Medical Coding and Billing Specialist

Choose the best answer from the choices provided. Each item is worth 5 points.

  1. Which of the following statements about unbundling is true?
    a. Unbundling is a form of fraud.
    b. It is the process of coding individual pieces of a service rather than coding a
    single code that includes all services.
    c. Unbundling is like charging someone for six individual sodas instead of one
    six pack.
    d. All of the above
  2. All of the “regular CPT codes” fall into what category of codes?
    a. Category III
    b. Category II
    c. Category I
    d. None of the above
  3. Look up code 27725 in your CPT manual. How do you read this procedure?
    a. Repair of nonunion or malunion, tibia; without graft, by synostosis, with
    fibula, any method
    b. Repair of nonunion or malunion, tibia; without graft, with sliding graft,
    with iliac or other autograft, by synostosis, with fibula, any method
    c. Repair of nonunion or malunion, tibia; by synostosis, with fibula,
    any method
    d. Repair of nonunion or malunion, tibia; without graft, (eg, compression
    technique) by synostosis, with fibula, any method
  4. The six main sections are divided into _.
    a. sections, subsections and categories
    b. subsections, headings and subheadings
    c. main terms and subterms
    d. anatomical sites
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  5. Which appendix contains a summary of additions, deletions and revisions?
    a. Appendix B
    b. Appendix C
    c. Appendix E
    d. Appendix G
  6. In the Index, code numbers can be listed by _.
    a. multiple codes using a comma
    b. the specific code
    c. range of codes using a hyphen
    d. all of the above
  7. Which section is a mini-guide to the manual?
    a. The Introduction
    b. The Table of Contents
    c. The Index
    d. All of the above
  8. The period of time following the surgical procedures is called the _.
    a. recovery period
    b. global surgery period
    c. time off without pay
    d. postsurgical time
  9. Procedural main terms can be a(n) _.
    a. anatomical site
    b. synonym
    c. disease
    d. all of the above
  10. Which is not a true statement about Category II codes?
    a. These codes are optional.
    b. Category II codes are a special collection of codes used by providers to track
    and measure performance internally.
    c. These codes are used by insurance companies to determine reimbursement.
    d. Physicians use them to see just how much work they’re doing for
    certain consultations.
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  11. Locate the page for code 25565 and identify the heading.
    a. Surgery
    b. Forearm and Wrist
    c. Musculoskeletal System
    d. Fracture and/or Dislocation
  12. Locate the page for code 69200 and identify the subheading.
    a. Removal
    b. Surgery
    c. External Ear
    d. Auditory System
  13. Locate the page for code 33120 and identify the heading.
    a. Cardiac Tumor
    b. Cardiovascular System
    c. Heart and Pericardium
    d. Surgery
  14. Locate the page for code 12001 and identify the subsection.
    a. Surgery
    b. Integumentary System
    c. Repair (Closure)
    d. Repair—Simple
  15. Locate the page for code 63600 and identify the subheading.
    a. Nervous System
    b. Spine and Spinal Cord
    c. Surgery
    d. Stereotaxis
  16. In the Index, locate Dialysis, Arteriovenous Fistula and select the tentative
    code(s) listed.
    a. 36831, 36833
    b. 36831-36833
    c. 36833
    d. 36831
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  17. In the Index, locate Fluoride, Urine and select the tentative code(s) listed.
    a. 82735
    b. 81001
    c. 82735, 81001
    d. 81001-82735
  18. In the Index, locate Nose, Removal, Foreign Body and select the tentative
    code(s) listed.
    a. 30300
    b. 30310
    c. 30320
    d. 30330
  19. In the Index, locate X-Ray, Abdomen and select the tentative code(s) listed.
    a. 74000,74022
    b. 74000-74022
    c. 74000
    d. 74022
  20. In the Index, locate Clavicle, Tumor, Excision and select the tentative
    code(s) listed.
    a. 23140-23146, 23200
    b. 23140, 23145-23146, 23200
    c. 23140-23146-23200
    d. 23140, 23146-23200
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    Mail-in Quiz 32
    Part 1 Anatomy & Physiology
    Choose the best answer from the choices provided. Each question is worth 3 points.
  21. The humerus, femur and phalanges are examples of _ bones.
    a. sesamoid
    b. cartilaginous
    c. flat
    d. long
  22. The dermis is thinnest _.
    a. over the palms
    b. in the eyelids
    c. over the soles of the feet
    d. in the nail body
  23. To stop the backward flow of blood in the heart, there are _ valves at the
    entrances and exits to the ventricles.
    a. one-way
    b. obstructive
    c. occipital
    d. two-way
  24. Permanent to fatal damage can occur to the heart and brain if the body as a
    whole is without oxygen for more than _ minutes.
    a. one to three
    b. two to four
    c. five to seven
    d. seven to nine
    e. three to five
  25. The esophagus extends from the _.
    a. phalanges to the sternum
    b. phalanges to the stomach
    c. pharynx to the stomach
    d. pharynx to the stapes
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    Part 2 Multiple Choice
    Choose the best answer for each of the following. Each question is worth 3 points.
  26. Hernia repairs are often categorized by _.
    a. type
    b. frequency
    c. location
    d. all of the above
  27. The accurate code(s) to assign for shaving two dermal lesions, one 0.5 cm
    lesion on the arm and one 0.5 cm lesion on the hand, would be _.
    a. 11300 11305-51
    b. 11306
    c. 11305 11300
    d. 11301
  28. A _ is a device that senses when the heart is beating too fast and delivers
    an electrical shock to convert the fast rhythm to a normal rhythm.
    a. single chamber pacemaker
    b. dual chamber pacemaker
    c. cardioverter-defibrillator
    d. pulse generator
  29. Which is not a true statement about coding breast procedures from the
    integumentary system?
    a. Only a portion of the lesion is removed with incisional biopsies.
    b. Breast codes reflect bilateral procedures, as there are two breasts.
    c. With excisional biopsies, the entire lesion is removed.
    d. None of the above
  30. What is the correct procedure code for the control of a simple anterior nasal
    hemorrhage?
    a. 31238
    b. 30903
    c. 30901
    d. 30905
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  31. If a fracture care procedure is not documented as open or closed treatment,
    you would code to _.
    a. percutaneous skeletal fixation
    b. open treatment
    c. closed treatment
    d. dislocation
  32. A __ looks inside both the bladder and the urethra.
    a. cystoscope
    b. cystourethroscope
    c. urethroscope
    d. none of the above
  33. Turn to code 11771 in the CPT manual. What is the description for this code?
    a. Extensive
    b. Excision of pilonidal cyst or sinus; simple or extensive
    c. Excision of pilonidal cyst or sinus; extensive
    d. None of the above
  34. Which is a true statement of a pulse generator?
    a. The battery within the pulse generator is the power behind the pacemaker.
    b. The pulse generator produces the pacing impulses for the pacemaker.
    c. When the battery is out of energy, the entire pulse generator must
    be replaced.
    d. All of the above
  35. What is the correct procedure code for the removal of a bead located
    in the nose?
    a. 30300
    b. 30310
    c. 30320
    d. None of the above
  36. Superficial wounds that require a simple one layer closure, including local
    anesthesia, are classified as _.
    a. Repair – Simple
    b. Repair – Intermediate
    c. Repair – Complex
    d. dehiscence
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  37. Vascular families in the Cardiovascular System are similar to a _.
    a. cluster of grapes
    b. tree with branches
    c. sunflower
    d. none of the above
  38. Cells are collected from the patient’s own bone marrow for this type
    of transplant.
    a. Autologous
    b. Allogeneic
    c. Autograft
    d. Allograft
  39. For the Integumentary System, under Repair (Closure), when multiple
    wounds in the same classification are repaired, you _.
    a. code each wound separately
    b. add together those wounds in the same groupings
    c. locate the code for the repair of multiple wounds
    d. none of the above
  40. When a surgeon decides to remove the appendix during another
    intra-abdominal surgery, with no justification for the appendectomy, you
    would code _.
    a. 44955 in addition to the primary procedure
    b. 44950 in addition to the primary procedure
    c. the primary procedure
    d. 44955
  41. Fine needle aspiration is the removal of a _ from a cyst.
    a. gas
    b. cluster of cells
    c. fluid
    d. all of the above
  42. _ is an examination of the entire colon, from the rectum up to the
    cecum, which may include looking at the terminal ileum.
    a. Sigmoidoscopy
    b. Proctosigmoidoscopy
    c. Colonoscopy
    d. None of the above
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  43. When the medical documentation does not specify the incision and drainage
    procedure as complicated or featured multiple incisions and drainage, you
    will _.
    a. code to complicated
    b. code to simple or single
    c. call the patient for the information
    d. not code a procedure at all
  44. Which is not a true statement of Manipulation in the Musculoskeletal System?
    a. It is the process of immobilizing the bone in a splint or cast without having
    to align the fracture into proper position.
    b. “Reduction” and “restoration” are terms that indicate manipulation.
    c. It is the process of using anatomic alignment and manual force to set
    fractures and/or dislocations.
    d. None of the above
  45. When 20 skin tags are removed by scissors, what code(s) would you assign?
    a. 11201 x 2
    b. 11200 11201
    c. 11200
    d. 11201
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    Part 3 CPT Coding
    Read the following scenarios. Following the Steps to CPT coding, use the surgery
    procedure codes from General through the Urinary System to assign the accurate
    CPT code. Each CPT code is worth 5 points.
  46. Scenario #1
    PREOPERATIVE DIAGNOSIS
    Recurrent pleural effusions with exacerbation of congestive heart failure.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE PERFORMED
    THERAPEUTIC THORACENTESIS.
    PROCEDURE
    With the patient appropriately prepped, and the area marked by ultrasound prior
    to the procedure, the site was anesthetized with 15 mL of 1% lidocaine. A 21-gauge
    caliber needle was inserted into the pleural space. Approximately 20 mL of fluid
    was removed from the pleural space. Blood gases were drawn and results indicated
    a remarkable improvement. A postoperative x-ray was taken and signs of a
    pneumothorax were negative. The patient tolerated the procedure well.
    CPT code: ___________
  47. Scenario #2
    PREOPERATIVE DIAGNOSIS
    90% carotid stenosis, right side.
    POSTOPERATIVE DIAGNOSIS
    90% carotid stenosis, right side.
    PROCEDURE PERFORMED
    RIGHT-CAROTID THROMBOENDARTERECTOMY.
    DESCRIPTION
    This 65-year-old patient was brought to the operating room and placed supine on the
    table. Under general anesthesia, the patient’s neck was prepped and draped on the
    right side. An incision was made across the medial border of the sternocleidomastoid
    muscle and the platysma was divided. The common carotid artery was located. The
    external and internal carotid arteries were isolated and loops were placed around
    them. Clamps were placed on the internal, common, and external carotid arteries.
    The stenosing atherosclerotic plaque was removed. The artery was sutured at the
    distal end, the proximal end, and the meeting in the middle. This caused the desired
    back bleed and the artery was then closed. The wound was then closed in layers after
    placing a Hemovac drain. The patient tolerated the procedure well and was discharged
    to the post anesthesia unit.
    CPT code: ___________
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  48. Scenario #3
    PREOPERATIVE DIAGNOSIS
    Lymph node metastases to upper mediastinum.
    POSTOPERATIVE DIAGNOSI
    Same.
    PROCEDURE PERFORMED
    MEDIASTINOSCOPY.
    PROCEDURE
    The patient was placed in the supine position, neck extended, and general
    anesthesia given. A transverse incision was made in the suprasternal notch on the
    right side. The mediastinoscope was introduced. A dissection was performed in the
    pretracheal fascia and extended under direct vision to the regional lymph nodes,
    where the biopsy was performed. Specimen was sent to laboratory and positive
    results were reported. Hemostasis was noted with minimal blood loss. Patient
    tolerated procedure well. Recovery was uneventful.
    CPT code: ___________
  49. Scenario #4
    PREOPERATIVE DIAGNOSIS
    Rectal pain.
    POSTOPERATIVE DIAGNOSIS
    Perirectal abscess.
    PROCEDURE PERFORMED
    I&D OF PERIRECTAL ABSCESS.
    DESCRIPTION OF PROCEDURE
    After informed consent, the patient was brought to the operating room and placed
    in the lithotomy position. After adequate induction of anesthesia, the rectal area
    was prepped and draped in a sterile manner. Examination of the rectal area
    revealed no evidence of fissure but obvious abscess was present. The skin around
    the abscess was palpated. The anus was then dilated and the speculum introduced.
    With mild pressure, the abscess was ruptured by incision and drained of purulent
    material. The abscess appeared to be in between the subcutaneous tissue and the
    sphincters. The area was completely drained, irrigated and packed thoroughly with
    gauze. The patient tolerated the procedure well and was discharged to the post
    anesthesia care unit.
    CPT code: ___________
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  50. Scenario #5
    PREOPERATIVE DIAGNOSIS
    Medial and lateral meniscus tears, left knee.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE PERFOMED
    ARTHROSCOPY WITH MEDIAL AND LATERAL MENISCECTOMIES,
    LEFT KNEE.
    BRIEF HISTORY
    The patient felt a pop in his knee while moving furniture at the nursing home
    where he is employed.
    PROCEDURE
    The patient was placed on the operating table in the supine position under
    general anesthesia. The left knee was prepped and draped in the usual manner.
    Ports were established in the knee and the joint was inflated. Arthroscopy was
    carried out beginning in the inferolateral portal. After initial exploration, the
    medial compartment was explored. The arthroscopy exposed the meniscus that
    revealed a tear. The torn portion was removed with forceps. Attention was
    then turned to the lateral compartment that also revealed a tear in the lateral
    meniscus. The torn portion was removed with forceps. After completion of the
    meniscectomies, there were no other significant findings. The knee joint was
    thoroughly irrigated and the instruments were removed. Dressing was applied.
    The patient tolerated the procedure well and left the operating room in good
    condition.
    CPT code: ___________
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    For School Use Only:
    Grade: _
    0205502LB01B-44 15
    CB2
  51. Fill in your student ID and your course code below.
    STUDENT ID NUMBER COURSE CODE
  52. Be sure your name and address are filled in below.
  53. Mark your answers on this cover sheet.
  54. Write the year of the coding manual used to complete this quiz. _
    NAME
    ADDRESS
    CITY STATE ZIP
    Medical Coding and Billing Specialist
    Mail-in Quiz 32
    This Space for Instructor Use
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  75. _
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  80. CPT code: _______
  81. CPT code: _______
  82. CPT code: _______
  83. CPT code: _______
  84. CPT code: _______
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    Mail-in Quiz 33
    Choose the best answer from the choices provided. Each item is worth 3.33 points.
    Part 1 Multiple Choice
  85. What excision procedure is found within the Parathyroid, Thymus,
    Adrenal Glands, Pancreas and Carotid Body heading?
    a. Parathyroidectomy
    b. Thymectomy
    c. Adrenalectomy
    d. All of the above
  86. _ is a procedure in which a long needle is inserted through the
    abdominal wall to withdraw amniotic fluid.
    a. Cordocentesis
    b. Amniocentesis
    c. Fetal non-stress test
    d. None of the above
  87. You are the medical coding and billing specialist for Dr. Johnson.
    The documentation states that Dr. Johnson performed the definitive
    procedure of skull base surgery while Dr. White performed the approach
    procedure. What will you code for Dr. Johnson?
    a. The approach and definitive procedures
    b. The approach procedure
    c. The definitive procedure
    d. None of the above
  88. Which is not a true statement of Intersex Surgery?
    a. You will find code 55970 Intersex surgery; male to female.
    b. The procedures are part of the Male Genital System.
    c. You will find code 55980 Intersex surgery; female to male.
    d. These are very specialized procedures performed by physicians with the
    training and skill.
  89. Which is a true statement of Operating Microscope?
    a. This subsection contains only one code.
    b. This code can be used alone if necessary.
    c. This code is used when surgical services are performed using the techniques
    of microsurgery.
    d. Both a and c
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  90. In the Female Genital System, which code is performed under general
    anesthesia due to the patient’s inability to tolerate the procedure
    while awake?
    a. 57400
    b. 57415
    c. 57410
    d. All of the above
  91. _ is the removal of the contents of the eyeball, leaving the sclera and
    sometimes the cornea.
    a. Enucleation
    b. Evisceration
    c. Exenteration
    d. Evacuation
  92. Code 54015 is for _.
    a. an abscess on the skin of the penis
    b. draining an abscess in the deep tissue of the penis
    c. procedures found in the Integumentary System
    d. none of the above
  93. Which is the correct code for the removal of a marble from the external
    ear, with the use of anesthesia?
    a. 69200
    b. 69205
    c. 69210
    d. None of the above
  94. For those who have had a previous cesarean delivery, plan on a vaginal, but
    end up with another cesarean delivery, you would use codes _.
    a. 59618-59622
    b. 59610-59614
    c. 59510-59525
    d. 59400-59430
  95. A craniotomy is a(n) _.
    a. excision of a portion of the skull
    b. incision into the skull with a possible removal of a portion of the skull
    c. opening into the skull
    d. repair to the base of the skull
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  96. Hysterorrhaphy is a repair made during the _.
    a. delivery
    b. conception
    c. postpartum period
    d. pregnancy
  97. Temporary closure of the eyelids by suture is termed _.
    a. blepharotomy
    b. orbitomy
    c. tarsorrhaphy
    d. canthotomy
  98. Which is the correct description of a vulvectomy with the removal of less than
    80 percent of the skin and deep subcutaneous tissue in the vulvar area?
    a. Vulvectomy, radical, partial
    b. Vulvectomy, simple, partial
    c. Vulvectomy, radical, complete
    d. Vulvectomy, simple, complete
  99. Removal of one or both testes is termed _.
    a. oophorectomy
    b. salpingectomy
    c. orchiectomy
    d. testecomy
    Part 2 CPT Coding
    Select the answer that corresponds to the correct CPT code for the given procedure.
    Each item is worth 3.33 points.
  100. Partial adrenalectomy
    a. 60650
    b. 60540
  101. Cryosurgery destruction of a lesion located on the penis, extensive
    a. 54056
    b. 54065
  102. Lumbar puncture for drainage of cerebrospinal fluid
    a. 62272
    b. 62270
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  103. Laparoscopic prostatectomy
    a. 52601
    b. 55866
  104. Bilateral oophorectomy
    a. 58940-50
    b. 58940
  105. Cesarean delivery only
    a. 59514
    b. 59510
  106. Burr holes drilled for drainage of subdural hematoma on right and
    left side
    a. 61154
    b. 61154-50
  107. Newborn circumcision, surgical excision
    a. 54161
    b. 54160
  108. Complicated Vesiculotomy
    a. 55605
    b. 55650
  109. Hemilaminectomy L4-L5 for excision of herniated disc
    a. 63020
    b. 63030
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    Part 3 Anatomy & Physiology
    Choose the best answer from the choices provided. Each item is worth 3.33 points.
  110. The endocrine glands occur in the _.
    a. brain, reproductive tract, chest, gastrointestinal tract and neck
    b. brain, reproductive tract, neck, spinal tract and chest
    c. brain, stomach, reproductive tract, neck and spinal tract
    d. brain, stomach, reproductive tract, chest and spinal tract
  111. Thymosin stimulates the maturation of T-cells, which are _.
    a. part of the immune response system and red blood cells
    b. red and white blood cells
    c. white blood cells
    d. part of the immune response system and white blood cells
  112. Each time the _ affects its target organ, you get the same result.
    a. somatic nervous system
    b. somatic sensory area
    c. autonomic nervous system
    d. autonomic reflex
  113. Elder vision, or _, is caused by the decrease of lens elasticity.
    a. hyperopia
    b. presbyopia
    c. myopia
    d. trochlea
  114. The metabolic rate is increased by _.
    a. vasodilation caused by cold
    b. vasoconstriction caused by heat
    c. vasodilation caused by heat
    d. vasoconstriction caused by cold
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    Mail-in Quiz 34
    Part 1 Multiple Choice
    Choose the best answer from the choices provided. Each item is worth 4 points.
  115. The _ component is the doctor’s interpretation and report of the film.
    a. professional
    b. global
    c. technical
    d. physician
  116. If the physician tested for automated CBC and automated differential
    WBC count, hepatitis B surface antigen (HbsAg), rubella antibody,
    qualitative syphilis test, RBC antibody screening, ABO blood typing and
    Rh (D) blood typing, you would code _.
    a. each test separately and append the 51 modifier
    b. each test separately
    c. the obstetric panel
    d. none of the above
  117. What is the standard formula developed by the American Society of
    Anesthesiologists (ASA) for payment of anesthesia services? _
    a. Base value + time spent + modifying factor
    b. Procedure code + physical status modifier + qualifying circumstance
    c. Procedure code x conversion factor
    d. Basic units + time units + modifying units
  118. Which type of diagnostic radiology involves a computer taking a 3-D
    picture of an echo off your body?
    a. MRI
    b. CT
    c. X-ray
    d. Both a and b
  119. Codes for qualifying circumstances can be found in the _.
    a. anesthesia guidelines
    b. surgery section
    c. medicine section
    d. both a and c
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  120. Which is a one-dimensional scan that measures the time it takes for sound
    waves to reach a structure and reflect back to the source?
    a. M-mode
    b. B-scan
    c. A-mode
    d. Real-time scan
  121. When the lab tests are repeated on the same day to obtain multiple
    results, you will list the appropriate procedure code _.
    a. twice
    b. twice and append the modifier 51 to the second code
    c. twice and append the modifier 91 to the second code
    d. once
  122. Code 99140 is _.
    a. an add-on code
    b. a qualifying circumstance
    c. anesthesia complicated by emergency conditions
    d. all of the above
  123. To be successful in coding for anesthesia you will need _.
    a. the Relative Value Guide published by the American Society
    of Anesthesiologists
    b. the Physician’s Desk Reference
    c. a strong knowledge in anatomy
    d. both a and c
  124. _ is a technique that trains a person to consciously regulate their
    bodily functions.
    a. Biofeedback
    b. Psychotherapy
    c. Neurophysiology
    d. Both a and c
  125. The correct code for a single view chest x-ray is _.
    a. 70100
    b. 71010
    c. 71015
    d. 71020
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  126. _ involves injecting minimal dosages of radioactive material into
    the body.
    a. Nuclear medicine
    b. Diagnostic radiology
    c. Radiation oncology
    d. Ultrasounds
  127. The Relative Value Guide (RVG) is published by _.
    a. the American Medical Association
    b. the American Society of Anesthesiologists
    c. Medicare
    d. Optum
  128. The subheading of Diagnostic Radiology includes _.
    a. computed tomography
    b. x-rays
    c. MRIs
    d. all of the above
  129. A(n) _ is one who specializes in that branch of medicine that uses radiant
    energy to diagnose and treat patients.
    a. anesthesiologist
    b. radiologist
    c. pathologist
    d. archeologist
    Part 2
    Determine whether the statement is (a) True or (b) False. Each item is worth 4 points.
  130. General anesthesia is full body anesthesia with complete loss
    of consciousness.
    a. True
    b. False
  131. Angiography is the radiological examination of vessels after injecting a dye.
    a. True
    b. False
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  132. Any time you code a vaccination you will code the immunization
    administration code as well.
    a. True
    b. False
  133. Drug tests are quantitative.
    a. True
    b. False
  134. When multiple services are provided during the same anesthesia session,
    both services are reported.
    a. True
    b. False
  135. According to the Pathology and Laboratory Guidelines, services in the
    Pathology and Laboratory section are provided by a technologist without
    any supervision.
    a. True
    b. False
  136. Radiation oncology is the use of radiation in treating cancer patients.
    a. True
    b. False
  137. For a urinalysis, bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite,
    pH, protein, specific gravity, urobilinogen must all be tested and documented.
    a. True
    b. False
  138. The physical status modifier P5 represents a normal, healthy patient.
    a. True
    b. False
  139. Unless otherwise indicated, radiological services are bilateral.
    a. True
    b. False
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    Mail-in Quiz 35
    Read the dictation to determine the accurate ICD-9-CM and CPT codes, as well as modifiers
    that may apply. E codes are not used in this Quiz. Each code is worth 2 points. Each modifier
    is worth 1 point.
    Mail-in Quiz Scenario 1
    PREOPERATIVE DIAGNOSIS
    Chronic pyelonephritis.
    POSTOPERATIVE DIAGNOSIS
    Vesicoureteral reflux.
    PROCEDURE PERFORMED
    URETHROCYSTOGRAPHY.
    BRIEF HISTORY
    This 25-year-old male has had a history of long-standing urinary tract infections with
    multiple recurrences. Urine cultures were positive for Escherichia coli.
    PROCEDURE
    Consent forms were signed, and the patient was taken to the radiology procedure
    suite. He was placed on the combination table and adjusted to allow for the films to be
    centered at the level of the upper border of the pubic symphysis. He was given mild
    sedation, prepped, and draped. A catheter was inserted into the urinary meatus through
    the urethra into the bladder. The bladder was then distended with the contrast material
    until the patient felt the urge to micturate. Voiding was then recorded on videotape.
    Vesicoureteral reflux was noted. The patient tolerated the procedure well and was taken
    to a recovery room. After he was fully awake, he was advised to have the abnormality
    surgically corrected.
    Hint: Code for radiological supervision and interpretation.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 2
    PREOPERATIVE DIAGNOSIS
    Hallux valgus.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE PERFORMED
    REPAIR OF HALLUX VALGUS, KELLER.
    BRIEF HISTORY
    This 59-year-old construction worker has been seen over the past six weeks complaining
    of a painful prominence at the base of his left great toe. He has worn pads over and
    around the bunion, but the pain is getting worse. Because of his job, metaltoe footwear
    is required. He has developed calluses over the area. The patient denies having diabetes
    or a family history of abnormally shaped metatarsal bones.
    PROCEDURE
    The skin of the left foot was examined and was free from infection. The patient signed
    the consent forms and opted for general anesthesia. Following sedation, the patient
    was placed in a supine position on the table. A tourniquet was applied to allow little or
    no bleeding of the surgical site. The skin of the foot was then thoroughly cleansed with
    Betadine solution. Sterile towels covered all of the leg other than the surgical site. A
    5 cm lengthwise incision was made over the bunion. The bone was exposed just to the
    inner side of the tendon. The tendon was carefully pulled to one side so that the base of
    the phalanx bone could be completely severed using an electric rotating saw. Great care
    was taken while sawing to prevent damage to the tendon on the underside of the toe.
    Once the base of the phalanx was removed, the exostosis on the side of the metatarsal
    bone was shaved off with a chisel and mallet to narrow the end of the bone. The
    ligamentous tissue that overlies the bone on the inner edge of the foot was sutured. The
    incision site was then sutured and a firm gauze pad was placed between the big toe and
    the second toe to keep them parallel. The tourniquet was released. Minimal blood loss
    was noted. The foot was dressed with sterile gauze and taped securely. The patient was
    then taken to the recovery room in good condition.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 3
    PREOPERATIVE DIAGNOSIS
    Infertility.
    POSTOPERATIVE DIAGNOSIS
    Infertility associated with peritubal adhesions.
    PROCEDURE PERFORMED
    HYSTEROSALPINGOGRAPHY.
    BRIEF HISTORY
    This 27-year-old woman and her husband of six years have been attempting to conceive
    a child for the last two years to no avail. After a consultation with a fertility specialist,
    they have agreed to a hysterosalpingography before attempting any
    other measures.
    PROCEDURE
    The patient confirmed that she was seven days post menses. She read and signed
    the consent form. Following irrigation of the vaginal canal, complete emptying of the
    bladder, and perineal cleansing, she was placed on the cystoscopic-radiographic table,
    draped, sedated, and adjusted in the cystoscopic position, with her knees flexed over
    the leg rests. Following inspection of the preliminary film, and with a vaginal speculum
    in position, a uterine cannula was inserted through the cervical canal. The attached
    rubber plug was fitted firmly against the external cervical os. Counter pressure was
    applied with a tenaculum to prevent reflux of the contrast medium, and the speculum
    was withdrawn. An opaque medium was introduced via the cannula into the uterine
    cavity, where it flowed through the fallopian tubes and spilled into the peritoneal cavity.
    Bilateral peritubal adhesions were noted. The patient tolerated the procedure well and
    will be discharged to her husband following complete recovery from the sedation.
    HINT: Code for radiological supervision and interpretation as well as for the
    injection portion.
    ICD-9-CM: _
    ICD-9-CM: _

    CPT: _
    CPT: _

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    Mail-in Quiz Scenario 4
    CHIEF COMPLAINT
    Sinus tachycardia.
    HISTORY
    This anxious 45-year-old male presents with breathlessness, lightheadedness, and a
    feeling that his heart is beating too fast.
    PROCEDURE
    TWELVE-LEAD ELECTROCARDIOGRAM EVALUATION, INCLUDES TRACING.
    The P waves were 130/min. The atrial depolarization is consistent with origin at the
    junction of the high right atrium and superior vena cava. Carotid sinus massage
    temporarily slowed the heart rate, but it returned to a tachycardic level as soon as the
    carotid sinus pressure was removed.
    ASSESSMENT
    Sinus tachycardia.
    PLAN
    A cardiology consultation was recommended to further evaluate his cardiac status.
    ICD-9-CM: _
    CPT: _

    Mail-in Quiz Scenario 5
    The patient is a 45-year-old female. While attempting to release the blades from an
    electric knife after carving a turkey, her hand slipped and cut the 2nd digit on her
    left hand. She immediately applied pressure but was unable to stop the bleeding. The
    patient had her last tetanus shot 3 years ago prior to minor surgery. After signing the
    consent form, she was taken to the procedure room, placed supine on the bed with her
    left forearm and hand extended on the movable armrest. The wound was noted to be 2
    cm in length. A 35 mL syringe with a 19-gauge needle was used to irrigate the wound
    with saline. The wound was then anesthetized with 1% lidocaine using the aspiration
    technique first to prevent intravascular injection of the drug. Adison’s forceps were used
    with gentle pressure to decrease trauma when handling the skin edges. A simple repair
    of the superficial wound was made using 5-0 nylon and a locked-running suture pattern.
    The suture was secured with Steri-Strips. The patient was instructed to keep the wound
    dry for at least 24-48 hours and to report any redness or swelling around the wound.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 6
    DIAGNOSIS
    Osteoarthritis of diarthrodial joint, right knee.
    PROCEDURE PERFORMED
    CELL COUNT, BODY FLUID
    Arthrocentesis was performed prior to obtain synovial fluid, specimen #1, right
    knee noninflammatory articular osteoarthritis. Synovial fluid is clear, viscous, and
    amber-colored with a white blood cell count of 1900/mL and a predominance of
    mononuclear cells. The viscosity was assessed by expressing fluid from the syringe
    one drop at a time with a stringing effect and a long tail behind each drop. The fluid
    was not hemorrhagic. These results are consistent with noninflammatory articular
    osteoarthritis.
    ICD-9-CM: _
    CPT: _

    Mail-in Quiz Scenario 7
    ROTATOR CUFF SYNDROME
    This 22-year-old female is a member of the tennis team at the college she is attending.
    She was seen 2 weeks ago and diagnosed with rotator cuff syndrome affecting the
    supraspinatus muscle. Since her visit she has not played any sports and has been
    using a sling to rest the shoulder muscle. She has been taking an over-the-counter
    NSAID and applying moist heat with minimal symptomatic relief. Because conservative
    management has not resolved the symptoms, she is seen today for a trigger point
    injection of the supraspinatus muscle. The patient was seated on the examination table,
    bent forward, with a patient gown open in the back. The injection site was prepped. A
    solution of 1 mL of triamcinolone, 40 mg/mL, and 2 mL of lidocaine hydrochloride 2%,
    was injected into the supraspinatus muscle. There was minimal bleeding, and sterile
    gauze was secured with a bandage over the site. The patient tolerated the procedure
    well and was assured the pain should subside within the next 24 to 48 hours. She was
    also asked to return if she had any redness or swelling at the injection site.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 8
    HISTORY
    This pleasant 55-year-old male presented to his family doctor with symptoms of a loss
    of sexual drive and a reduction in the size of his testes. He appears to have an abnormal
    bronze skin color. Laboratory findings included mildly abnormal liver tests (AST,
    alkaline phosphatase), elevated plasma iron level with greater than 50% saturation of
    the transferin, and an elevated serum ferritin. The liver biopsy showed extensive iron
    deposition in hepatocytes and in bile ducts. The hepatic iron index was greater than
    1.9. Studies confirm hemochromatosis and venesection was strongly recommended. The
    venesection procedure was explained to the patient. He understands that he will require
    weekly phlebotomy for about 1 or 2 years, after that it will be performed at intervals as
    required to maintain levels within the normal range. He agreed and signed the consent
    form.
    PROCEDURE PERFORMED
    The patient was here today for his first treatment. He states he does not have any
    questions at this time and was ready to begin treatments. Using sterile technique, his
    first phlebotomy session with 500 mL of blood (about 250 mg of iron) was performed.
    Following the procedure, the site was negative for abnormal bleeding or hematoma.
    Sterile gauze secured with tape was placed over the puncture site. Since there were no
    complications or abnormalities, the patient was discharged and driven home by his very
    supportive wife.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 9
    PREOPERATIVE DIAGNOSIS
    Prostate hypertrophy.
    POSTOPERATIVE DIAGNOSIS
    Benign prostatic hypertrophy (BPH) with urinary retention.
    PROCEDURE PERFORMED
    PROSTATE GLAND RESECTION, TRANSURETHRAL, ELECTROSURGERY.
    BRIEF HISTORY
    The 55-year-old male presented with increased urinary urgency and frequency,
    especially at night, a weak urinary stream, and a feeling that the bladder could not be
    emptied completely. He does not experience any incontinence. There was slight burning
    on urination and the color was abnormal. He has been experiencing frequent impotence.
    A rectal examination revealed an enlargement of the prostate.
    PROCEDURE
    Consent forms were signed. The patient was taken to the operating room and given
    general anesthesia. He was then prepped, draped, and placed in the lithotomy position.
    The resectoscope was passed through the opening at the tip of the penis and into the
    inside of the urethra. The edge of the resectoscope was used to cut away the urethra
    wall to reach the interior of the prostate gland. The loop of tungsten wire was heated
    using electric current, passed through the scope, and used to cut away part of the
    enlarged prostate gland. The pieces of tissue were washed out through the resectoscope,
    and all bleeding vessels were cauterized. The resectoscope was slid gently out, and
    a catheter was gently pushed inside the urethra into the bladder for temporary
    facilitation of urination and bladder irrigation. The patient appeared to tolerate the
    procedure well and was taken to the recovery room.
    ICD-9-CM: _
    ICD-9-CM: _

    CPT: _
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    Mail-in Quiz Scenario 10
    PREOPERATIVE DIAGNOSIS
    Chronic hepatitis.
    POSTOPERATIVE DIAGNOSIS
    Chronic viral hepatitis C.
    PROCEDURE
    NEEDLE BIOPSY OF LIVER, PERCUTANEOUS.
    BRIEF HISTORY
    This 29-year-old male admits to multiple heterosexual sex partners and recreational
    intravenous drug use with shared needles for the past 10 years. He thinks he has
    been diagnosed with hepatitis in the past, but was unsure of when or what type. He
    presented with symptoms of poor appetite, fatigue, low-grade fever, and some upper
    abdominal discomfort. Noted were jaundice, enlarged spleen, spider-like blood vessels in
    the skin, and fluid retention. A liver biopsy was recommended to obtain hepatic tissue
    for diagnosis and treatment. Preoperative testing was completed, and there were no
    contraindications for the procedure.
    PROCEDURE PERFORMED
    The patient signed the consent form and was taken to the operating room. He was
    placed on the table in a supine position with a pillow under his left side and his right
    arm over his head. The site was prepped, draped, and infiltrated with a local anesthetic.
    A small incision was made between the 6th and 7th intercostal space on the right
    side. The patient was instructed to hold his breath while the needle was inserted, and
    a sample of liver tissue was withdrawn. The needle was removed and pressure was
    held over the site. Minimal bleeding was noted, and sterile gauze was secured over the
    incision. The sample was taken to the laboratory for an immediate cytohistologic study
    to determine adequacy of the specimen. The patient tolerated the procedure well and
    was discharged in 4 hours after being observed for an unremarkable recovery.
    ICD-9-CM: _

    CPT: _
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    Mail-in Quiz Scenario 11
    PREOPERATIVE DIAGNOSIS
    Open Colles fracture, left wrist.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE PERFORMED
    OPEN REDUCTION INTERNAL FIXATION LEFT DISTAL RADIUS FRACTURE
    WITH DEBRIDEMENT OF OPEN FRACTURE SITE.
    BRIEF HISTORY
    This 59-year-old female presents with an open Colles fracture of the left wrist following
    an automobile accident. The patient was a passenger in the vehicle that was struck by
    another vehicle. The air bag deployed which caused the fracture. It was determined that
    closed treatment was insufficient for fracture treatment.
    PROCEDURE
    After the attainment of adequate general anesthesia, the left upper extremity was
    prepped and draped. A skin marker was used to identify the appropriate location using
    the position on the forearm for the radius pins. The fracture and open wound were
    addressed. The wound required significant debridement of the skin and subcutaneous
    tissue prior to proceeding with the repair of the fracture. After adequate debridement,
    the fracture was reduced to the appropriate anatomic position. Excellent stable fixation
    was obtained. Rotational alignment appeared to be satisfactory. The wound was
    irrigated, sutured closed, and dressed with Xeroflo, cast padding, and Ace wrap. The
    patient tolerated the procedure well and arrived in the recovery room in good condition.
    ICD-9-CM: _

    CPT: _
    CPT: _

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    Mail-in Quiz Scenario 12
    PREOPERATIVE DIAGNOSIS
    Otalgia of left ear due to persistent middle ear effusion.
    POSTOPERATIVE DIAGNOSIS
    Chronic otitis media with effusion.
    PROCEDURE PERFORMED
    MYRINGOTOMY.
    BRIEF HISTORY
    The patient is a 3-year-old male with a history of chronic otitis media. He has
    been treated in the past with amoxicillin over a 3-month period. Bacterial cultures
    were positive for Haemophilus influenzae and he was treated with amoxicillin and
    sulfonamide for 10 days. The mother and father claim their son does not appear to be
    improving and, after a thorough explanation of the procedure, have agreed to sign the
    consent forms.
    PROCEDURE
    The patient was given mild sedation in the preoperative area with the mother and
    father present. The patient was then taken to the operating room and given general
    anesthesia. The left ear was prepped and draped. A small incision was made around
    the eardrum and care was taken not to injure the small bones of the middle ear. Most of
    the fluid was removed by suction. A small sample was sent to the laboratory for culture.
    At the same time, a small tube was left in place to continue drainage. The tube will be
    removed in approximately 1 to 3 weeks. The patient tolerated the procedure well and
    will be sent to the recovery room where his mother and father will be present when he
    awakens.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 13
    PREOPERATIVE DIAGNOSIS
    Hemorrhoids.
    POSTOPERATIVE DIAGNOSIS
    Thrombosed internal hemorrhoids.
    PROCEDURE PERFORMED
    SIMPLE HEMORRHOIDECTOMY.
    DESCRIPTION
    After discussing the procedure with the patient, the consent was signed. He was then
    taken to the operating room and placed in a prone position. He was anesthetized,
    then prepped, and draped in a sterile fashion. A large internal hemorrhoid, which was
    significantly thrombosed, was palpated. The hemorrhoid was injected with 30 mL of
    Marcaine that infiltrated the tissue around the hemorrhoid. After allowing adequate
    time for the anesthesia to take effect, the hemorrhoid was grasped with a clamp while
    another clamp was placed at the base of the hemorrhoid. The hemorrhoid was excised
    above the clamp and a running stitch going in the opposite direction was looped over
    the clamp. The clamp was then removed and the stitch was tightened. Another set of
    sutures was run down the length of the excised hemorrhoid. Bleeding was controlled
    with cautery and sutures. The area was dressed and packed with gauze. The patient
    tolerated the procedure well and was discharged to the postanesthesia care unit.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 14
    PREOPERATIVE DIAGNOSIS
    Ascites and pleural effusion.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE
    PARACENTESIS. THORACENTESIS.
    A paracentesis of the abdomen was performed using a 24-gauge needle and 200 mL
    of straw-colored fluid was withdrawn. Pressure was applied for five minutes to the
    puncture site. No complications were encountered. A 22-gauge needle was then used to
    perform a right thoracentesis in the left lateral decubitus and 75 mL of serosanguineous
    fluid was withdrawn. Pressure was applied for five minutes to the puncture site with
    no significant blood loss. Good bilateral breath sounds were auscultated following the
    procedure. Both fluid samples were sent for cell count, acid-fast stain, and glucose
    and protein levels. A culture and sensitivity was also ordered on both samples.
    Nonmalignant ascites and exudative effusion confirmed by laboratory studies.
    ICD-9-CM: _
    ICD-9-CM: _

    CPT: _
    CPT: _

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    Mail-in Quiz Scenario 15
    PREOPERATIVE DIAGNOSIS
    Subdural hematoma.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE
    BURR HOLE FOR EVACUATION AND DRAINAGE OF SUBDURAL HEMATOMA.
    BRIEF HISTORY
    The patient is a 16-year-old student. During cheerleading practice, she was standing
    on the top of a “human pyramid,” lost her balance and fell on her head hitting the right
    side. She immediately felt drowsy and confused. By the time the paramedics arrived,
    she complained of a unilateral headache on the right side. Pupillary dilation was
    ipsilateral to the injured side. At the hospital, the location of the hematoma was located
    by angiography followed by x-ray and a CT scan.
    PROCEDURE
    The consent form was signed by the parents and the patient was taken to the operating
    room. She was anesthetized and the right frontotemporal region was prepped and
    draped. A burr hole, using a rounded tip, was made into the skull. Immediate
    evacuation and decompression resulted. The patient’s vitals were stable and she was
    discharged to the neurosurgeon for evaluation of a craniotomy.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 16
    PREOPERATIVE DIAGNOSIS
    Proteinuria.
    POSTOPERATIVE DIAGNOSIS
    Same.
    PROCEDURE PERFORMED
    CT GUIDED RIGHT KIDNEY BIOPSY.
    Patient was informed of the risks and benefits and potential alternatives for the
    procedure. The consent was signed. The patient was placed in a prone position on
    the CT table and initial images were obtained to find the best path for biopsy. The
    lower pole of the right kidney was selected as the clearest path. The overlying skin
    was prepped and draped in a sterile fashion, following local anesthesia. An 18-gauge
    coaxial system was positioned to the right at the renal capsule of the lower pole for
    needle extraction. Three passes were made. These samples were put in divided doses
    of preservative and sent for analysis. No complications were noted at this time. The
    patient was then transferred to ambulatory care for observation.
    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 17
    PREOPERATIVE DIAGNOSIS
    Obstructive sleep apnea with deviated septum.
    POSTOPERATIVE DIAGNOSIS
    Same with turbinate hypertrophy.
    PROCEDURE PERFORMED
    SEPTOPLASTY WITH BILATERAL TURBINECTOMY.
    BRIEF HISTORY
    This 35-year-old female was experiencing increasing problems with sleep apnea.
    She also has a prior history of nasal trauma. Examination shows significant septal
    deviation. We will correct her nasal airway and determine if there are any additional
    problems.
    PROCEDURE PERFORMED
    After appropriate consent was obtained, the patient was taken to the operating room
    and placed in the supine position on the table. General anesthesia was introduced,
    then the patient was turned and draped for nasal surgery. The patient’s nose was
    packed with cotton pledgets and soaked with 4% cocaine. Xylocaine with Epinephrine
    was infiltrated into the septum. It was then infiltrated into the interior turbinates,
    bilaterally. Using a right incision, the mucoperichondrium and mucoperiosteal flaps
    were elevated. The deviated portion of the bony septum was then removed. Hemostasis
    was achieved with suction and cautery. Attention was then turned to the inferior
    turbinates. These were examined bilaterally and found to be significantly hypertrophic
    and the decision was made to remove them. The anterior mucosa was treated with a
    radiofrequency-submucosal excision of the inferior turbinates, bilaterally. Splints were
    placed on both sides of the nasal septum and secured with nylon suture. The nose was
    then packed bilaterally. The patient tolerated the procedure well. The patient was
    extubated and taken to the postanesthesia care unit in good condition.
    (Hint: More than one modifier applies.)
    ICD-9-CM: _
    ICD-9-CM: _

    ICD-9-CM: _
    CPT: _

    CPT: _
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    Mail-in Quiz Scenario 18
    PREOPERATIVE DIAGNOSIS
    Abdominal pain.
    POSTOPERATIVE DIAGNOSIS
    Abdominal pain, unknown etiology. External hemorrhoids.
    OPERATION PERFORMED
    FLEXIBLE SIGMOIDOSCOPY.
    The patient was taken to the endoscopy suite where preparation was done for a flexible
    sigmoidoscopy. The sigmoidoscope was inserted into the rectum and advanced into the
    sigmoid colon. All structures of the intestine appeared to be normal. The scope was then
    carefully withdrawn to visually inspect for polyps. The results were negative. Although
    an incidental finding of external hemorrhoids was made, it must be noted that this
    finding has no clinical significance with the patient’s abdominal pain. Further studies
    will be discussed with the patient following an appropriate recovery time.
    ICD-9-CM: _

    ICD-9-CM: _
    CPT: _

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    Mail-in Quiz Scenario 19
    PREOPERATIVE DIAGNOSIS
    Subarachnoid hemorrhage.
    POSTOPERATIVE DIAGNOSIS
    Subarachnoid hemorrhage. Nontraumatic.
    PRIMARY PROCEDURE
    LUMBAR SPINAL PUNCTURE.
    ANESTHESIA
    Local anesthesia.
    BRIEF HISTORY
    The patient was asymptomatic until this morning when he woke up with a severe
    headache and a brief fainting spell. His wife called 911 and he was brought to the
    emergency department.
    PROCEDURE
    Due to the patient’s drowsy state, he and his wife were advised of complications,
    both agreed to the procedure, and both signed the consent. The patient was placed on
    his right side, curled with knees down in towards the chest and his neck maximally
    flexed. The area was cleaned, prepped, and draped. The L4-L5 was identified. The area
    was cleaned, prepped, and draped. Lidocaine was injected into the skin and deeper
    subcutaneous tissue. The spinal needle with stylette was passed, bevel upwards, and
    as the first drop of CSF was seen in the needle hub, the manometer was immediately
    attached to the needle via connecting tubing. The patient’s legs and hips were extended.
    Since the opening pressure remained markedly elevated, the 3-way stopcock was closed
    and only the CSF in the manometer was collected. All tubing was disconnected and the
    stylette was reinserted. The patient was placed in a prone position and will be observed
    following protocol by post-op nursing. A neurosurgical consultation was requested.
    ICD-9-CM: _
    CPT: _

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    Fold on dotted line
    For School Use Only:
    Grade: _
    0205502LB01B-44 45
    CB2
    Medical Coding and Billing Specialist
    Mail-in Quiz 35
  140. Fill in your student ID and your course code below.
    STUDENT ID NUMBER COURSE CODE
  141. Be sure your name and address are filled in below.
  142. Mark your answers on this cover sheet.
  143. Write the year of the coding manual used to complete this quiz. _
    NAME
    ADDRESS
    CITY STATE ZIP
    This Space for Instructor Use
  144. ICD-9-CM: _______
    CPT: _______
  145. ICD-9-CM: _______
    CPT: _______
  146. ICD-9-CM: _______
    ICD-9-CM: _______
    CPT: _______
    CPT: _______
  147. ICD-9-CM: _______
    CPT: _______
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  148. ICD-9-CM: _______
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  149. ICD-9-CM: _______
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  150. ICD-9-CM: _______
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  152. ICD-9-CM: _______
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  153. ICD-9-CM: _______
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  154. ICD-9-CM: _______
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  155. ICD-9-CM: _______
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  156. ICD-9-CM: _______
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  157. ICD-9-CM: _______
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  158. ICD-9-CM: _______
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  159. ICD-9-CM: _______
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  160. ICD-9-CM: _______
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  161. ICD-9-CM: _______
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  162. ICD-9-CM: _______
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    48 e0205502AS04A-44
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