Friday, November 24, 2017

Surgery Section CPC Practice Questions - Musculoskeletal System Part V


Surgery Section CPC Practice Questions for 2018 - Musculoskeletal System Part V

This post is for Musculoskeletal System (20000 Series) CPC practice questions PART V for 2018,  Practice more and more these question, I will publish more question on coming days, Check my blog regularly for practice more question, Find the answers above the comment box, Share this post to your friends, if you have any clarification please comment i am ready to help you, Do well wish you all the best for your exam.

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APPLICATION OF CASTS AND STRAPPING (29000-29799)


1. Replacement of  fiber-glass shoulder-to hand (long arm) cast for a 54 year old patient -

a) 29105
b) 29065
c) 29055
d) 29710

2. Initial application of a walking-type short legs cast for a sprain -

a) 29405
b) 29515
c) 29425
d) 29440

3. Removal of a full leg cast by a physician who did not apply the cast -

a) 29705
b) 29358
c) 29505
d) 29700

4. Strapping of a 46 year old patient's knee -

a) 29520
b) 29530
c) 29405
d) 29540

5. Replacement of a thigh-to toes cast on the right leg of a 35 year old female patient -

a) 29358
b) 29405
c) 29355
d) 29345

6. A 17 year old male presents to the emergency department after being involved in a car accident. The patient's primary physician calls the orthopedic surgeon to the emergency department. The orthopedist diagnoses a sprained knee ligament. He places a long leg walking cast and instructs the patients to return to his office for follow-up care. What are the procedure and diagnosis codes?

a) 29355
b) 29345
c) 39405
d) 29425





ENDOSCOPY/ ARTHROSCOPY (29800-29999)


1. Surgical arthroscopy of ankle which includes extensive debridement -

a) 29897
b) 29898
c) 29894, 11444
d) 29895

2. Diagnostic knee arthroscopy with a synovial biopsy -

a) 29871
b) 29870
c) 29870, 29871
d) 29866

3. Arthroscopic repair of tuberosity fracture of knee with manipulation -

a) 29851
b) 29850
c) 29855
d) 29856

4. Surgical arthroscopy of ankle including drilling and excision of tibial defect -

a) 29892
b) 29891
c) 29885
d) 29889

5.  The patient presented for medial meniscal tear left knee. Arthroscopy with partial medial menisectomy left knee and arthroscopic picking (drilling pick holes)of the lateral femoral condyle left knee was performed. Code the procedure and diagnosis codes -

a) 29881, 29877
b) 29880, 29879
c) 29881, 29879
d) 29882, 29877

6. 42 year old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. 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 interval was very thick and contracted and this was released with electrocautery and the Bovie including the superior glenohumeral ligament. After this was all released, the middle glenohumeral ligament was released as well as the tendinous portion of the subscapularis. After this was all done with a shaver and electrocautery, the arthroscope was placed anteriorly and the shaver and used to debride some of the posterior capsule and the posterior capsule was released in its posterosuperior and then posteroinferior aspect. After this was done, the arthroscope was then placed back posteriorly and used to release the anteroinferior capsule down to 6’oclock. This was done with electrocautery. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope was then placed back posteriorly and used to confirm that there was still one little strip of capsule around the biceps superiorly and there was one little strip from 6-7 o’clock posteroinferiorly that was only partially cut. The rest of the capsule was completely circumferentially released. What CPT code describes this procedure?

a) 29825
b) 23020
c) 29806
d) 29805

7. PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee The patent was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT and ICD-9-CM codes should be reported?

a) 29881, 29875
b) 29881, 29876
c) 29881, 29877
d) 29881, 29875-59

8. Postoperative Diagnosis: 1. Impingement syndrome left shoulder. 2. AC synovitis left shoulder Procedure: Arthroscopy with subacromial decompression and AC resection left shoulder. The patient was placed supine on the operating table prepped and draped in usual sterile fashion. The scope was introduced from a posterior  portal and the joint was inspected.The rotated cu  looked in good condition. The articular surfaces looked good. the bicep also was in good condition. We went subacromially and there was a fair amount of bursal inflammation encountered. We did a thorough bursectomy. A ligament chisel was used to take down the coracoacromial ligament. A high speed bur was used  to do a subacromial decompression going from lateral to medial. We took off about 2cm of bone anteriorly. Next we opened the AC joint through an anterosuperior portal. We ground off about 10mm of distal clavile because there was a large subchondral cyst and we wanted to get this totally ground out, which we did. Then the wounds were irrigated out, Nylon suture was placed in our portals. The patient was placed in a bulky dressing and an arm sling and sent to the recovery room in stable condition. Code the procedure.

a) 29826-LT, 29824-LT
b) 29824, 29826
c) 23130, 23120
d) 23415, 23120

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Surgery Section CPC Practice Questions - Musculoskeletal System Part IV


Surgery Section CPC Practice Questions for 2018 - Musculoskeletal System Part IV

This post is for Musculoskeletal System (20000 Series) CPC practice questions PART IV for 2018,  Practice more and more these question, I will publish more question on coming days, Check my blog regularly for practice more question, Find the answers above the comment box, Share this post to your friends, if you have any clarification please comment i am ready to help you, Do well wish you all the best for your exam.

For All Part Click here - https://prabusha.blogspot.in/p/cpc-practise-questions.html



FEMUR (THIGH REGION) AND KNEE JOINT (27301-27599)


1. Femoral shaft fracture repair using closed treatment -

a) 27502
b) 27506
c) 27508
d) 27500

2. While playing at home, Riley dislocated his patella, when he fell from a tree. The surgeon documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would you report the treatment and diagnoses -

a) 27566
b) 27562
c) 27560
d) 27437

3. How should you report a deep biopsy of soft tissue of the thigh or  knee area -

a) 20206
b) 27323
c) 27324
d) 20205

4. Mike had a bicycle accident and suffered deep hematomas in both knees. He underwent a bilateral incision and drainage. How would you report the procedure -

a) 27301
b) 27303
c) 27301-50
d) 27372

5. A Grade I, high velocity open right femur shaft fracture was incurred when a 15-year old  female pedestrian was hit by a car. She was taken to the operating room within four hours of her injury for thorough irrigation and debridement, including exicision of devitalized bone. The patient was then reprepped, redraped, and repositioned. Intramedullary rodding was then carried out with proximal and distal locking screws. What are the correct codes for this diagnosis and procedure?

a) 27506
b) 27506, 11012-51
c) 27507, 11012-51
d) 27506, 11044-51





6. An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate 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 2-0 Vicryl and 3-0 Monocryl. What procedure code should be used?

a) 27475-50
b) 27477-50
c) 27485-50
d) 27580-50

LEG (TIBIA AND FIBULA) AND ANKLE JOINT (27600-27899)


1. Open distal fibula fracture repair with internal fixation -

a) 27784
b) 27788
c) 27792
d) 27829

2. Ankle dislocation, closed treatment -
a) 27842
b) 27846
c) 27848
d) 27840

3. A 47-year-old patient was previously treated with external fixation. for a Grade lll left tibia 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 and three screws and the harvested bone graft were packed into the fracture site. What are the correct codes for this diagnosis and procedure?

a) 27724
b) 27722
c) 27535
d) 27536

FOOT AND TOES (28001-28899)


1. Interphalangeal joint dislocation of toe open treatment with internal fixation -

a) 28666
b) 28665
c) 28675
d) 28645

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Thursday, November 23, 2017

Surgery Section CPC Practice Questions - Musculoskeletal System Part III


Surgery Section CPC Practice Questions for 2018 - Musculoskeletal System Part III

This post is for Musculoskeletal System (20000 Series) CPC practice questions PART III for 2018,  Practice more and more these question, I will publish more question on coming days, Check my blog regularly for practice more question, Find the answers above the comment box, Share this post to your friends, if you have any clarification please comment i am ready to help you, Do well wish you all the best for your exam.

For All Part Click here - https://prabusha.blogspot.in/p/cpc-practise-questions.html



FOREARM AND WRIST (25000-25999)


1. Percutaneous skeletal fixation of a Coiles-type fracture on the distal radius with manipulation and external fixation. -

a) 25605
b) 25607
c) 25606
d) 25608

2. PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distalward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What code should be used for this procedure?

a) 25645
b) 25635
c) 25630 
d) 25628

3. PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. OPERATIVE PROCEDURE: Reduction with application external fixator, left wrist fracture FINDINGS: The patient is a 46-year-old right-hand-dominant female who fell off stairs 4 to 5 days ago sustaining an impacted distal radius fracture with possible intraarticular component and an associated ulnar styloid fracture. Today in surgery, fracture was reduced anatomically and an external fixator was applied. PROCEDURE: Under satisfactory general anesthesia, the fracture was manipulated and C-arm images were checked. The left upper extremity was prepped and draped in the usual sterile orthopedic fashion. Two small incisions were made over the second metacarpal and after removing soft tissues including tendinous structures out of the way, drawing was carried out and blunt-tipped pins were placed for the EBI external fixator. The frame was next placed and the site for the proximal pins was chosen. Small incision was made. Subcutaneous tissues were carried out of the way. The pin guide was placed and 2 holes were drilled and blunt-tipped pins placed. Fixator was assembled. C-arm images were checked. Fracture reduction appeared to be anatomic. Suturing was carried out where needed with 4-0 Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings were applied. Vascular supply was noted to be satisfactory. Final frame tightening was carried out. What CPT and ICD-9-CM codes should be reported?

a) 25605
b) 25605, 20690-51
c) 25606
d) 25607

HANDS AND FINGERS (26010-26989)


1.  The patient is a 66-year-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 Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial 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 should be used?

a) 26123, 26125
b) 26121
c) 26045
d) 26123, 26125 x 2





PELVIS AND HIP JOINT


1. Percutaneous skeletal fixation of impact fracture of proximal end of  femoral neck -

a) 27236
b) 27230
c) 27232
d) 27235

2. A patient suffered a fracture of the femoral neck. He had an open treatment of the femoral head with a replacement using a Medicon alloy femoral head and methyl methacrylate cement. How would you report this procedure -

a) 27125
b) 27244
c) 27236
d) 27130

3. Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is placed prone and under fluoroscopic guidance; the needle is placed into the SI joint with a mixture of 20mg of Celestone and Marcaine for pain relief. Code the procedure(s) -

a) 27096, 77002
b) 20610
c) 27096
d) 27093

4. This is a 32 year old female who presents today with sacroilitis. On the physical exam there was pain on palpation of the left sacroiliac joint and imaging confirmation was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 ml of bupivacaine at 0.5% was injected into the left sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. The correct CPT code is -

a) 27093
b) 27096
c) 27095
d) 20610

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