2018 Chapter 8 - Quiz (includes answers)
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____
1. A patient is seen in the same day surgery unit for an arthroscopy to remove some loose bodies in the shoulder
area. What CPT® code is reported?
a. 29805
c. 29807
b. 29806
d. 29819
____
2. What is being removed for hallux valgus surgery?
a. Bunion
c. Tendon
b. Big Toe
d. A bone in one of the toes
____
3. What is the acromion?
a. Part of the elbow joint
b. Ligament near the knee
c. Tendon in the shoulder
d. Extension of the scapula
____
4. Hallux rigidus is a condition affecting what part of the body?
a. Spine
c. Foot
b. Ankle
d. Knee
____
5. What is segmental instrumentation?
a. Rods attached only at the top and bottom of a spinal fixation device.
b. Bone plates in more than one area of the skull
c. A spinal fixation device attached at each end of a rod and at additional bony attachment
d. The instruments used in surgery of the metatarsals.
____
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
c. S52.311A
b. S52.301B
d. M84.439A
____
7. The acronym BKA means:
a. bilateral knee arthritis
b. bursitis knee & arthritis
c. bilateral knee amputation
d. below knee amputation
____
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
c. M53.3
b. S33.8XXA
d. M54.5
____
9. ___________ fixation with pins, screws, plates, or wires is placed directly on or in the bone to immobilize a
fractured bone and to maintain alignment while it heals.
a. Reduction
c. Manipulation
b. Internal
d. Casting
____ 10. The patient fell and fractured his left femoral shaft in three places. The fracture is treated with 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(s) is/are reported?
a. 27245
c. 27513, 29505
b. 27507, 29505
d. 27506
____ 11. A 44 year-old male with biplanar deformity, acquired limb length discrepancies and tibial nonunion has
undergone deformity correction. He now requires exchange of an external fixation strut 45 days
postoperatively. One of the struts for his multiplane external fixation device is removed and then replaced
with an adjustable strut. The intraoperative mounting parameters, deformity parameters and initial strut
settings are entered into the computer prior to Jim’s discharge and a daily schedule is generated for him to
perform the gradual deformity correction necessary. What CPT® code(s) is/are reported?
a. 20696
c. 20694
b. 20697
d. 20692, 20697
____ 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
c. 20225
b. 20206
d. 27324
____ 13. The patient presents today for closed reduction of a nasal fracture. The depressed right nasal bone was
elevated using heavy reduction forceps while the left nasal bone was pushed to the midline. This resulted in
good alignment of the external nasal dorsum. What CPT® code is reported for this procedure?
a. 21325
c. 21315
b. 21310
d. 21337
____ 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 with a
transverse incision through the subcutaneous tissue to the bone. The retained Kirschner wire was located
within the distal phalanx. It was removed and the skin was closed with sutures. What CPT® code is reported?
a. 10120-F4
c. 20670-F4
b. 20680-F4
d. 10121-F4
____ 15. A 63 year-old man presents with a neck mass to be excised. The neck mass was palpated and an incision was
then made and carried down through the dermis with electrocautery. The subcutaneous tissue of the skin was
opened encountering an organized mass with a benign appearance of a lipoma. Using careful blunt and sharp
dissection, the mass measuring 5 cm was completely excised around its entire circumference leaving the
capsule intact. The mass was removed from its posterior attachments using electrocautery. What CPT® code
is reported for this procedure?
a. 11426
c. 11626
b. 21552
d. 21555
____ 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) is/are reported for this
procedure?
a. 20550 x 4
c. 20552
b. 20553
d. 20552, 20553-51
____ 17. A 42 year-old with chronic right trochanteric bursitis is scheduled to receive an injection at the Pain Clinic. A
22-gauge spinal needle is introduced into the trochanteric bursa, and a total volume of 8 cc of normal saline
and 40 mg of Kenalog is injected. What are the CPT® codes?
a. 20610-RT, J3301 x 4
c. 20550-RT, J3301 x 4
b. 27093-RT, J3301 x 1
d. 20611-RT, J3301 x 1
____ 18. A 63 year-old man sustained a gunshot wound through the right maxillary sinus penetrating into 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 aerodigestive tract (respiratory and digestive tracts). 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 it was 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
c. 20100
b. 35201
d. 21899
____ 19. A 66 year-old sustained a left proximal humerus fracture. Standard deltopectoral approach was used and
dissection was carried down to the fracture site. The fracture site was identified and fragments were mobilized
and the humeral head fragments removed. Once this was done, the stem was prepared up to a size 10. A trial
reduction was carried out with the DePuy trial stem and implant head. Sutures were placed in key positions
for closure of the tuberosities down to the shaft including sutures through the shaft. The shaft was then
prepared and cement was injected into the shaft. The implant was placed. Once the cement was hardened, the
head was placed on Morse taper and reduced. A bone graft was placed around the area where the tuberosities
were being brought down. The tuberosities were then tied down with a suture previously positioned. This
gave excellent closure and coverage of the significant motion at the repair sites. The wound was thoroughly
irrigated. The skin was closed with Vicryl over a drain and also staples in the epidermis. A sterile dressing
and sling was applied. The patient was taken to recovery in stable condition. No immediate complications.
What CPT® code is reported?
a. 23616-LT
c. 23615-LT
b. 23605-LT
d. 23670-LT
____ 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
c. 10060-F5
b. 26010-F5
d. 26011-F5
____ 21. An 85 year-old has developed a lump in her right groin. An incision over the lesion was made and tissue was
dissected through the skin and subcutaneous tissue going deep through the femoral fascia. Sharp dissection of
the mass was performed, freeing it from surrounding structures. The 3 cm mass was isolated and excised. The
incision was closed, the area was cleaned and dried, and a dressing applied. What CPT® code is reported?
a. 27087
c. 27048
b. 27047
d. 27049
____ 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
c. 23415-RT
b. 29824-RT, 29826-RT
d. 29822-RT, 29826-RT
____ 23. A 14 year-old status post injury over one year ago to her left wrist presented with recurrent wrist pain. The
patient was taken to the operating room and placed under general anesthesia. She was placed in wrist traction.
The radiocarpal joint was entered endoscopically through sharp skin incisions and blunt dissection into the
joint. There was found to be mild synovitis in the dorsal ulnar aspect of the wrist. This was debrided
arthroscopically with a shaver. There was a peripheral tear of the triangular fibrocartilage. This area was
shaved to promote healing. Using outside-in technique, a PDS suture was placed across the TFCC and into
the capsule. There was synovitis within the midcarpal joint, but there was no articular injury. All instruments
were removed and the wounds were closed with interrupted nylon sutures. What CPT® code(s) is /are
reported?
a. 29846-LT, 29844-LT
c. 29847-LT
b. 29846-LT, 29845-LT
d. 29846-LT
____ 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
c. 25607-LT
b. 25405-LT
d. 25609-LT
____ 25. A patient presented with a closed, displaced supracondylar fracture of the left elbow. After conscious
sedation, the left upper extremity was draped and closed reduction was performed, achieving anatomical
reduction of the fracture. The elbow was then prepped and with the use of fluoroscopic guidance, two K-wires
were directed crossing the fracture site and piercing the medial cortex of the left distal humerus. Stable
reduction was obtained, with full flexion and extension. K-wires were bent and cut at a 90-degree angle. Telfa
padding and splint were applied. What CPT® code(s) is/are reported?
a. 24535-LT, 29105-LT
c. 24582-LT
b. 24538-LT
d. 24566-LT, 29105-LT
____ 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
c. 27823-RT
b. 27792-RT
d. 27784-RT
____ 27. A 49 year-old female presented with chronic deQuervain’s disease and has been unresponsive to physical
therapy, bracing or cortisone injection. She has opted for more definitive treatment. After induction of
anesthesia, the patient’s left arm was prepared and draped in the normal sterile fashion. Local anesthetic was
injected using a combination 2% lidocaine and 0.25% Marcaine. A transverse incision was made over the
central area of the first dorsal compartment. The subcutaneous tissues were gently spread to protect the neural
and venous structures. The retractors were placed. The fascial sheath of the first dorsal compartment was then
incised and opened carefully. The underlying thumb abductor and extensor tendons were identified. The
tissues were dissected and the extensor retinaculum of the first extensor compartment was incised. The
fibrotic tissue was incised and the tendons gently released. The tendons were freely moving. Subcutaneous
tissues were closed with a 3-0 Vicryl and the skin with 3-0 Prolene subcuticular closure. Steri-strips,
Xeroform and dry sterile dressings were applied. What CPT® code is reported?
a. 25001-LT
c. 25118-LT
b. 25000-LT
d. 25085-LT
____ 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
c. 23075-RT
b. 23066-RT
d. 23030-RT
____ 29. A 6 year-old male suffered a fracture after falling off the monkey bars at school. He fell on an outstretched
hand and suffered a transcondylar fracture of the left humerus. After prep and drape, a manipulation was
done to achieve anatomic reduction. Once the joint was adequately reduced, pins were placed through the skin
distally and proximally into the bone to maintain excellent fixation and anatomic reduction. The pins were
bent, trimmed and covered with a sterile dressing and a posterior splint was placed on the patient’s arm. What
CPT® code is reported?
a. 24516-LT
c. 24538-LT
b. 24530-LT
d. 24546-LT
____ 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, C4-C5, and C5-C6. What CPT® codes should be reported?
a. 63081, 22554-51, 22845, 20930
b. 63081, 22554-51, 22846, 22854, 20930
c. 63081, 22554-51, 22845, 20931
d. 63081, 22548-51, 22846, 20931
____ 31. This 45 year-old male presents to the operating room with a painful mass of the right upper arm. General
anesthesia was induced. Soft tissue dissection was carried through the proximal aspect of the teres minor
muscle. Upon further dissection a large mass was noted just distal of the IGHL (inferior glenohumeral
ligament), which appeared to be benign in nature. With blunt dissection and electrocautery, the 4 cm mass
was removed en bloc and sent to pathology. The wound was irrigated, and repair of the teres minor with
subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular
fashion. What CPT® code is reported?
a. 23076-RT
c. 23075-RT
b. 23066-RT
d. 11406-RT
____ 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
c. 29881, 29877-59
b. 29870, 29877-59
d. 29881
____ 33. A 3 year-old is brought into the ED crying. He cannot bend his left arm after his older brother twisted it. The
physician performs an X-ray to diagnose the patient has a dislocated nursemaid elbow. The ED physician
reduces the elbow successfully. The patient is able to move his arm again. The patient is referred to an
orthopedist for follow-up care. What CPT® and ICD-10-CM codes are reported?
a. 24640-54-LT, S53.032A, W50.2XXA
b. 24565-54-LT, S53.194S, Y33.XXXA
c. 24640-54-LT, S53.091A, W50.2XXA
d. 24600-54-LT, S53.002A, W49.9XXA
____ 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
c. 10140-76, T81.9XXA
b. 27603-78, T81.4XXA
d. 27301-78, M96.840
____ 35. A 22 year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture while on
vacation. The patient was given general anesthesia and the elbow was reduced and was stable. The medial
epicondyle was held in the appropriate position and was reduced in acceptable position and elevated. A long
arm splint was applied. The patient is referred to an orthopedist when she returns to her home state in a few
days. What CPT® code(s) are reported?
a. 24575-54-RT, 24615-54-51-RT
c. 24577-54-RT, 24600-54-51-RT
b. 24576-54-RT, 24620-54-51-RT
d. 24565-54-RT, 24605-54-51-RT
____ 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 approximately
1-inch incision was made over the A1 pulley in the distal transverse palmar crease. This incision was taken
through skin and subcutaneous tissue. The A1 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
c. 26055-F6, 20610-51-LT
b. 20552-F6, 20605-52-LT
d. 20553-F6, 20610-51-LT
____ 37. A patient presents with a healed fracture of the left ankle. The patient was placed on the OR table in the
supine position. After satisfactory induction of general anesthesia, the patient’s left ankle was prepped and
draped. A small incision about 1 cm long was made in the previous incision. The lower screws were removed.
Another small incision was made just lateral about 1 cm long. The upper screws were removed from the plate.
Both wounds were thoroughly irrigated with copious amounts of antibiotic- saline solution. Skin was closed
in a layered fashion and sterile dressing applied. What CPT® code(s) should be reported?
a. 20680-LT
c. 20670-LT
b. 20680-LT, 20680-59-LT
d. 20680-LT, 20670-59-LT
____ 38. A patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced 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
c. 24579-RT, S42.451A
b. 24577-RT, S42.451A
d. 24575-RT, S42.434B
____ 39. A 47 year-old patient was previously treated with external fixation for a Type IIIA left lateral condyle tibial
fracture. There is now nonunion of the left proximal tibia, and he is admitted for open reduction of tibia with
bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture
site was exposed and the area of nonunion was osteotomized, cleaned and repositioned. Intrafragmentary
compression was applied with three screws. The harvested bone graft was packed into the fracture site. What
CPT® and ICD-10-CM codes are reported?
a. 27724-LT, S82.122N
c. 27722-LT, S82.102N
b. 27722-LT, S82.122S
d. 27724-LT, S82.102C
____ 40. A 16 year-old female was hit by a car while crossing a two-lane highway. She was taken to the hospital by
ambulance. She was found to have an open wound of the left lower thigh, just above the knee and a displaced
fracture of the left femoral neck. She was taken to the operating room within four hours of her injury. She was
given general endotracheal anesthesia and was prepped and draped in sterile fashion. Debridement including
excision of devitalized skin and muscle was performed on the lateral thigh. The area was approximately 15 sq
cm. After debridement and thorough copious irrigation, the wound was closed with layer sutures and a
dressing was applied and then covered with adhesive plastic. The patient was then prepped and draped for the
fracture and turned on her right side. We all rescrubbed. An 8 inch incision was made over the left hip and the
head of the femur was exposed. Multiple fragments from the neck and the greater tuberosity were removed.
The decision was made to replace the femoral head. The femur was removed from the acetabulum and the
femoral head was removed. The femoral canal was reamed and a prosthesis was placed. It was then replaced
in the acetabulum with a good fit, and the capsule was closed. The wound was closed. The patient was sent to
recovery in good condition. What CPT® and ICD-10-CM codes are reported?
a. 27130-LT, 11010-59-LT
b. 27125-LT, 11010-59-LT
c. 27236-LT, 11043-59-LT
d. 27244-LT, 11043-59-LT
____ 41. A 49 year-old female had two previous rotator cuff procedures and now has difficulty with shoulder function,
deltoid muscle function and axillary nerve function. An arthrogram is scheduled. After preparation, the
shoulder is anesthetized with 1% lidocaine, 8 cc without epinephrine. The needle was placed into the shoulder
area posteriorly under image intensification. It appeared as if the dye was in the shoulder joint. A good return
of flow was obtained. The shoulder was then mobilized and there was no evidence of any cuff tear from the
posterior arthrogram. What CPT® codes are reported?
a. 20551, 73040-26
c. 23350, 73040-26
b. 20610, 73040-26
d. 20552, 73040-26
____ 42. A 31 year-old secretary returns to the office with continued complaints of numbness involving three radial
digits of the upper left 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 of 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-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
c. 20526, J3301
b. 20551, J3300 x 40
d. 20550, J3300 x 40
____ 43. An elderly female presented with increasing pain in her left dorsal foot. The patient was brought to the
operating room and placed under general anesthesia. A curvilinear incision was centered over the lesion itself.
Soft tissue dissection was carried through to the ganglion. The ganglion was clearly identified as a gelatinous
material. It was excised directly off the bone and sent to pathology. There was noted to be a large bony spur at
the level of the head of the 1st metatarsal. Using a double action rongeur, the spur itself was removed and
sequestrectomy was performed. A rasp was utilized to smooth the bone surface. The eburnated bony surface
was then covered utilizing bone wax. The wound was irrigated and closed in layers. What CPT® codes are
reported?
a. 28122-LT, 28090-51-LT
c. 28045-LT, 28090-51-LT
b. 28111-LT, 28092-51-LT
d. 28100-LT, 28092-51-LT
____ 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)
is/are reported?
a. 29847
c. 29840
b. 29846
d. 29847, 29840-51
____ 45. A 74 year-old male presented with ankle avascular necrosis of the talus with collapse of the body. After
general anesthesia and sterile prep, the patient was placed prone. A lateral incision was made. The fibula was
dissected and approximately 6 cm of the fibula was removed for the autograft. There were a lot of free
fragments of bone around the subtalar joint and the talus itself. The bone fragments were removed and a large
defect consistent with avascular necrosis of the body of the talus was noted. An egg-shaped burr was
introduced and the articulating cartilage of the ankle joint was excised and debrided. The subtalar joint was
approached and resection of the articulating surface of the subtalar joint was completed. Bone graft from the
fibula was prepared on the back table. We made two large blocks to fill the defect in the talus and then
additional small fragments of cortical cancellous bone to fill in smaller defects around the talus and ankle.
Fixation was performed in the calcaneocuboid. The talar screw was inserted, followed by fixation of the
talonavicular, tibiotalar and additional compression. The ankle screws were inserted proximally and the
wound was irrigated and closed in layers. What CPT® codes are reported?
a. 28730, 20900-51
c. 28715, 20910-51
b. 28705, 20902-51
d. 28725, 20924-51
____ 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 was controlled with electrocautery. We then subperiosteally
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
c. 24675-RT
b. 24635-RT
d. 24586-RT
____ 47. This 56 year-old female presented with a degenerative posteromedial meniscal flap tear of the right knee.
After appropriate preoperative evaluation, the patient was taken to the operating room where general
anesthesia was instituted. The patient was placed supine on the operating table. The right lower extremity was
sterilely prepped and draped for arthroscopic surgery. The leg was exsanguinated and the tourniquet inflated.
The arthroscope was introduced first through the anterolateral portal with medial suprapatellar portal utilized.
The lateral compartment looked fairly good. There were some minimal medial degenerative changes. In the
medial compartment there was a full-thickness area of osteochondral degeneration with a flap of cartilage
noted. It was possible to remove this with a bleeding bony bed with beveled edges of cartilage. The ligament
itself was intact. The retropatellar area was normal with Grade I chondromalacia changes noted. The medial
joint was inspected and there was a tear at the junction of the middle and posterior portions of the meniscus, a
flap tear was based more anteriorly. This was shaved with a combination of small baskets and punches, and
the meniscus debrided back to a smooth stable rim. There was additional synovitis in the medial aspect of the
intercondylar notch and this was removed with the curved automated meniscal incisor. What CPT® code(s)
should be reported?
a. 29880, 29879-51
c. 29882
b. 29881
d. 29881, 29875-59
____ 48. This 36 year-old female presents with an avulsed anterior cruciate ligament off the femoral condyle with a
complete white on white horizontal cleavage tear of the posterior horn of the medial meniscus, causing
instability. A general endotracheal anesthesia was performed, and the patient was placed supine on the
operating table. The right lower extremity was prepped with Betadine and draped free. Standard arthroscopic
portals were created, and the knee was systematically examined and probed. The posterior horn of the medial
meniscus was noted to be buckled and frayed. This area was carefully probed and found to be irreparable. It
was decided that our best option was to proceed with a limited partial meniscectomy, with the goal being to
leave as much viable meniscal tissue as possible. Therefore, a medial infrapatellar portal was developed with
a longitudinal stab wound. A series of straight-angled and curved basket punches was used to perform a
saucerization of the damaged portion of the meniscus, leaving the intact portion of the medial meniscus in
place. Debris was meticulously removed with the 4.0 meniscal cutter. Approximately 50% of the medial
meniscus remained. Next, our attention was turned to the ACL repair. Through a 5 cm longitudinal anterior
incision, a central one-third tendon bone was harvested. A 10 mm graft was taken and bone plug sculpted.
Anterolateral notchplasty was done with a curette and polished with the burr. All debris was removed and
instruments were used to ensure proper isometry. The graft was tightened in extension about 2.5 mm and
actually lengthened in flexion, and this was considered acceptable. Endoscopic guides were used to create the
tibial and femoral tunnels, and the edges were rasped smooth. Using a percutaneous guide pin, the graft was
placed retrograde to the knee and secured proximally with an 8 x 25 mm interference screw. The knee was put
through range of motion, and with the leg in 30 degrees of flexion with the posterior drawer applied to the
proximal tibia; an 8 x 20 mm interference screw was used to secure the bone plug distally. The graft was
tight, isometric and without adverse features. The wound was copiously irrigated with Kantrex1. Cancellous
bone fragments from bone plugs were used to graft the donor site defect in the patella. The paratenon was
closed over this to house the graft with a running #1 Vicryl. The edge of the distal bone plug was beveled
with the rongeur. The subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0
Prolene in a subcuticular fashion. Steri-Strips, sterile dressing, cryo cuff and hinged knee brace were applied.
The patient was awakened and taken to the recovery room in satisfactory condition. What CPT® codes are
reported?
a. 29888-RT, 29880-51-RT
c. 29888-RT, 29881-51-RT
b. 29888 -RT, 29882-51-RT
d. 29889-RT, 29880-51-RT
____ 49. This patient presented with internal derangement of the left knee. After satisfactory anesthesia was
administered for the arthroscopic procedure, the left lower extremity was prepped and draped in a sterile
fashion. Routine portals were made in the knee. We first looked at the medial compartment which showed a
complex small tear of the posterior horn of the medial meniscus. This was debrided using a 4.0 meniscal
shaver. There was an area of grade 4 chondromalacia on the proximal medial distal femur and this was all the
way down to bone. There was also evidence of chondromalacia over the patellofemoral joint of grade 4. This
area was drilled with a 0.45 K-wire. Multiple drill holes were placed in an attempt to get some scar tissue to
form. The notch area was normal and lateral compartment normal. Following microfracture technique, the
knee was irrigated, each portal was closed with 4-0 nylon and the patient was taken to recovery. What CPT®
codes are reported?
a. 29879-LT, 29881-51-LT
c. 29879-LT, 29880-51-LT
b. 29876-LT, 29879-51-LT
d. 29877-LT, 29881-51-LT
____ 50. A 68 year-old female with long-standing degenerative arthritis in her right knee presented. Risks and benefits
were discussed. She was agreeable to surgery. After adequate anesthesia, the patient was prepped and draped
in usual sterile fashion with DuraPrep1 and Betadine scrub. The leg was exsanguinated and tourniquet
inflated. An anterior incision was made and carried through the skin and bursa, cauterizing all bleeders. The
bursa was elevated medially and a medial parapatellar incision was made. The proximal tibia was cleaned.
The knee had an 18-degree flexion contracture. The cruciate ligaments were debrided along with the menisci.
The proximal tibial cutting guide was placed and the proximal tibial cut made. The femoral canal was entered
and a 6 degree cut was made for the anterior jig. The distal cut was made at 6 degrees. The femur measured a
size 2. The 2 cutting block was placed and the anterior, posterior and chamfer cuts were made. The notch cut
was made and the trial component was placed with a size 2 tibia and 12 mm spacer and was found to fit
beautifully and it tracked well. The patella was cut and measured to be a 32. The holes were drilled and the
proximal tibial cuts were made. All the excess meniscal tissue and hypertrophic synovium were debrided. The
wound was thoroughly irrigated and the bone dried. The cement was mixed; the size 2 tibia with a 12 mm
tibial tray, size 2 femur and a size 32 patella were all cemented in place removing all excess cement. After the
cement was hard, the tourniquet was released. The knee was placed through a range of motion and was found
to track beautifully. The knee was thoroughly irrigated. The retinaculum was closed with interrupted figureof-eight 1 Vicryl. The bursa was closed with 1 and 0. The subcutaneous layers were closed with 0 and 2-0 and
the skin with staples. Sterile dressing was applied. The patient was taken to the recovery room in stable
condition. What CPT® code is reported?
a. 27447-RT
c. 27420-RT
b. 27445-RT
d. 27488-RT
____ 51. What information is required to accurately code osteoarthritis in ICD-10-CM?
a. Whether the osteoarthritis is primary, secondary, post-traumatic, the site and laterality.
b. Whether the osteoarthritis is healed or healing.
c. Whether the osteoarthritis is a result of a fracture.
d. Whether the osteoarthritis is related to a neoplasm.
____ 52. In ICD-10-CM, what classification system is used to report open fracture classifications?
a. Muller AO classification of fractures
c. Gustilo classification for open fractures
b. PHF classification of fractures
d. Danis-Weber classification
____ 53. Which statement is TRUE regarding code selection for lumbago in ICD-10-CM?
a. There is only one generalized code for lumbago that cannot be further specified.
b. Lumbago is not assigned an ICD-10-CM code; instead, the code for the cause of the
lumbago is assigned.
c. Codes for lumbago with sciatica do not further specify laterality.
d. Codes exist to indicate whether sciatica is present with the low back pain.
____ 54. Most of the codes in ICD-10-CM Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue
have site and laterality designations. According to ICD-10-CM guidelines 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 is only the joint involved.
d. The site is only the muscle involved.
____ 55. What ICD-10-CM code is used to report effusion of the right ankle joint?
a. M25.471
c. M25.48
b. M25.474
d. M25.571
2018 Chapter 8 - Quiz (includes answers)
Answer Section
MULTIPLE CHOICE
1. ANS: D
Rationale: In the CPT® Index look for Arthroscopy/Surgical/Shoulder which directs you to 29806-29828.
Check the numeric section and 29819 reports shoulder arthroscopy to remove loose bodies.
PTS: 1
DIF: Easy
2. ANS: A
Rationale: Bunion is also called a hallux valgus. In the ICD-10-CM Alphabetic look for Hallux/valgus
(acquired) referring you to M20.1-. In the Tabular List under subcategory code M20.1 you will see the term
bunion listed. Hallux valgus correction is known as a bunionectomy or bunion surgery. CPT® code 28292
also indicates this by looking for Bunion Repair in the CPT® Index.
PTS: 1
DIF: Easy
3. ANS: D
Rationale: The acromion is an extension of the scapula that meets the clavicle at the shoulder to form the
acromioclavicular joint.
PTS: 1
DIF: Easy
4. ANS: C
Rationale: Hallux rigidus is an arthritic condition of the big toe or first metatarsophalangeal joint causing
rigidity and inability to bend the toe. Look in the ICD-10-CM Alphabetic Index for Hallux/rigidus (acquired)
referring you to code M20.2-. In the Tabular List the foot is in the code description. One of the treatments for
it is a cheilectomy, an operation to remove a bony growth to release the joint. Look in the CPT® Index for
Cheilectomy which directs you to 28289.
PTS: 1
DIF: Easy
5. ANS: C
Rationale: Segmental instrumentation of the spine is a procedure used to repair a spinal defect where the
fixation device is attached in at least three places: at each end of the construct (rod) and at least one additional
interposed bony attachment.
PTS: 1
DIF: Easy
6. ANS: C
Rationale: A greenstick fracture occurs when the bone does not break completely through, and the bone does
not protrude through the skin; this is a closed fracture. The treatment to fix the fracture is an open approach to
expose the bone to insert the plate across the fracture site; however, the fracture care treatment is not
considered when coding for the diagnosis. In the ICD-10-CM Alphabetic Index look for Fracture,
traumatic/radius/shaft/greenstick S52.31-. In ICD-10-CM codes are specific for laterality (left, right) and the
episode of care. Check the Tabular List and seven characters are needed to complete the code. Right radial
shaft is indicated in the question and because the encounter is being treated surgically, this meets the
definition of initial encounter or active treatment (See ICD-10-CM guideline I.C.19.a.). The complete code is
S52.311A.
PTS: 1
7. ANS: D
DIF: Easy
Rationale: BKA is the acronym for below-knee amputation.
PTS: 1
DIF: Easy
8. ANS: A
Rationale: In the ICD-10-CM Alphabetic Index, look for Sprain/lumbar (spine) and you are directed to S33.5. In the Tabular List this code requires a 7th character to describe the episode of care. Because the patient is
presenting to the ED, this supports the definition of initial encounter. For the 5th and 6th characters use the X
placeholder to maintain the 7th character position of A. Back pain is not reported because a definitive
diagnosis was documented, and pain is a symptom of lumbar sprain. (See ICD-10-CM guideline I.B.6.).
PTS: 1
DIF: Easy
9. ANS: B
Rationale: Some fractures are treated with either internal or external fixation to maintain the alignment of the
bone and immobilize it while it heals, or to reinforce the bone permanently. Internal fixation can be performed
with pins, screws, plates or wires placed directly in or on the bone to immobilize it.
PTS: 1
DIF: Easy
10. ANS: D
Rationale: Documentation shows the patient had a fracture of his left femoral shaft. The fracture was repaired
with open reduction and internal fixation (ORIF) using an intramedullary nail and interlocking screws.
Selection of codes depends on the fracture site and the method of treatment (closed, open, or percutaneous).
The range of codes can be found in the CPT® Index by looking for
Fracture/Femur/Peritrochanteric/Intramedullary Implant Shaft. Check the numeric section to select the correct
code. Code 27245 is not correct, because this was not a peritrochanteric fracture; it is a femoral shaft fracture.
The approach is from the peritrochanteric region. The application of the first cast or splint is included in
27506. See the guidelines for Application of Casts and Strapping in the CPT® codebook.
PTS: 1
DIF: Moderate
11. ANS: B
Rationale: The exchange of an external strut guided by stereotactic computer-assisted adjustment is coded
with 20697. There is a parenthetical note under code 20697 that it is not used in combination with 20692 or
20696. In the CPT ® Index look for External Fixation/Application/Stereotactic Computer Assisted directing
you to 20696-20697.
PTS: 1
DIF: Moderate
12. ANS: B
Rationale: In the CPT® Index, look for Biopsy/Muscle. You are referred to 20200-20206. The biopsy is
taken through the skin, or percutaneously, with a needle. Although the biopsy is deep, it is performed by
percutaneous technique, which is reported with 20206.
PTS: 1
DIF: Moderate
13. ANS: C
Rationale: In the CPT® Index look for Fracture/Nasal Bone/Closed Treatment. You are referred to 2131021320. Review codes to choose the appropriate service. 21315 is the correct code to report a displaced nasal
fracture manipulated with forceps to realign the nasal bones. Code 21310 is reported when a non-displaced
fracture of the nose requires no manipulation just treatment by prescribing medication and application of ice.
PTS: 1
14. ANS: B
DIF: Moderate
Rationale: In the CPT® Index look for Removal/Fixation Device. You are referred to 20670-20680. Review
the codes to choose the appropriate service. 20680 is the correct code because a deep incision was made all
the way to the bone to locate the wire for removal. Modifier F4 is reported to indicate the left little finger.
PTS: 1
DIF: Moderate
15. ANS: B
Rationale: In the CPT® Index, look for Neck/Tumor/Excision. You are referred to 21552-21558. Review the
codes to choose the appropriate service. 21552 is the correct code to report the excision of a 5 cm mass where
the surgeon incised the subcutaneous tissue to remove the mass. Codes 11426 and 11626 are reported for
removal of a benign or malignant lesion, not an internal mass.
PTS: 1
DIF: Moderate
16. ANS: B
Rationale: In the CPT® Index look for Injection/Trigger Point(s)/Three or More Muscles. You are referred to
20553. Review the code to verify accuracy. 20553 covers the three muscles (rhomboid major, rhomboid
minor and scapular muscles) with a total of four (multiple) trigger point injections. Codes for trigger point
injections are determined by the number of muscles injected not the number of injections administered.
PTS: 1
DIF: Moderate
17. ANS: A
Rationale: In the CPT® Index look for Injection/Bursa. You are referred to 20600-20611. Review the codes
to choose appropriate service. 20610 is the correct code because the injection was given in the trochanteric
bursa (hip, a major joint) without ultrasound guidance for drug therapy. In the HCPCS Level II codebook
look in the Table of Drugs and Biologicals for Kenalog and you see Kenalog -10 and Kenalog-40, which both
refer you to See Triamcinolone Acetonide. Triamcinolone Acetonide leads to several codes J3300, J3301,
and J3302. J3301 10 mg lists Kenalog in the notes below the code. Report 4 units for 40 mg of Kenalog.
PTS: 1
DIF: Moderate
18. ANS: C
Rationale: In the CPT® Index, look for Exploration/Neck/Penetrating Wound. You are referred to 20100.
Review the code to verify accuracy. 20100 is the correct code because the patient was sent to the operating
room for exploration of a gunshot (penetrating trauma) wound to identify damaged structures. The category
guidelines for Wound Exploration-Trauma indicate that these codes include removal of foreign bodies,
ligation or coagulation of minor subcutaneous and muscular blood vessels, damaged tissue debridement,
repair and wound closure.
PTS: 1
DIF: Moderate
19. ANS: A
Rationale: In the CPT® Index, look for Fracture/Humerus/Open Treatment. You are referred to 23615-23616.
Review the codes to choose appropriate service. 23616 is the correct code because the surgeon made an
incision to expose the fracture site. The fracture repair included a prosthetic replacement (implant head) and
the repair of the tuberosities. Modifier LT is appended to indicate that the procedure was performed on the left
side.
PTS: 1
20. ANS: B
DIF: Moderate
Rationale: There are specific Incision and Drainage (I&D) procedure codes when performed on a specific
anatomical area. In the CPT® Index, look for Finger/Abscess/Incision and Drainage. You are referred to
26010-26011. Review the codes to choose the appropriate service. 26010 is the correct code. Code 26011
includes extensive debridement, multiple incisions or extensive dissection. Insertion of a drain or gauze strip
packing to allow continuous drainage does not constitute complicated incision and drainage.
PTS: 1
DIF: Moderate
21. ANS: C
Rationale: In the CPT® Index look for Excision/Tumor/Pelvis. You are referred to 27043, 27045, 27047,
27048, 27049 and 27059. Review the codes to choose the appropriate service. 27048 is the correct code to
report the removal of the 3 cm mass below the fascia.
PTS: 1
DIF: Moderate
22. ANS: D
Rationale: In the CPT® Index, look for Arthroscopy/Surgical/Shoulder. You are referred to 29806-29828.
The procedure performed was a decompression of the subacromial space with partial acromioplasty, 29826.
The report states that the anterior lip of the acromion was resected and a bursectomy was performed. Also
mentioned is the removal of spurs from the distal clavicle. The report does not state that a distal
claviculectomy was performed; therefore, 29824 is not reported. The debridement of the distal clavicle is
performed and reported with 29822. Modifier RT is appended to indicate the procedure is performed on the
right side. Code 29826 is an add-on code and modifier 51 exempt.
PTS: 1
DIF: Moderate
23. ANS: D
Rationale: In the CPT® Index, look for Arthroscopy/Surgical/Wrist. You are referred to 29843-29847. Code
29846 describes the arthroscopic excision and repair of triangular fibrocartilage and joint debridement.
Endoscopically, arthroscopically and through the scope all mean the same thing. This is not an open surgery;
it is arthroscopic. Modifier LT is appended to indicate the procedure is performed on the left side. Only one
code is reported. The debridement (partial synovectomy) is included in the more intensive procedure.
PTS: 1
DIF: Moderate
24. ANS: A
Rationale: This is not the repair of a fracture; it is repair of a malunion. In the CPT® Index look for
Repair/Radius/Malunion or Nonunion, 25400, 25405, 25415, 25420. Code 25400 reports repair of a malunion
of the radius. There is no mention of an autograft; therefore, 25405 is incorrect. Norian SRS is a
biocompatible bone gap filler, not a graft. Modifier LT is appended to indicate the procedure is performed on
the left side.
PTS: 1
DIF: Moderate
25. ANS: B
Rationale: This is a supracondylar fracture of the elbow repaired by percutaneous fixation. In the CPT®
Index look for Fracture/Humerus/Supracondylar/Percutaneous Fixation and you are referred to 24538.
Modifier LT is appended to indicate the procedure is performed on the left side. The application of the first
cast or splint is included in the fracture codes. See the guidelines before Application of Casts and Strapping in
your CPT® codebook. Fluoroscopy guidance 76000, is listed as a separate procedure; therefore, is included in
the procedure.
PTS: 1
26. ANS: B
DIF: Moderate
Rationale: In the CPT® Index look for Fracture/Fibula/Open Treatment and you are referred to 27784, 27792,
27814. Code 27784 reports open treatment of a proximal fibular fracture or shaft fracture. The correct code is
27792 for the open treatment and internal fixation. Modifier RT is appended to indicate the procedure is
performed on the right side.
PTS: 1
DIF: Moderate
27. ANS: B
Rationale: The report states that the extensor retinaculum of the first extensor compartment was incised.
Look in the CPT® Index for Incision/Wrist/Tendon Sheath 25000-25001. Code 25000 shows deQuervain’s
disease in the description. Code 25001 refers to the flexor tendon sheath and this involved the extensor tendon
making 25000 correct. Note this was an incision, not excision of the tendon of the extensor tendon sheath.
Modifier LT is appended to indicate the procedure is performed on the left side.
PTS: 1
DIF: Moderate
28. ANS: C
Rationale: Look in the CPT® Index for Excision/Tumor/Shoulder and you are referred to 23071-23078. Code
23075 reports the excision of a soft tissue mass (tumor), subcutaneous. The mass was removed with deep,
blunt dissection; however, there is no mention of the depth and you cannot assume that the mass was
subfascial because of the word deep. The measurement of the mass is not documented resulting in the default
to the smallest measurement of less than 3 cm for code 23075. It is a rule of thumb that if a coder cannot ask
the physician to document the size of a mass, lesion or repair in order to give the physician credit, the smallest
measurement is reported. Modifier RT is appended to indicate the procedure is performed on the right side.
PTS: 1
DIF: Moderate
29. ANS: C
Rationale: Fracture codes are based on the location of the fracture and the treatment method. Documentation
describes a closed reduction of a transcondylar fracture with percutaneous placement of pins. This is
described with code 24538. This can be found in the CPT® Index by looking for
Fracture/Humerus/Transcondylar/Percutaneous directing you to code 24538. Modifier LT is appended to
indicate the procedure is performed on the left side.
PTS: 1
DIF: Moderate
30. ANS: B
Rationale: Anterior approach is used to perform several procedures on the cervical spine. The corpectomy
has the highest RVUs and is listed first. Code 63081 is the removal of one single cervical segment by anterior
approach. In the CPT® Index look for Vertebral/Body/Excision/Decompression directing you to 6308163103. Arthrodesis, anterior interbody technique is coded with 22554. In the CPT® Index, look for
Arthrodesis/Cervical/below C2 referring you to several codes including 22551-22554. Plates are used for
anterior instrumentation and placed over a total of five segments (C2, C3, C4, C5, and C6), 22846. In the
CPT® Index, look for Instrumentation/Spinal/Insertion referring you to 22840-22848. Report only one unit of
22846, regardless of how many devices placed at one level. Modifier 51 is appended to 22554 to indicate
multiple procedures. The application of the titanium cages is described by add-on code 22854. In the CPT®
Index look for Application/Intervertebral Device. The morselized allograft is described by 20930. In the
CPT® Index look for Allograft/Bone/Spine Surgery/Morselized.
PTS: 1
31. ANS: A
DIF: Difficult
Rationale: The 4 cm mass was removed from the soft tissue of the shoulder. To access the mass, the provider
had to go through the proximal aspect of the teres minor muscle. The mass was located distal to the inferior
glenohumeral ligament (IGHL). Masses that are removed from joint areas as opposed to masses removed
close to the skin require special knowledge and become more of an orthopedic concern due to joint
involvement. Therefore, it is reported from codes within the musculoskeletal section. Code 23076 is used
because dissection was carried through the proximal aspect of the teres minor. In the CPT® Index, look for
Excision/Tumor/Shoulder directing you to 23071-23078.
PTS: 1
DIF: Difficult
32. ANS: D
Rationale: In the CPT® Index look for Arthroscopy/Surgical/Knee. You are referred to 29866-29868, 2987129889. Review the codes to choose appropriate service. 29881 is the correct code because the tear was in the
medial meniscus. A meniscectomy as well as debridement with a shaver (or chondroplasty) were performed.
29877 is not reported as this is included in 29881. 29880 is not appropriate because a meniscectomy was not
performed in both the medial and lateral compartments. The surgery started out as a diagnostic procedure, but
changed when the physician decided to perform surgical procedures on the knee.
PTS: 1
DIF: Difficult
33. ANS: A
Rationale: In the CPT® Index, look for Elbow/Dislocation/Nursemaid Elbow. You are referred to 24640.
Review the code for appropriate service. 24640 is the correct code to report treatment of a dislocated
nursemaids elbow with manipulation. Modifier 54 is appended to report that the ED physician performed only
the surgical portion of the service. The patient is referred to an orthopedist for follow-up care. Modifier LT is
appended to indicate the procedure was performed on the left side.
In the ICD-10-CM Alphabetic Index, look for Nursemaid’s elbow. You are referred to S53.03-. Reviewing
the subcategory code in the Tabular List, the 6th character indicates the selection is based on left or right.
Documentation supports this as the left arm. A 7th character is also required to indicate the episode of care.
Because the patient is in the ED, this supports initial encounter and A is used. The complete code is
S53.032A. In the ICD-10-CM External Cause of Injuries Index look for Twisted by person(s) (accidentally)
referring you to W50.2. In the Tabular List this code requires a 7th character in which the character A is used
and X will be used as a placeholder for the 5th and 6th character positions. The place of occurrence and status
is not given; therefore, it is not reported.
PTS: 1
DIF: Difficult
34. ANS: D
Rationale: In the CPT® Index look for Hematoma/Leg, Upper. You are referred to 27301. Verify the code for
accuracy. Modifier 78 is appended to 27301 to indicate that an unplanned procedure related to the initial
procedure was performed during the postoperative period. Use modifier 78 for a return to the OR for a
complication in the global period of another procedure. In the ICD-10-CM Alphabetic Index look for
Complication/surgical procedure (on)/hematoma/post procedural – see Complication, postprocedural,
hematoma. Look for Complication/post procedural/hematoma (of)/musculoskeletal structure/following
musculoskeletal surgery M96.840. His wound was explored down to the level of the rectus femoris muscle;
the excision of the mass was intramuscular. The code selection is specific to the location of the hematoma as
well as the body system for which the procedure was performed. Review the code in the Tabular List for
accuracy.
PTS: 1
35. ANS: D
DIF: Difficult
Rationale: In the CPT® Index look for Fracture/Humerus/Epicondyle/Closed Treatment. You are referred to
code 24560-24565. Review the codes to choose the appropriate service. 24565 is the correct code to report the
alignment of an epicondyle fracture with manipulation (reduced) without a surgical incision. In the CPT®
Index, look for Dislocation/Elbow/Closed Treatment. You are referred to 24600, 24605. Review the codes to
choose appropriate service. 24605 is the correct code because the patient was given general anesthesia for the
procedure. Modifier 54 is appended to report the physician performed the surgical portion only. The patient is
referred to an orthopedist for follow up or postoperative care. Modifier 51 is needed to report multiple
procedures were performed. Append modifier RT to indicate the procedure is performed on the right side.
PTS: 1
DIF: Difficult
36. ANS: C
Rationale: In the CPT® Index look for Trigger Finger Repair. You are referred to 26055. Review the code to
verify accuracy. In the CPT® Index look for Injection/Joint. You are referred to 20600, 20604-20606, 20610,
20611. Review the codes to choose appropriate service. 20610 is the correct code for the shoulder injection.
Modifier F6 is used to report the right index finger that was repaired. Modifier LT is used to indicate the left
shoulder joint. Modifier 51 is used to indicate multiple procedures were performed.
PTS: 1
DIF: Difficult
37. ANS: A
Rationale: When reporting the removal of hardware (pins, screws, nails, rods), the code is selected by
fracture site, not the number of items removed or the number of incisions made. To report 20670 or 20680
more than once, there must be more than one fracture. In this case, there is only one fracture site requiring two
incisions. We know the removal is deep because the screws were in the bone. In the CPT® Index look for
Removal/Implantation and you are referred to 20670-20680. Verify the correct code is 20680. Modifier LT is
appended to indicate the procedure is performed on the left side.
PTS: 1
DIF: Difficult
38. ANS: C
Rationale: In the CPT® Index look for Fracture/Humerus/Condyle/Open Treatment which refers to 24579.
The manipulation and internal fixation is included in 24579. The application of the first cast is always
bundled with the initial surgical service and not reported separately.
In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/humerus/lower end/condyle/lateral
(displaced) referring you to S42.45-. In the Tabular List seven characters are required to report the code. The
6th character is specific to left or right. Documentation supports this as the right elbow, and the 7th character
A is supported as this is the initial surgical procedure. The complete code is S42.451A. This is the open
treatment of a closed fracture, so the 7th character B is not reported.
PTS: 1
DIF: Difficult
39. ANS: A
Rationale: This is the repair of a nonunion of a tibial fracture. In the CPT® Index look for Nonunion
Repair/Tibia, 27720, 27722, 27724, 27725. The correct code is 27724 for the repair of nonunion or malunion
of the tibia; with iliac or other autograft (includes obtaining graft). Modifier LT is appended to indicate the
procedure was performed on the left side.
This was nonunion of a fracture of the tibia. In the ICD-10-CM Alphabetic Index, look for Fracture,
traumatic/tibia/upper end/lateral condyle (displaced) referring you to S82.12-. The notes do not indicate
displacement; however, the parentheses mean that displacement may or may not be noted in the
documentation. In this case a type IIIA fracture is an open fracture. In the Tabular List the code is completed
with seven characters. The 6th character 2 indicates laterality (left). The 7th character for fractures is used to
identify the episode of care and the healing process. Documentation indicates a nonunion of Type IIIA
fracture, and the appropriate 7th character is N subsequent encounter for open fracture Type IIIA, IIIB, IIIC
with nonunion. The complete code is S82.122N.
PTS: 1
DIF: Difficult
40. ANS: C
Rationale: The main procedure is repair of a right femoral neck fracture. Look in the CPT® Index for
Fracture/Femur/Neck/Open referring you to 27236. Modifier LT is appended to show the left side. Next look
in the CPT® Index for Debridement/Skin/Subcutaneous Tissue referring you to 11042-11047. The correct
code is 11043 for debridement of subcutaneous tissue including muscle for less than 20 sq cm. Do not report
11010-11012, because this was not debridement of an open fracture site. Codes 27236 and 27244 are only
reported for hip arthroplasty, not for femoral neck fractures. Modifier 59 is appended to 11043 to show that
this is a different site and not included in 27236.
PTS: 1
DIF: Difficult
41. ANS: C
Rationale: Contrast material is being injected into the shoulder joint for a radiographic look of the joint and
internal structures (arthrogram). Look in the CPT® Index for Arthrography/Shoulder/Injection referring you
to 23350. In the Musculoskeletal section, there is a parenthetical note under code 23350 that indicates to use
code 73040 for radiographic arthrography. Modifier 26 is required to indicate the radiologic professional
service.
PTS: 1
DIF: Difficult
42. ANS: A
Rationale: For the CPT® code, look in the CPT® Index for Injection/Carpal Tunnel/Therapeutic, 20526.
Verify in the numeric section.
Look in your HCPCS Level II codebook in the Table of Drugs and Biologicals for Kenalog, and you are
referred to See Triamcinolone Acetonide, which refers you to J3300 and J3301. Check the tabular listing to
verify. Kenalog-10 is not listed; however, Kenalog is listed under J3301. Code J3301 is reported for 10 mg,
and 4 units are reported to cover the 40 mg given.
PTS: 1
DIF: Difficult
43. ANS: A
Rationale: Look in the CPT® Index for Excision/Metatarsal/Head, and you are referred to 28110-28114,
28122, 28140, 28288. Code 28122 reports a partial excision or sequestrectomy of metatarsal bone. Next in the
CPT® Index look for Lesion/Foot/Excision referring you to 28080, 28090. Code 28090 reports the excision
of the ganglion of the foot. Modifier 51 is appended to indicate multiple procedures performed during the
same session. Modifier LT is appended to indicate the procedure is performed on the left side.
PTS: 1
44. ANS: A
DIF: Difficult
Rationale: The wrist arthroscopy and stabilization was surgically performed to provide stabilization. Look in
the CPT® Index for Arthroscopy/Surgical/Wrist referring you to 29843-29847. Check the numeric section
and 29847 reports arthroscopy of the wrist with internal fixation for fracture or instability. Although several
K-wires were passed, 29847 is reported only once. The diagnostic arthroscopy is included in the procedure
code and is not coded separately.
PTS: 1
DIF: Difficult
45. ANS: B
Rationale: The physician fused the tibiotalar, talonavicular, the calcaneocuboid and subtalar joints making
this a pantalar arthrodesis. Look in the CPT® Index for Arthrodesis/Talus/Pantalar referring you to 28705. A
pantalar arthrodesis is the fusion of the tibiotalar, subtalar, talonavicular and calcaneocuboid joints. Autograft
was taken from the fibula (bone graft) for the arthrodesis, 20902. In the CPT® Index, look for Bone
Graft/Any Donor Area referring you to 20900, 20902. Modifier 51 is required to indicate multiple procedures
during the same session.
PTS: 1
DIF: Difficult
46. ANS: A
Rationale: This is a fracture of the olecranon process which is located at the upper end of the ulna. An
incision was made to expose the fracture site, making it an open treatment. Look in the CPT® Index for
Fracture/Ulna/Olecranon/Open Treatment 24685. Modifier RT is appended to indicate the procedure was
performed on the right side.
PTS: 1
DIF: Difficult
47. ANS: B
Rationale: This was a surgical arthroscopy of the knee. In the CPT® Index look for
Arthroscopy/Surgical/Knee, directing you to 29866-29868, 29871-29889. The medial meniscectomy and
debridement are reported with 29881. In this case the synovectomy, code 29875, is a separate procedure and
bundled with 29881; it is not reported separately.
PTS: 1
DIF: Difficult
48. ANS: C
Rationale: The anterior cruciate ligament repair can be found in the CPT® Index by looking for Cruciate
Ligament/Repair/Arthroscopic Repair 29888, 29889. This was the anterior cruciate ligament; 29888 is the
correct code. A medial meniscectomy was also performed which is reported with 29881. In the CPT® Index
look for Arthroscopy/Surgical/Knee referring you to 29866-29868, 29871-29889. This is a medial
meniscectomy 29881. Modifier -51 is required to report multiple procedures performed during the same
session. The patellar tendon bone graft is included in 29888. The notchplasty (29999) is also bundled as only
one procedure can be reported per compartment (patellofemoral). Modifier RT is appended to indicate the
right side.
PTS: 1
DIF: Difficult
49. ANS: A
Rationale: The procedure was a surgical arthroscopy of the knee reported with codes in the range of 2987129889. In the CPT® Index look for Arthroscopy/Surgical/Knee directing you to 29866-29868, 29871-29889.
The microfracture performed in the patellofemoral joint is reported with 29879. This code is found in the
same code range as indicated above. The medial meniscectomy is reported with 29881. The microfracture
procedure is more complex than the meniscectomy and it is listed first. Modifier 51 is required for the
meniscectomy to indicate multiple procedures. Modifier LT is appended to indicate the procedures were
performed on the left side.
PTS: 1
DIF: Difficult
50. ANS: A
Rationale: The procedure performed was an arthroplasty of the knee found in the CPT® Index by looking for
Arthroplasty/Knee referring you to 27437-27447. This was a total knee arthroplasty with patella resurfacing
reported with 27447. Modifier RT is appended to indicate the procedure is performed on the right side.
PTS: 1
DIF: Difficult
51. ANS: A
Rationale: To accurately code osteoarthritis in ICD-10-CM, the documentation needs to include whether the
arthritis is primary, secondary, post-traumatic, the site and laterality (right/left).
PTS: 1
DIF: Easy
REF: ICD-10-CM
52. ANS: C
Rationale: Open fracture designations are based on the Gustilo open fracture classification. 7th characters are
added to indicate the type of encounter. This classification is grouped into three major category types to
indicate the mechanism of the injury, soft tissue damage and the degree of skeletal involvement. One of the
main categories, Type III, is further subdivided into IIIA, IIIB, and IIIC to report levels of extensive damage.
PTS: 1
DIF: Easy
REF: ICD-10-CM
53. ANS: D
Rationale: In ICD-10-CM, there are codes to indicate when sciatica is present with the low back pain, or low
back pain is due to intervertebral disc disorder or displacement of intervertebral disc.
PTS: 1
DIF: Easy
REF: ICD-10-CM
54. ANS: B
Rationale: According to ICD-10-CM guideline I.C.13.a., the site may be the bone, joint or muscle involved.
PTS: 1
DIF: Easy
REF: ICD-10-CM
55. ANS: A
Rationale: Look in the ICD-10-CM Alphabetic Index for Effusion/joint/ankle and you are referred to
M25.47-. In the Tabular List, code M25.47- requires the application of a 6th character to specify the location
(foot or ankle) and laterality. Report M25.471 for effusion of the right ankle.
PTS: 1
DIF: Moderate
REF: ICD-10-CM