the scope was inserted. Dissection of the renal artery and vein was performed isolating the kidney. The kidney was suspended only by the renal artery and vein as well as ureter .A stapler was used todivide the vein just above the aorta and three clips across the ureter, extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT code is: A.50543 B.50547 C.50300 D.50320 26.67 year-old female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopyperformed with a placement of a sling. An incision was made over the mid urethras dissected laterally to urethra pelvic ligament. Cystoscopy revealed no penetration of the bladder. The edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What CPT codes(s) is/are reported? A.57288 B.57287 C.57288, 52000-51 D.51992, 5200-51 27.16 day -old male baby is in the OR for a repeat circumcision due to redundant foreskin that caused circumferential scarring from the original circumcision. Anesthetic was injected and an incision was madeat base of the foreskin. Foreskin was pulled back and the excess foreskin was taken off and the two raw skin surfaces were sutured together to create a circumferential anastomosis. Select the appropriate codefor this surgery: A.54150 B.54160 C.54163 D.54164 28.5 year -old female has a history of post void dribbling. She was found to have extensive labialMOCK the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent granulation tissuewas excised on either side. What code should be used for this procedure? A.58660 B.58740 C.57061 D.56441. 29, Syear-old male with a history of prematurity was found to have a chordee due to congenital hypospadias. He presents for surgical management for a plastic repair in straighteni8ng the abnormal curvature .Under general anesthesia ,bands were placed around the base of the penis and incisions were made degloving the penis circumferentially .The foreskin was divided in Byers flaps and the penile skin wasreapproximated at the 126 clock position. Two Byers flaps were reapproximated, recreating a mucosal collar which was then criss-crossed and trimmed in the midline in order to accommodate median raphe reconstruction. This was reconstructed with use of a horizontal mattress suture. The shaft skin was then approximated to the mucosal collar with sutures correcting the defeat. Which CPT code should be used? A.54304 B.54340 c.54400 D.54440 30, 22year-old is 14 weeks pregnant and wants to terminate the pregnancy. She has consented for a D&E. She was brought to the operating room where MAC anesthesia was given. She was then placed in the dorsal lithotomy position and weighted speculum was placed into her posterior vaginal vault. Cervix was identified and dilated. A 6.5-cm suction catheter hooked up to a suction evacuator was placed and products of conception were evacuated. A medium size curette was then used to curette her endometrium. There was noted to be a small amount of remaining products of conception in her left cornua .Once again the suction evacuator was placed and the remaining products of conception were evacuated. At this point she had a good endometrial curetting with no further products of conception noted. Which CPT code should be used? A.59840 B.59841 C.59812 D.59851 31, The patient is a 73 year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was recommended thatthe patient proceed forward with right frontal ventriculoperitoneal shunt placement with Codman programmable valve. What is the correct code for this surgery? A.62220 B.62223 C.62190 D.62192 32. What is the CPT code for the decompression of the median nerve found in the space in the wrist on thepalmar side? A.64704 B.64713 C.64721 D.64719 33.2 year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia. With a#11 blade the chalazion was incised and a small curette was then used toretrieve any granulomatous material on both lids. What CPT code should be used for this procedure? A.67801 B.67805 C.67800 D.67808, 34. MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical laminectomy at C3 through C6 and fusion. The edges of the laminectomy were then cleaned up with a Kerrison and foraminotomies were done atC4,C5 and C6.The stenosis is central; a facectomy is performedby using a burr. Nerve root canals were freed by additional resection of the facet, and compression of thespinal cord was relived by removal of a tissue