1. Medial and lateral meniscus repair performed arthroscopically.

a. 27447
b. 29868
c. 29882
d. 29883

2. A patient comes into the emergency department complaining of sever wrist pain after falling onto her out stretched hands. The physician evaluates the patient taking a detailed history, a detailed exam, and medical decision making of moderate complexity. Upon examination the physician notes that there is a small portion of bone protruding through the skin. After ordering xrays of the forearm and wrist the patient is diagnosed with an open distal radius fracture of the right arm. The physician provides an IV drip of morphine to the patient for pain and reduces the fracture. 5- 0 absorbable sutures were used to close the subcutaneous layer above the fracture and the surface was closed with 6-0 nylon interrupted sutures. Wound length was measured at 2.5 cm. It was then dressed with sterile gauze and the wrist was stabilized with a Spica fiberglass cast. The physician provided the patient with a prescription for Percocet for pain and instructions for her to follow up with her orthopedist in 7 days.

a. 99284-25, 25574-RT
b. 99284-57-25, 25605-54-RT, 12031
c. 99284-57, 25574-54
d. 99284-25, 25605-RT, 12031

3. A Scapulopexy is found under what heading

a. Incision
b. Excision
c. Introduction
d. Repair, Revision, and/or Reconstruction

4.A patient with muscle spasms in her back was seen in her physician’s office for treatment. The area over the myofascial spasm was prepped with alcohol utilizing sterile technique. After isolating it between two palpating fingertips a 25-gauge 5" needle was placed in the center of the myofascial spasms and a negative aspiration was performed. Then 4 cc of Marcaine 0.5% was injected into three points in the muscle. The patient tolerated the procedure well without any apparent difficulties or complications. The patient reported feeling full relief by the time the block had set.

a. 64400
b. 20552
c. 64520
d. 20553


5. OPERATIVE NOTE
PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4- C5 and C5- C6. POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4-C5 and C5- C6.
PROCEDURE PERFORMED:
1. Anterior discectomy, C5-C6.
2. Arthrodesis, C5-C6.
3. Partial corpectomy, C5.
4. Machine bone allograft, C5-C6.
5. Placement of anterior plate with a Zephyr C6.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 60 mL.
OMPLICATIONS: None.
INDICATIONS: This is a patient who presents with progressive weakness in the left upper extremity as well as imbalance. He has a very large disc herniation that came behind the body at C5 as well and as well as a large disc herniation at C5-C6. Risks and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion, progressive spondylosis, and lack of improvement were all discussed. He understood and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Preoperative antibiotics were given. The patient was placed in the supine position with all pressure points noted and well padded. The patient was prepped and draped in standard fashion. An incision was made approximately above the level of the cricoid. Blunt dissection was used to expose the anterior portion of the spine with carotid moved laterally and trachea and esophagus moved medially. I then placed needle into the disc spaces and was found to be at C5-C6. Distracting pins were placed in the body of C6. The disc was then completely removed at C5-C6. There was very significant compression of the cord. This was carefully removed to avoid any type of pressure on the cord. This was very severe and multiple free fragments noted. This was taken down to the level of ligamentum. Both foramen were then also opened. Part of the body of C5 was taken down to assure that all fragments were removed and that there was no additional constriction. The nerve root was then widely decompressed. Machine bone allograft was placed into C5-C6 and then a Zephyr plate was placed in the body C6 with a metal pin placed into the body at C5. Excellent purchase was obtained. Fluoroscopy showed good placement and meticulous hemostasis was obtained. Fascia was closed with 3-0 Vicryl, subcuticular 3-0 Dermabond for skin. The patient tolerated the procedure well and went to recovery in good condition.

a. 22554, 63081, 63082, 20931, 22845
b. 22551, 63081, 20931, 22840
c. 22551, 63081, 63082, 20931, 22845
d. 22554, 63081, 20931, 22840

6. A general surgeon and a neurosurgeon are performing an osteotomy on the L4 vertebral segment. The general surgeon establishes the opening using an anterior approach. While the neurosurgeon performs the osteotomy the general surgeon performs a discectomy. After completion the general surgeon closes the patient up.

a. General: 22224-59 Neurosurgeon: 22224-54
b. General: 22224-62 Neurosurgeon: 22224-62
c. General: 22224-66 Neurosurgeon: 22224-66
d. General: 22224 Neurosurgeon: 22224-80

7.A patient comes into his physician’s office with a prior diagnosis of a Colles type distal radius fracture. He complains that the cast he currently has on is too tight and is causing numbness in his fingers. The physician removes the cast and ensures the patient’s circulation is intact. He then reapplies a short arm fiberglass cast and checks the patient’s neurovascular status several times during the procedure. The patient is given instructions to follow-up with his orthopedist within seven days.

a. 25600-77
b. 25600-52
c. 29705, 29075
d. 29075

8. A patient is brought into the OR for a diagnostic arthroscopy of the shoulder. The patient has been complaining of pain since his surgery 4 months ago. The surgeon explores the shoulder and discovers a metal clamp which had been left in from the prior surgery. The surgeon removed the clamp and closed the patient up.

a. 29805, 23330
b. 29805, 29819
c. 29819-78
d. 29819

9. This 59 year-old female was brought to the operating room and placed on the surgical table in a supine position. Following anesthesia, the surgical site was prepped and draped in the normal sterile fashion. Attention was then directed to the right foot where, utilizing a # 15 blade, a 6 cm linear incision was made over the 1st metatarsal head, taking care to identify and retract all vita structures. The incision was medial to and parallel to the extensor hallucis longus tendon. The incision was deepened through subcutaneous underscored, retracted medially and laterally – thus exposing the capsular structures below, which were incised in a linear longitudinal manner, approximately the length of the skin incision. The capsular structures were sharply under scored off the underlying osseous attachments, retracted medially and laterally. Utilizing an osteotome and mallet the medial eminence of the metatarsal bone was removed and the head was remodeled with the Liston bone forceps and the bell rasp. The surgical site was then flushed with saline. The base and excised from the surgical site. There was no hemi implant used and Kirschner wire was used to hold the joint in place. Superficial closure was accomplished using Vicryl 5-0 in a running subcuticular fashion. Site was dressed with a light compressive dressing. The tourniquet was released. Excellent capillary refill to all the digits was observed without excessive bleeding noted.

a. 28296
b. 28292
c. 28899
d. 28298

10. A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture while on vacation. The patient was put under general anesthesia and the elbow was reduced and was stable. The medial elbow was held in the appropriate position and was reduced in acceptable position and elevated to treat non-surgically. 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
b. 24576-54-RT, 24620-54-51-RT
c. 24577-54-RT, 24600-54-51-RT
d. 24565-54-RT, 24605-54-51-RT

 

11.True or false: The procedures used for skeletal and skin traction are the same.

a. True

b. False

 

12. A surgeon performed a radical resection of both a malignant tumor from the soft tissue of the scalp and a malignant tumor of the mandible. A bone graft was completed during the same surgical session to the mandible. How would the surgeon code this procedure?

a. 21015, 21215-51, 21045-51

b. 21015, 21045-59, 21215-51

c. 61501, 21045, 21215

d. 61501, 21045-59, 21215-51

 

13. Dr. Rami, an orthopedic surgeon, removed prosthesis from Cindy’s left knee. Dr. Rami inserted a spacer during the same surgery. How would you code for Dr. Rami’s services?

 

a. 27445-LT

b. 27310

c. 27331

d. 27488-LT

​

14. During a postpartum check-up, Kayla told Dr. Terry, her OBGYN, about a recurrent lump on her right wrist. Kayla has a history of ganglion cysts on both wrists. Dr. Terry refers Kayla to Dr. Eagen, a general surgeon, who excises the cyst. How would you code Dr.Eagen’s services?

 

a. 25112-RT

b. 26160

c. 25111

d. All services are included in postpartum care and should not be reported separately

 

15. A patient has been diagnosed with Treacher-Collins Syndrome. A surgeon performs LeFortII to reconstruct the midface by anterior intrusion. How would you code for the surgeon’s services?

 

a. 21150-22

b. 21141

c. 21150

d. 21151

​

16. Bart’s jaw needs to be set back. He consults with Dr. Todd, an orthopedic surgeon, and is scheduled for the recommended procedure. Dr. Todd reconstructs the mandibular rami by sagittal split with internal rigid fixation. She uses a saw to cut the mandible bone along the inside, top, and outside surfaces. Then, she uses osteotomes to pry the mandible bone apart along cuts in the sagittal plane. Once separated, she moves the mandible into the desired position and stabilized the bone with screws. She repairs a one cm incision site of the skin and mucosa membranes with sutures. How would you code for Dr. Todd’s services?

a. 21196, 13131-51

b. 21195

c. 21196

d. 21196, 12001

​

17. What code(s) would be used to report the transfer of tendons to restore intrinsic function on all four fingers on the left hand with layered closure?

 

a. 26498, 12041

b. 26492

c. 26498 x 4

d. 26498-LT

​

18. Judy noticed swelling in both her hips. She is referred to Dr. Roy, an orthopedic surgeon, who performs a fasciotomy on both hips. Prior to surgery, Dr. Roy obtains the patient’s permission to have a resident observe the surgery. What is the correct code for Dr. Roy’s services?

 

a. 27025 x 2

b. 27025-50

c. 27025

d. 27025-80

​

19.Zachery injured his back while playing tennis; his injury required surgery. He was taken to the operating room where an orthopedic surgeon preformed an anterior osteotomy, including diskectomy to three thoracic vertebral segments. Additionally, Zachery required a structural bone graft obtained from a cadaver. How would you code this procedure?

 

a. 22222, 22226 x 2, 20931

b. 22226, 22222, 20931-51

c. 22216, 22212, 20938

d. 22212, 22216 x 2, 20938-51

​

20. A patient noticed a mass on his neck. He was referred to a general surgeon who determined that the mass was a five cm soft tissue lipoma. The surgeon took the patient to the operating room and removed the lipoma. The surgeon dictated in the operative report that the procedure was deep. How would you code the surgeon’s services?

 

a. 21556

b. 21555

c. 21556, 15819-51

d. 21555, 15819-59

​

**END OF TEST**

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