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質問 # 87
An incision is made in the scalp, a craniectomy is performed to access the area where electrodes are present. The electrodes are removed. The surgical wound is closed.
What procedure code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：A
質問 # 88
When a patient has ESRD, which system is affected?
- A. Neurologic
- B. Genitourinary
- C. Cardiovascular
- D. Respiratory
正解：B
解説：
End-Stage Renal Disease (ESRD) is a condition in which the kidneys fail to work effectively to remove waste products and excess fluids from the blood. This primarily affects the genitourinary system, which includes the kidneys, ureters, bladder, and urethra. Patients with ESRD often require dialysis or a kidney transplant.
References: ICD-10-CM (current year), Chapter 14: Diseases of the Genitourinary System (N00-N99).
質問 # 89
A surgeon removes the right and left fallopian tubes and the left ovary via an abdominal incision. How is this reported?
- A. 0
- B. 58700-50
- C. 1
- D. 58720-50
正解：C
質問 # 90
The gynecologist performs a colposcopy of the cervix including biopsy and endocervical curettage.
What CPT code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
解説：
* Colposcopy of the Cervix: This involves a visual examination of the cervix using a colposcope.
* Biopsy and Endocervical Curettage: The procedures performed include taking a biopsy and scraping the lining of the cervical canal.
* CPT Code 57454: This code represents a colposcopy of the cervix with biopsy and endocervical curettage.
References:
* AMA's CPT Professional Edition (current year)
質問 # 91
A 35-year-old female has cancer in her left breast. The surgeon performs a mastectomy, removing the breast tissue, skin, pectoral muscles, and surrounding tissue, including the axillary and internal mammary lymph nodes.
Which mastectomy code is reported?
- A. 0
- B. 1
- C. 2
- D. 3
正解：B
解説：
For a mastectomy that involves removing the breast tissue, skin, pectoral muscles, and surrounding tissue, including the axillary and internal mammary lymph nodes, the appropriate CPT code is:
* 19306: Mastectomy, radical, including pectoral muscles, axillary lymph nodes.
This code captures the extent of the surgery, including the removal of the breast tissue, skin, pectoral muscles, and lymph nodes.
References:
* CPT Professional Edition (current year)
* Surgery guidelines for mastectomy procedures
質問 # 92
A patient presents to the ER from a nursing home after the patient was found to have foul smelling, large sacral pressure ulcer during daily nursing rounds. The ER provider swabbed the wound for culture (which measured at 7cm in largest diameter); then cleaned the site before painting with povidone around the entire sacrum to reduce cutaneous bacterial load. The provider made an elliptical excision with 3mm margins around the outer edge of the ulcer and removed the lesion in its entirety.
Further examination revealed deep tissue damage, prompting muscle and
segmental bone removal. The wound was then closed using a layered skin flap closure.
What CPTcoding and ICD-10-CM coding is reported?
- A. 15933, L89.153
- B. 15937, L89.156
- C. 15935, L89.156
- D. 15931, L89.153
正解：B
解説：
In this scenario, the procedure involved the excision of a large sacral pressure ulcer with deep tissue damage that required muscle and bone removal and was followed by a layered flap closure. The coding reflects both the extent of the ulcer and the procedure performed:
1. CPTCode 15937: This code describes excision of a pressure ulcer with muscle and bone removal followed by flap closure, which matches the detailed procedure performed on the sacral ulcer.
2. ICD-10-CM Code L89.156: This code is used for a stage 4 sacral pressure ulcer, indicating the presence of deep tissue damage down to muscle and possibly bone, which aligns with the clinical findings.
Explanation of other options:
A: 15933, L89.153 and B. 15931, L89.153: These codes do not adequately describe the excision with muscle and bone removal nor the stage 4 severity of the ulcer.
C: 15935, L89.156: Although L89.156 is correct for a stage 4 ulcer, 15935 does not account for both muscle and bone excision with flap closure.
Therefore, the correct answer is D. 15937, L89.156, accurately capturing the procedure performed and the severity of the ulcer.
質問 # 93
A couple presents to the freestanding fertility clinic to start in vitro fertilization. Under radiologic guidance, an aspiration needle is inserted (by aid of a superimposed guiding-line) puncturing the ovary and preovulatory follicle and withdrawing fluid from the follicle containing the egg.
What is the correct CPT code for this procedure?
- A. 0
- B. 1
- C. 2
- D. 3
正解：B
質問 # 94
View MR 001394
MR 001394
Operative Report
Procedure: Excision of 11 cm back lesion with rotation flap repair.
Preoperative Diagnosis: Basal cell carcinoma
Postoperative Diagnosis: Same
Anesthesia: 1% Xylocaine solution with epinephrine warmed and buffered and injected slowly through a 30-gauge needle for the patient's comfort.
Location: Back
Size of Excision: 11 cm
Estimated Blood Loss: Minimal
Complications: None
Specimen: Sent to the lab in saline for frozen section margin control.
Procedure: The patient was taken to our surgical suite, placed in a comfortable position, prepped and draped, and locally anesthetized in the usual sterile fashion. A #15 scalpel blade was used to excise the basal cell carcinoma plus a margin of normal skin in a circular fashion in the natural relaxed skin tension lines as much as possible The lesion was removed full thickness including epidermis, dermis, and partial thickness subcutaneous tissues. The wound was then spot electro desiccated for hemorrhage control. The specimen was sent to the lab on saline for frozen section.
Rotation flap repair of defect created by foil thickness frozen section excision of basal cell carcinoma of the back. We were able to devise a 12 sq cm flap and advance it using rotation flap closure technique. This will prevent infection, dehiscence, and help reconstruct the area to approximate the situation as it was prior to surgical excision diminishing the risk of significant pain and distortion of the anatomy in the area. This was advanced medially to close the defect with 5 0 Vicryl and 6-0 Prolene stitches.
What CPT coding is reported for this case?
- A. 14001, 11606-51, 12034-51
- B. 14001, 11606-51
- C. 0
- D. 1
正解：C
質問 # 95
A patient presents with recurrent spontaneous episodes of dizziness of unclear etiology. Caloric vestibular testing is performed irrigating both ears with warm and cold water while evaluating the patient's eye movements. There is a total of three irrigations.
What CPT coding is reported?
- A. 92537-50
- B. 92537-50-52
- C. 92538-50
- D. 92537-52
正解：D
質問 # 96
Eric is buying his first life insurance policy from XYZ Life Insurance Company. The company requires Eric have a physical exam prior to issuance of the policy. Eric sees his primary care provider who completes the required documentation and forms provided by the insurance company.
How does the primary care provider report his services?
- A. 0
- B. 1
- C. 2
- D. 3
正解：D
解説：
CPT code 99450 is used for the examination of a patient for the purpose of establishing medical baseline information or for insurance purposes. Since Eric's primary care provider completed the required physical exam documentation for his life insurance policy, this is appropriately reported with code 99450. References:
CPT Professional Edition (current year), AMA.
質問 # 97
View MR 099407
MR 099407
Emergency Department Visit
Chief Complaint: VOMITING.
This started just prior to arrival and is still present. He has had nausea and vomiting. No diarrhea, black stools, bloody stools or abdominal pain. Pt is diabetic and has been having elevated blood sugars (320 mg/dL).
REVIEW OF SYSTEMS: Unobtainable due to patient's altered mental status.
PAST HISTORY: Poorly controlled diabetes mellitus, with history of poor compliance.
Medications: See Nurses Notes.
Allergies: PCN.
SOCIAL HISTORY: Nonsmoker. No alcohol use or drug use.
ADDITIONAL NOTES: The nursing notes have been reviewed.
PHYSICAL EXAM
Appearance: Lethargic. Patient in mild distress.
Vital Signs: Have been reviewed-tachycardic.
Eyes: Pupils equal, round and reactive to light.
ENT: Dry mucous membranes present.
Neck: Normal inspection. Neck supple.
CVS: Tachycardia. Heart sounds normal. Pulses normal.
ED. Course: Insulin IV drip per protocol, at 10 units/hr.
Zofran 8 mg 01:33 Jul 13 2008 IVP.
Phenergan 25 mg IVP. 07:52. Discussed case with physician. Dr. X. Reviewed test results. Agreed upon treatment plan. Physician will see patient in hospital.
Total critical care time: 45 min.
Disposition: Admitted to Intensive Care Unit. Condition: stable.
Admit decision based on need for monitoring and IV hydration and medications.
CLINICAL IMPRESSION: Vomiting, diabetic ketoacidosis, probable diabetes insipidus.
What E/M code is reported for this encounter?
- A. 0
- B. 1
- C. 2
- D. 99291, 99292
正解：D
解説：
* 99291: This code is used for the first 30-74 minutes of critical care, evaluation, and management of the critically ill or critically injured patient.
* 99292: This code is used for each additional 30 minutes of critical care service beyond the first 74 minutes.
* The documentation indicates that the patient received a total of 45 minutes of critical care, which involves continuous IV insulin for diabetic ketoacidosis, administration of antiemetics, and admission to the ICU. The critical care time documented justifies the use of 99291 for the first 30-74 minutes and
99292 for each additional 30 minutes.
References:
* CPT Professional Edition, AMA
質問 # 98
A patient is having a thyroidectomy for malignancy on the right lobe. During the procedure, a lesion was found on the left lower side of the parathyroid gland and is suspected for malignancy.
The total right lobe of the thyroid and the parathyroid gland are removed.
What is the CPTcodes are reported for this encounter?
- A. 60505,60240-59
- B. 60505, 60220-59
- C. 60500, 60220-59
- D. 60500, 60210-59
正解：B
解説：
1. Procedure and CPTCode Selection:
The patient underwent a thyroidectomy for malignancy in the right lobe, as well as the removal of the parathyroid gland due to a suspected malignant lesion.
CPTCode 60505 is for the parathyroidectomy with exploration of parathyroid glands and is appropriate for the removal of the parathyroid gland due to a suspected malignancy.
CPTCode 60220 represents a thyroid lobectomy (total removal of one lobe of the thyroid), which applies to the removal of the right thyroid lobe in this case.
2. Modifier 59:
Modifier 59 is added to 60220 to indicate that the thyroid lobectomy is a distinct procedure from the parathyroidectomy, performed in a separate anatomical site during the same surgical session.
3. Rationale for Excluding Other Options:
Code 60500 (in options A and C) is for a parathyroid exploration only, not including the actual removal of the parathyroid gland, so it does not apply here.
Code 60240 (in option D) is for a total thyroidectomy, which involves removal of the entire thyroid gland.
Since only the right lobe was removed, 60220 (thyroid lobectomy) is correct.
4. AAPC and CPTCoding Guidelines:
Per AAPC guidelines, 60505 is the appropriate code for parathyroidectomy procedures involving exploration or suspected malignancy, and 60220 with Modifier 59 accurately reflects the separate and distinct thyroid lobectomy procedure.
Thus, the correct answer is B. 60505, 60220-59.
質問 # 99
A catheter was placed into the abdominal aorta via the right common femoral artery access. An abdominal aortography was performed. The right and left renal artery were adequately visualized. The catheter was used to selectively catheterize the right and left renal artery. Selective right and left renal angiography were then performed, demonstrating a widely patent right and left renal artery.
What CPT coding is reported?
- A. 36252, 75625-26
- B. 0
- C. 1
- D. 36253, 75625-26
正解：A
解説：
CPT code 36252 describes selective catheter placement of the main renal artery with angiography of both kidneys, which matches the procedure of selectively catheterizing the right and left renal arteries and performing angiography. Additionally, CPT code 75625-26 is for an abdominal aortography with interpretation and report. The -26 modifier indicates that the professional component of the service was performed.
References:
* AMA's CPT Professional Edition (current year), Codes 36252, 75625-26
質問 # 100
A 53-year-old male arrived at the ER due to severe ocular trauma to the right eye. He was at work on a metal drilling machine and a metallic item penetrates his right eyeball. A foreign body is in the posterior segment of the eye and corneal laceration with multiple posterior perforated sites were noted. He is brought back to the surgical suite. The surgeon removes the metallic foreign body using large retinal forceps. The laceration of the cornea is sutured and the provider also performs a pars plana lensectomy.
What is the CPTand ICD-10-CM codes are reported?
- A. 65235-RT, 66852-51-RT, 65275-51-RT. S05.51XA, W31.1XXA
- B. 65235-RT, 66852-51-RT, 65280-51-RT. S05.31XA, W31.0XXA
- C. 65265-RT, 66852-51-RT, 65275-51-RT, S05.31XA, W31.0XXA
- D. 65265-RT, 66852-51-RT, 65280-51-RT, S05.51XA, W31.1XXA
正解：D
解説：
1. Procedure and CPTCode Selection:
The patient required surgical intervention for severe ocular trauma involving removal of a foreign body from the posterior segment of the eye, suturing of the corneal laceration, and a pars plana lensectomy.
CPTCode 65265 is for removal of a foreign body from the posterior segment of the eye without the use of a magnet. This code is appropriate for the removal of the metallic foreign body using retinal forceps.
CPTCode 66852 covers the pars plana lensectomy, which was performed as part of the surgical treatment.
CPTCode 65280 is used for repairing a corneal laceration with multiple perforations, which applies to the corneal suturing.
2. Modifiers:
Modifier RT is used to indicate that the procedures were performed on the right eye.
Modifier 51 is added to indicate multiple procedures performed during the same surgical session.
3. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code S05.51XA is appropriate for penetrating wound of the right eyeball with a foreign body in the posterior segment.
ICD-10-CM Code W31.1XXA is used to indicate that the injury was caused by contact with a metalworking and woodworking machine.
4. Rationale for Excluding Other Options:
Codes 65235 and 65275 in options B, C, and D refer to foreign body removal from the anterior chamber and the anterior segment, respectively, which are not appropriate since the foreign body was located in the posterior segment.
Codes S05.31XA and W31.0XXA in options C and D represent different eye injuries and types of machines, which do not match the scenario described.
5. AAPC and CPTCoding Guidelines:
According to AAPC guidelines, codes should be selected based on the specific location (posterior segment) and the type of foreign body removal. Each procedure, including the corneal repair, should be coded to capture the full extent of the treatment.
Therefore, the correct answer is A. 65265-RT, 66852-51-RT, 65280-51-RT, S05.51XA, W31.1XXA.
質問 # 101
A complete cardiac MRI for morphology and function without contrast, followed by contrast with four additional sequences and stress imaging, is performed on a patient with systolic left ventricular congestive heart failure and premature ventricular contractions.
What CPT and ICD-10-CM codes are reported?
- A. 75559, I50.20, I49.3
- B. 75563, I50.20, I49.3
- C. 75561, 75563, I50.1, I49.1
- D. 75557, 75559, I50.1, I49.1
正解：C
解説：
* Procedure: Complete cardiac MRI for morphology and function without contrast, followed by contrast with four additional sequences and stress imaging.
* CPT Codes:
* 75561: Cardiac MRI for morphology and function without contrast material.
* 75563: Cardiac MRI with contrast and further sequences.
* ICD-10-CM Codes:
* I50.1: Left ventricular failure.
* I49.1: Premature ventricular contractions.
* Code Selection Justification: The CPT codes accurately capture the MRI procedures performed. The ICD-10-CM codes represent the diagnoses of left ventricular failure and premature ventricular contractions.
References:
* AMA CPT Professional Edition (current year)
* ICD-10-CM (current year)
* HCPCS Level II (current year)
質問 # 102
According to the Application of Cast and Strapping CPTguidelines, what is reported when an orthopedic provider performs initial fracture care treatment for a closed scaphoid fracture of the wrist, applies a short arm cast, and the patient will be returning for subsequent fracture care?
- A. 0
- B. 25622, 29075
- C. 29075-22
- D. 1
正解：A
解説：
For initial fracture care of a closed scaphoid fracture, code 25622 is used, which includes treatment and initial casting. The application of the cast is part of the fracture care and is not reported separately. CPTguidelines specify that casting or strapping performed as part of the fracture care is included in the fracture care code.
References: AMA's CPTProfessional Edition (current year), Surgery section, Musculoskeletal System.
質問 # 103
The outermost protective layer of skin is called the:
- A. Subcutaneous tissue
- B. Epidermis
- C. Dermis
- D. Hypodermis
正解：B
質問 # 104
View MR 007400
MR 007400
Radiology Report
Patient: J. Lowe Date of Service: 06/10/XX
Age: 45
MR#: 4589799
Account #: 3216770
Location: ABC Imaging Center
Study: Mammogram bilateral screening, all views, producing direct digital image Reason: Screen Bilateral digital mammography with computer-aided detection (CAD) No previous mammograms are available for comparison.
Clinical history: The patient has a positive family history (mother and sister) of breast cancer.
Mammogram was read with the assistance of GE iCAD (computerized diagnostic) system.
Findings: No dominant speculated mass or suspicious area of clustered pleomorphic microcalcifications is apparent Skin and nipples are seen to be normal. The axilla are unremarkable.
What CPT coding is reported for this case?
- A. 77066-50, Z12.31, Z80.3
- B. 77067, Z12.31, Z80.3
- C. 77066, Z80.3, Z12.31
- D. 77067-50, Z80.3, Z12.31
正解：B
解説：
The procedure performed is a bilateral screening mammogram with computer-aided detection (CAD). CPT code 77067 is for bilateral screening mammography with CAD. ICD-10-CM code Z12.31 is for an encounter for screening mammogram for malignant neoplasm of the breast. Z80.3 is for a family history of malignant neoplasm of the breast. Therefore, the correct coding is 77067, Z12.31, Z80.3. References: CPT Professional Edition (current year), ICD-10-CM (current year).
質問 # 105
A 42-year-old male is diagnosed with a left renal mass. Patient is placed under general anesthesia and in prone position. A periumbilical incision is made, and a trocar inserted. A laparoscope is inserted and advanced to the operative site. The left kidney is partially removed.
What CPT @ code is reported for this procedure?
- A. 0
- B. 1
- C. 2
- D. 3
正解：B
解説：
1. Procedure and CPTCode Selection:
The patient underwent a partial nephrectomy (removal of part of the left kidney) via a laparoscopic approach.
CPTCode 50543 is specifically used for a laparoscopic partial nephrectomy, which is an accurate description of this procedure.
2. Rationale for Excluding Other Options:
Code 50548 is used for a laparoscopic radical nephrectomy, which involves the complete removal of the kidney and surrounding structures; therefore, it does not apply to this partial nephrectomy.
Code 50220 represents an open partial nephrectomy, not a laparoscopic approach, and is therefore incorrect for this procedure.
Code 50546 is for a laparoscopic radical nephrectomy with bilateral removal of kidneys, which is not applicable in this case where only a partial removal of the left kidney was performed.
3. AAPC and CPTCoding Guidelines:
AAPC and CPTguidelines indicate that the use of 50543 is appropriate for any laparoscopic partial nephrectomy, regardless of the laterality, and it specifically identifies laparoscopic technique over open surgery.
Therefore, based on CPTguidelines, the correct answer is C. 50543.
質問 # 106
A patient presents to the labor and delivery department for a planned cesarean section for triplets. She is at 37 weeks gestation. She is given a continuous epidural for the delivery.
What anesthesia coding is reported?
- A. 01961
- B. 01958
- C. 01967
- D. 01967, 01968
正解：A
質問 # 107
Mr. Roland has difficulty breathing and congestion with a productive cough. The physician takes frontal and lateral view chest X-rays in the office (the equipment is owned by the physician group). The physician reads the X-rays and determines a diagnosis of walking pneumonia. The physician's interpretation is placed in the patient's chart.
How does the physician bill for the chest X-ray?
- A. 0
- B. 71046-26-TC
- C. 71046-26
- D. 71046-TC
正解：A
解説：
For a physician who owns the equipment and interprets the chest X-rays (both frontal and lateral views), code
71046 is used. This code includes both the technical and professional components, as the equipment is owned by the physician group and the physician also provides the interpretation.
References:
* AMA's CPT Professional Edition (current year)
* ICD-10-CM (current year)
質問 # 108
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AAPC CPC 認定試験の出題範囲：
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