Practice Exam 30000 SERIES
Question 1 A patient that has renal failure had a fistula that was deep and had multiple branches. The physician has elected to perform a revision of the AV AV fistula by moving it to a new location. Under local anesthesia the fistula in the right forearm was exposed from the wrist up near the antecubital fossa. It was then tunneled to a more lateral location and more superficial. nce it had been placed in the tunnel the anastomosis was sutured and clamps removed. !hich "#T$ code should be used% A. &'()1 *. &'(&) ". &'()& +. &'(&& Question ) A '),year,old female with bladder cancer re-uiring chemotherapy is getting a placement of a #ower#ort catheter. Insertion of large,bored catheter was accessed in the subclavian vein. Then a pocet was created on the anterior chest wall to place the port/ and then the catheter was tunneled connecting the catheter to the port. The port was then accessed through the sin/ flushed and aspirated. !hat code should be used for this procedure% A. &'0' *. &'0'2 ". &'00' +. &'0'1 Question & A 33,year,old 33,year,old patient who was found to have a huge aneurysm underwent a coronary artery bypass graft. A median sternotomy was made and the left internal mammary artery was harvested from the left chest wall. The saphenous vein was harvested from the left leg and bypassed distally as it ran in the left ventricular muscle. 4ext/ a second saphenous vein segment was placed to the diagonal vessel and then the left internal mammary artery was placed to the mid 5A+. The 5A+ was bypassed in the mid aspect of the 5A+ and good go od flow was measured in the graft. !hat "#T$ codes describe this procedure% A. &&0&&/ &&01( *. &&012/ &&013 ". &&0&6/ &&01( +. &&011/ &&013
Question 6 A patient that has a 7ediport for chemotherapy infusion is no longer need ed. The left chest was prepped and an incision was made in the old scar and dissection carried down to the port. The capsule around the port was incised and the port was removed. The correct "#T$ code is8 A. &'0( *. &'0() ". &'02 +. &'03' Question 0 A &0,year,old was diagnosed with stage I ductal carcinoma in situ in her right breast. 9he underwent a locali:ed biopsy of sentinel lymph and axillary nodes in her right breast. An incision was made with the scalpel/ once the glandular tissue of the breast was intercepted; dissection was carried down through the sin and subcutaneous tissue. ne to two centimeters of the breast tissue was dissected free to the lymph node. The incision was carried deep to the right axilla and two sentinel and non,sentinel lymph no des were identified and excised. !hat procedure code should be used% A. &(0)0 *. &(032 ". &(022 +. &(020 Question ' A neonatologist attends the delivery of a 1222 gram infant who re-uires intubation for respiratory distress as well as placement of both arterial and venous umbilical catheters. !hat are the codes for these procedures% A. &1022/ &'6)2/ &'')2 *. &1'21/ &'62'/ &'''2 ". &1'2&/ &'6)2/ &'')0 +. &1022/ &'012/ &'''2 Question 3 The patient is an (&,year,old female with a new onset of atrial fibrillation that has developed into a tachy,brady syndrome.
Question ( The patient is a ',year,old white female with a 12 years status,post dual chamber pacemaer where the generator is at end of life. The pacemaer generator was explanted and the leads were then attached to the new generator. The correct "#T$ code is8 A. &&)1& *. &&)2( ". &&)1) +. &&)23 Question A ),year,old female in the hospital who has full blown AI+9 has been put on a ventilator due to her weaness and dyspnea. The physician suspects she has pneumonia and performs a thoracoscopy. The contents of the chest cavity are inspected with an endoscope and multiple areas of consolidation are seen in the right lung and biopsied. #neumocystis carinii pneumonia is diagnosed The correct "#T$ and I"+,,"7 codes are8 A. &)'21/ 6('/ 26) *. &)'2)/ 26)/ 1&'.& ". &)'2'/ 26)/ 1&'.&/ V2( +. &)'02/ 1&'.&/ 26) Question 12 A 60,year,old=s blood pressure was progressively trending downward/ and it was determined that an emergent central venous access was needed for fluid resuscitation. A non,tunneled catheter was used to access the subclavian vein and secured into place to infuse medication. +ue to the patient>s low blood pressure and anticipated need for vasopressor agents/ a radial arterial line was also desired. The left radial artery pulse was easily palpable/ and the sin was punctured by a needle and the Angiocatheter was placed in the left wrist. !hat are the codes for these procedures% A. &'000/ &'')0,01 *. &'00'/ &'')2 ". &'00(/ &''62,01 +. &'0'/ &'')2 Question 11 A 60,year,old male with 9tage III non,
Question 1) A patient with chronic maxillary sinusitis underwent a prior ethmoid surgery. A recent "T scan reveals mucous membrane thicening/ and an opa-ue sinus. An endoscope along with a scalpel is used for a surgical removal of d iseased tissue along with an antrostomy. !hat code should be used for this procedure% A. &1)&& *. &12)2 ". &1222 +. &1)0' Question 1& A &2,year,old male had a #?T scan showing an enlarged spleen.
Question 13 A patient presents to the emergency room with recurrent epistaxis. The otolaryngologist on call cauteri:es the mucosa of the left turbinate to control the hemorrhage. !hich procedure code should the physician select% A. &2(21 *. &221 ". &22& +. &220 Question 1( A complete axillary lymphadenectomy was performed in a patient with metastatic disease from a primary breast site.
A49!?B9 Question 1 A two-year-old comes in for an initial WCE. Mom doesn't have immunization record. States that the childs last shot was when he was ! months old. Medical review and documentation of a new "atient su""orts one element of #$%& five elements of the (S& and a com"lete $ast& )amily& Social #istory. *he e+amination was , oran systems. *he "hysician orders the immunizations to /e iven in the office today. %mmunizations iven0 1 MM 2 3aricella What C$*4 codes should /e re"orted5 A. 66761& 689:1& 68:18 ;. 66282& 68:8:& 68:1< C. 667,2& 689:1& 689:2& 68:8:& 68:1< =. 66212& 689:1& 689:2& 68:8:-!1& 68:1<-!1 3iew ationale Question 2 An esta/lished 9!-year-old woman is seen today at her doctors office. She is com"lainin of /ein dizzy and feels li>e the room is s"innin. She has had "al"itations on and off for the "ast 12 months. She re"orts chest tihtness and dys"nea /ut denies nausea& edema& or arm "ain. She drin>s two cu"s of coffee "er day. #er sister has W$W syndrome. An e+tended five /ody area e+amination is "erformed. *his is a n ew "ro/lem for the "hysician. An E?@ is ordered and la/s are drawn& and "hysician documents a moderate com"le+ity M=M. Select the a""ro"riate C$*4 code for this visit0 A. 66287 ;. 66219 C. 6621! =. 66289 3iew ationale Question 7 A 77 year-old-white male was admitted to the hos"ital on 121:BB from the E& followin a motor vehicle accident& to have a s"lenectomy done. $atient is /ein dischared from the hos"ital on 1228BB. =urin his hos"italization he was e+"eriencin "ain and shortness of /reath& /ut with an anti/iotic reimen of evaDuin& he im"roved. $hysician "erformed final e+amination and reviewed chest B-ray that revealed "ossi/le infiltrates and a C* of the a/domen that ruled out any a/scess. #e was iven a "rescri"tion of osyn. $atient told to follow u" care with $C$ or return /ac> to the hos"ital for any "ain or /leedin. $hysician s"ent 28 minutes. Select the a""ro"riate C$*4 code for 1228 visit0 A. 662,7 ;. 66221 C. 66271 =. 6627, 3iew ationale
Question 9 A new "atient wants to Duit smo>in. *he "atient has constant couh due to smo>in and some shortness of /reath. Fo niht sweats& weiht loss& niht fever& C$& headache& or dizziness. #e has tried the "atches and nicotine um& which has not hel"ed. $atient has /een smo>in for 98 years and smo>es 2 "ac>s "er day. #as a family history of em"hysema. A limited three system e+am was "erformed. $hysician discussed the "ros and cons of medication used to Duit smo>in in detail& counselin and education done for 28 minutes of the 78 minute visit. $rescri"tion of Chantri+ and *etracylcin was iven. $atient to follow u" in 1 month. We will consider chest B-ray and cardiac wor> u" iSelect the a""ro"riate C$* codeGsH for this visit0f not im"roved. A. 66282 ;. 66219& 667!9 C. 66287 =. 66287& 667!9 3iew ationale Question ! *he "hysician was notified to o to the hos"ital floor for medical manaement of a !<-year-old "atient admitted one day ao for as"iration "neumonia and C($=. Fo chest "ain at "resent& /ut still S(; and some swellin in his lower e+tremities. Was tachy"enic yesterdayI luns reveal course crac>les in /oth / ases& riht worse than left. #e is oin to continue with intravenous anti/iotic treatment and res"iratory su""ort& reviewed chest B-ray and la/s. $atient is im"rovin and a "ulmonary consultation has /een reDuested. What C$*4 code should /e re"orted5 A. 66221 ;. 66271 C. 6621, =. 66272 3iew ationale Question < Esta/lished "atient "resents to the office with a recurrence of /ursitis in /oth shoulders. ane of motion is ood and full& /ut he has tenderness in the su/deltoid /ursa. ;oth shoulders were inJected in the deltoid with 128m =e"o-Medrol. Select the a""ro"riate C$*4 code for this visit0 A. 66212-2!& 28<18-!8 ;. 28<18-!8 C. 66211-2!& 28<18 + 2 =. 66212-2!& 28!!8-!8 3iew ationale Question : *he "hysician admitted an 1,-month-old infant from his office to rule out se"sis. %nfant is cryin inconsola/ly. #e has a lare amount of as in his /owel& no hematochezia associated with it. *he "hysician "erforms a com"rehensive history& com"rehensive e+am& and a moderate decision ma>in. %f afe/rile& cultures are neative and inconsola/le cryin resolves in 9, hours& we will dischare home. Watch very carefully vital sins& strict "arameters. Select the a""ro"riate C$*4 code for this visit5
A. 66222 ;. 66216 C. 6627, =. 66227 3iew ationale Question , Esta/lished "atient "resents to the clinic today for a follow-u" of his hos"italization for "neumonia. #e was hos"italized for < days& on %3 anti/iotics. #e was "laced /ac> on Sinulair and has /een doin well with his /reathin since then. An e+"anded "ro/lem focused e+am was "erformed. ecords were o/tained from the hos"ital and "hysician reviewed the la/s and B-rays. Was told to continue anti/iotics for another two wee>s to 28 days& and the "rescri"tion ?etec> was re"laced with ithroma+. $atient to return to the clinic in two wee>s for rechec> of his /reathin and a re-B-ray at that time. What C$*4 code should /e re"orted5 A. 66219 ;. 66292 C. 6677! =. 66217 3iew ationale Question 6 An esta/lished 9:-year-old "atient "resents with fallin last niht& sli""in on water in her house. She is com"lainin of /ac> "ain and no tinlin or num/ness. $hysician documents that she has full rane motion of the s"ine& with discomfort. #er ait is within normal limits. Straiht le raisin is neative. She reDuested no "ain >illers and was recommended to use a hot water /ottle. =octors Assessment0 ;ac> Strain What are the a""ro"riate EM and %C=-6-CM codes for this service5 A. 66212& ,9:.6& E,,,.,& E,96.8 ;. 66212& ,9:.6& E,,!.6& E,96.8 C. 66217& ,9<.6& E,,!& E,96.8 =. 66217& ,9:.6& E,,,.6& E,96.8 3iew ationale Question 18 A :!-year-old esta/lished "atient is /rouht in /y his son to have a "hysical screenin done to /e enrolled in a rou" home. Fo new com"laints. *he "atient has an esta/lished dianosis of Cere/ral $alsy and *y"e %% =ia/etes and is currently on h is meds. A com"rehensive history and e+amination is "erformed alon with a moderate M=M. ;lood wor> was ordered. $$= was done and flu vaccine iven. $atient already had a vision e+am. Fo a/normal historical facts or findin are noted. What C$*4 code should /e re"orted5 A. 6676: ;. 667,: C. 66219
=. 6621! 3iew ationale Question 11 A !-year-old is /rouht into the E /y am/ulance& havin /een found floatin in the "ool for un>nown amount of time. EMS started C$ which was continued /y the E "hysician a lon with an endotracheal intu/ation and "lacement of a C3$. *he. E "hysician s"ent 1 hour with the critically ill "atient. E "hysician ma>es a notation that the 1 hour does not include the time for the other se"arate /illa/le services that too> 78 minutes. What C$*4 codes should /e re"orted5 A. 626!8& 66261-2!& 7 normal. M% "rotocol was ruled out. $atient is "ain free and vitals are normal. $atient is /ein dischared& is already on asi+ and Coumadin and was told to follow u" with her cardioloist. Select the a""ro"riate C$*4 code for this visit0 A. 662,! ;. 6621: C. 66277 =. 6627, 3iew ationale Question 17 A !!-year-old esta/lished "atient is comin in for a "re-o" visitI he is ettin a liver trans"lant due to cirrhosis. *he "hysician "erforms an e+"anded "ro/lem focused history& detailed e+amination& and moderate M=M. $atient arees with his "hysicians recommendations and the trans"lantation will ta>e "lace as scheduled. After the evaluation& the "atient e+"resses a num/er of concerns and Duestions for the "ros"ective liver trans"lant. $hysician s"ends an additional 78 minutes& e+cludin the time s"ent in d oin the EM service& in counselin and answerin Duestions reardin the surery and discussin "ossi/le outcomes. What C$*4 codes should /e re"orted5 A. 66217& 667!9 ;. 66219& 667!, C. 66217& 667!, =. 66219& 667!9 3iew ationale
Question 19 A 68-year-old female was admitted this mornin from o/servation status for chest "ain to ro anina. =r. of cardioloy has come in to evaluate her "erformin a com"rehensive history and com"rehensive e+am. #er chest "ain has /een relieved with the nitrolycerin dri" iven /efore admission and she would li>e to o home. =octor has written out a cou"le of "rescri"tions to add to her reimen. #e had iven her %sosor/ide& and she is toleratin it well. #e will o ahead and send her home. Will follow u" with her in a wee>. $atient was admitted and dischared on the same date of service. What C$*4 code should /e re"orted5 A. 6627! ;. 6621: C. 6627, =. 66221 3iew ationale Question 1! A neonatoloist was called to the delivery room /y the (; unit to attend the /irth of an infant 2:wee> estation. *he newly /orn /a/y went into res"iratory distress. *he neonatoloist intu/ated the infant with /a ventilation and the "lacement of a venous um/ilical catheter. What C$*4 codes should /e re"orted5 A. 669s =r. K to loo> at a ee" monitorin "atient until he sta/ilizes. What C$*4 code should /e re"orted5 A. 66789 ;. 66279 C. 662!7 =. 66297 3iew ationale Question 1: A 2! year-old male is /rouht in /y the EMS to the E for nausea and vomitin. $atient has elevated /lood suars "er EMS. Lna/le to et a history due to "atients altered mental status. *he E "hysician "erformed an eiht oran system e+am and a hih level M=M. $atient was transferred to %CL in sta/le condition. *otal critical care time 2! minutes. What C$*4 code should /e re"orted5
A. 662,! ;. 66261 C. 6627< =. 66227 3iew ationale Question 1, A 7:-year-old female "atient has /een admitted to the (; unit due to severe "re-eclam"sia. )etal monitor show increasin fetal distress. A "ediatrician is reDuested / y an o/stetrician for stand/y durin the C-section. *otal time of stand/y is 9! minutes. What C$*4 code should /e re"orted5 A. 667<8 + 2 ;. 667<8 C. 6682< =. 669<9 3iew ationale Question 16 *he "atient "resents to the E= after a car accident. *he "atient f ell aslee" while she was drivin. She states that for the "ast few wee>s she will "eriodically fall aslee" while she is drivin. She states she ets eiht hours of slee" every niht. She is not sure why this is ha""enin. As a result of the accident she has a contusion on her forehead and a sliht headache. She denies /lurry vision& num/ness& tinlin& and nausea and vomitin. She denies alcohol or dru use. *he "hysician "erforms a detailed e+am. #e orders a C* scan and la/s. #e will also schedule a slee" study to determine the cause for her fallin aslee" while drivin. W hat is the C$*4 code for this encounter5 A. 662,7 ;. 662,9 C. 662,! =. 66261 3iew ationale Question 28 A "hysician ma>es a home care visit on a <7-year-old "atient that is a hemi"leic havin insomnia for the last two wee>s. $atient has /een home /ound for the last year. ast visit from this "hysician was four months ao to control his =M. $hysician "erforms an e+"anded "ro/lem focused e+amination and low M=M. $hysician then s"ea>s with the s"ouse a/out the "ossi/ility of "lacin the "atient in a nursin facility. What C$*4 should /e re"orted5 A. 66217 ;. 66792 C. 6679, =. 6677!
