Q.1 – James suffered a severe crushing injury to his left upper leg.

Two
days after surgery, Dr. Barnes completed a dressing change under
general anesthesia. How would you report this service?

 a) 16020- LT
 (b) 15852, 01232, J2060
 (c) 01232-P6
 (d) 15852-LT

Q.2 – Dr. Jess removed a 4.5 cm (excised diameter) cystic lesion from
Amy’s forehead. The ulcerated lesion was anesthetized with 20 mg of 1%
Lidocaine and then elliptically excised. The wound was closed with a
layered suture technique and a sterile dressing applied. The wound
closure, according to Dr. Jess’s documentation, was 5.3 cm. How would
you report this procedure?
(a) 11446, 12053-51

(b) 11646, 12013-51

(c) 11446, J2001 x 2, 12013-59

(d) 11313, 12053-59

Q.3 – Martha has a non-healing wound on the tip of her nose. After an
evaluation by Dr. Martino, a dermatologist, Martha is scheduled for a
procedure the following week. Dr. Martino documented an autologous
split thickness skin graft to the tip of Martha’s nose. A simple
debridement of granulated tissues is completed prior to the placement.
Using a dermatome, a split thickness skin graft was harvested from the
left thigh. The graft is placed on the nose defect and secured with
sutures. The donor site is examined, which confirms good hemostasis.
How would you report this procedure?

a) 99213-25, 15050

(b) 15050, 15004, 15005-59

(c) 15110, 11040-59

(d) 15120

.4 – A patient had a chest wall tumor excised. The procedure involved the
ribs with plastic reconstruction, and mediastinal lymphadenectomy. How
would you report this procedure?

(a) 21602, 32503-59

(b) 21603

(c) 32503, 21603-59, 21632-59

(d) 32422, 21601-51

Q.5 – Dr. Alexis completed Mohs surgery on Ralph’s left arm. She reported
routine stains on all slides, mapping, and color coding of specimens. The
procedure was accomplished in three stages with a total of seven blocks
in the second stage. How would you report Dr. Alexis’ services?

a) 17313, 17314-58, 17315- 59, 88314-59

(b) 17311, 17312 x 7

(c) 17313, 17314 x 2, 17315 x 2

(d) 17311, 88302, 17314 x 3, 17312 x 7

Q.6 – How should you code an excision of a lesion when completed with
an adjacent tissue transfer or rearrangement?

a) The excision is always reported in addition to the adjacent tissue

transfer or rearrangement.
(b) The excision is not separately reported with adjacent tissue transfer or
rearrangement codes.

(c) Code only malignant lesions in addition to the adjacent tissue transfer
or rearrangement codes.

(d) Code the lesion with a modifier -51 and code in addition to the
adjacent tissue transfer or rearrangement codes

Q.7 – Tina fell from a step ladder while clearing drain gutters at her home.
She suffered contusions and multiple lacerations. At the emergency room
she received sutures for lacerations to her arm, hand, and foot. The
doctor completed the following repairs: superficial repair to the arm of
12.8 cm, a single layered closure of 7.9 cm that required extensive
cleaning and removal of glass from the hand, and a simple repair to the
foot of 9.6 cm How would you report the wound repairs?

(a) 12034, 12036, 12046, 12007

(b)12006, 12034-59

(c) 12044, 12006-59

(d) 12005, 12004 x 2

Q.8 – Which modifier would you use if a re-excision procedure is

performed during the postoperative period of the primary excision of a
malignant lesion?

(a) 76

(b) 59

(c) 58
(d) 79

Q.9 – James had a malignant lesion removed from his right arm (excised
diameter 4.6 cm). During the same visit the dermatologist noticed a new
growth on James’ left arm. Dr. Terry took a incisional biopsy of the new
lesion and sent it in for pathology. The biopsy site required a simple
closure. How would Dr. Terry report the biopsy procedure?

(a) The biopsy is included in the primary procedure and not reported

(b) 11106-59

(c) 11406, 11106-59

(d) 11106, 12001, 11406-51

Q.10 – 46-year-old female had a previous biopsy that indicated positive

margins anteriorly on the right side of her neck. A 0.5 cm margin was
drawn out and a 15 blade scalpel was used for full excision of an 8cm
lesion. Light undermining of all margins was performed along with layered
closure. The specimen was sent for permanent histopathologic
examination. What are the code(s) for this procedure?

(a) 11426

(b) 11626

(c) 11626, 12044-51

(d) 11426, 13132, 13133

Q.11 – 30-year-old female is having debridement performed on an
infected ulcer with eschar on the right foot. Using sharp dissection, the
ulcer and eschar infection was debrided all the way to down to the bone
of the foot. The bone had to be minimally trimmed because of a sharp
point at the end of the metatarsal. After debriding the area, there was
minimal bleeding because of very poor circulation of the foot. It seems
that the toes next to the ulcer may have some involvement and cultures
were taken. The area was dressed with sterile saline and dressings and
then wrapped. What CPT code should be reported?

(a) 11000

(b) 11011

(c) 11044

(d) 15004

Q.12- 64-year-old female who has multiple sclerosis fell from her walker
and landed on a glass table. She lacerated her forehead, cheek and chin
and the total length of these lacerations was 6 cm. Her right arm and left
leg had deep cuts measuring 5 cm on each extremity. Her right hand and
right foot had a total of 3 cm lacerations. The ED physician repaired the
lacerations as follows: The forehead, cheek, and chin had debridement
and cleaning of glass debris with the lacerations being closed with 6-0
Prolene sutures. The arm and leg were repaired by 6-0 Vicryl
subcutaneous sutures and prolene sutures on the skin. The hand and foot
were closed with adhesive strips. Select the appropriate procedure codes
for this visit.

(a) 12014, 12034-51, 12002-51, 11042-51

(b) 12053, 12034-51, 12002-51

(c) 12014, 12034-51, 11042-51

(d) 12053, 12034-51

Q.13 – PRE-OP DIAGNOSIS: Left Breast Abnormal MMX or Palpable Mass;

Other Disorders Of Breast PROCEDURE: Automated Stereotactic Biopsy
Left Breast FINDINGS: Lesion is located in the lateral region, just at or
below the level of the nipple on the 90 degree lateral view. There is a
subglandular implant in place. I discussed the procedure with the
patient today including risks, benefits and alternatives. Specifically
discussed was the fact that the implant would be displaced out of the way
during this biopsy procedure. Possibility of injury to the implant was
discussed with the patient. Patient has signed the consent form and
wishes to proceed with the biopsy. The patient was placed prone on the
stereotactic table; the left breast was then imaged from the
inferior approach. The lesion of interest is in the anterior portion of the
breast away from the implant which was displaced back toward the chest
wall. After imaging was obtained and stereotactic guidance used to
target coordinates for the biopsy, the left breast was prepped with
Betadine. 1% lidocaine was injected subcutaneously for local anesthetic.
Additional lidocaine with epinephrine was then injected through the
indwelling needle. The SenoRx needle was then placed into the area of
interest. Under stereotactic guidance we obtained 9 core biopsy samples
using vacuum and cutting technique. The specimen radiograph confirmed
representative sample of calcification was removed. The tissue marking
clip was deployed into the biopsy cavity successfully. This was confirmed
by final stereotactic digital image and confirmed by post core biopsy
mammogram left breast.

The clip is visualized projecting over the lateral anterior left breast in
satisfactory position. No obvious calcium is visible on the final post core
biopsy image in the area of interest. The patient tolerated the procedure
well. There were no apparent complications. The biopsy site was dressed
with Steri-Strips, bandage and ice pack in the usual manner. The patient
did receive written and verbal post-biopsy instructions. The patient left
our department in good condition.
IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT
BREAST CALCIFICATIONS. 2.

SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP INTO THE

BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD CONDITION
TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT IS
PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE RECEIVE THE
PATHOLOGY REPORT. What are the codes for the procedures?

(a) 19081 -LT

(b) 19081- LT, 76098-26

(c) 19081, 19082, 76942-26

(d) 19081, 77012-26

Q.14 – 53-year-old male for removal of 2 lesions located on his nose and
lower lip. Lesions were identified and marked. Utilizing a 3-mm punch, a
biopsy was taken of the left supra tip nasal area. The lower lip lesion of
4mm in size was shaved to the level of the superficial dermis. What are
the codes for these procedures?

(a) 11106-59, 11310-51

(b) 11104, 11103

(c) 17000, 17003

(d) 11104, 11103-51

Q.15 – 76-year-old has dermatochalasis on bilateral upper eyelids. A
blepharoplasty will be performed on the eyelids. A lower incision line was
marked at approximately 5 mm above the lid margin along the crease.
Then using a pinch test with forceps the amount of skin to be resected
was determined and marked. An elliptical incision was performed on the
left eyelid and the skin was excised. In a similar fashion the same
procedure was performed on the right eye. The wounds were closed with
sutures. The correct CPT codes are?

(a) 15822, 15823-51

(b) 15823-50

(c) 15822-50

(d) 15820-LT, 15820-RT

Q.16 – Patient has basal cell carcinoma on his upper back. A map was
prepared to correspond to the area of skin where the excisions of the
tumor will be performed using Mohs micrographic surgery technique.
There were three tissue blocks that were prepared for cryostat, sectioned,
and removed in the first stage. Then a second stage had six tissue blocks
which were also cut and stained for microscopic examination. The entire
base and margins of the excised pieces of tissue were examined by the
surgeon. No tumor was identified after the final stage of the
microscopically controlled surgery. What procedure codes should be
reported?

(a) 17313, 17314 x 2

(b) 17313, 17315

(c) 17260, 17313, 17314

(d) 17313,17314, 17315

Q.17 – 45-year-old male is in outpatient surgery to excise a basal cell
carcinoma of the right nose and have reconstruction with an
advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm
was excised with a 15-blade scalpel down to the level of the
subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery
was used for hemostasis. An adjacent tissue transfers of 3 sq. cm was
taken from the nasolabial fold and was advanced into the primary defect.
Which CPT code(s) should be used?

(a) 14060

(b) 11642, 14060

(c) 11642, 15115

(d) 15574

Q.18 – 24-year-old patient had an abscess by her vulva which burst. She
has developed a soft tissue infection caused by gas gangrene. The area
was debrided of necrotic infected tissue. All of the pus was removed and
irrigation was performed with a liter of saline until clear and clean. The
infected area was completely drained and the wound was packed gently
with sterile saline moistened gauze and pads were placed on top of this.
The correct CPT code is:

(a) 56405

(b) 10061

(c) 11004

(d) 11042
Q.19 – 76-year-old female had a recent mammographic and ultrasound
abnormality in the 6 o’clock position of the left breast. She underwent
core biopsies which showed the presence of a papilloma. The plan now is
for needle localization with excisional biopsy to rule out occult
malignancy. After undergoing preoperative needle localization with hook
wire needle injection with methylene blue, the patient was brought to the
operating room and was placed on the operating room table in the supine
position where she underwent laryngeal mask airway (LMA) anesthesia.
The left breast was prepped and draped in a sterile fashion. A radial
incision was then made in the 6 o’clock position of the left breast
corresponding to the tip of the needle localizing wire. Using blunt and
sharp dissection, we performed a generous excisional biopsy around the
needle localizing wire including all of the methylene blue-stained tissues.
The specimen was then submitted for radiologic confirmation followed by
permanent section pathology. Once hemostasis was assured, digital
palpation of the depths of the wound field failed to reveal any other
palpable abnormalities. At this point, the wound was closed in 2 layers
with 3-0 Vicryl and 5-0 Monocryl. Steri-Strips were applied. Local
anesthetic was infiltrated for postoperative analgesia. What CPT and ICD-
10-CM codes describe this procedure?

(a) 19100, N63.0

(b) 19101, C50.919

(c) 19120, R92.8

(d) 19125, D24.2

Q.20 – Indication: Patient has a hypertrophic scar on the posterior side of

the left leg at the level of the knee. This has begun to restrict his mobility.
Physical therapy trial was unsuccessful. Procedure: After the proper
induction of anesthesia, the subcutaneous tissue of the patient’s left leg
beneath the scar was infiltrated with crystalloid solution containing
epinephrine to minimize blood loss. The scar was then excised down to
viable dermis. Hemostasis was obtained with epinephrine soaked pads.
Skin was harvested from the patient’s thigh in a split thickness fashion
and was used to cover the 90 sq cm defect created by the surgery. The
graft was secured with skin staples and then dressed with fine mesh
gauze followed by medication-soaked gauze. The donor site was dressed
with mesh followed by Adaptic, followed by a dry dressing and an Ace
wrap.

(a) 15110-52, 15002

(b) 15100, 11406

(c) 15100, 15002

(d) 15110, 15002

Q.21 – The physician is called in to perform repairs for a 17-year-old girl

involved in a motor vehicle accident. She sustained an 8.6 cm laceration
to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm laceration
to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm
laceration to her chest. The wound on her chin required a layered closure.
All other wounds required complex closure.

(a) 13132, 13133 x 4, 13101, 12052

(b) 13132, 13133 x 3, 13133-52, 13101, 13102, 12052

(c) 13132, 13133 x 3, 13101, 13102, 12052 -59

(d) 13131, 13132, 13133 x 3, 13101, 13102, 12052

Q.22 – A 36-year-old male presents to have multiple lesions destroyed.
Three benign lesions on his face are destroyed and five actinic keratoses
on his left arm are destroyed. Code for the procedures.

(a) 17000, 17003

(b) 17000, 17003 x 4, 17110

(c) 17110

(d) 17280 x 5, 17000, 17003

Q.23 – A 15-year-old boy was burned in a fire and assessed to have

received burns to 75 percent of his total body surface area. He was
transferred to a burn centre for definitive treatment. Once stable, he was
brought to the OR.

Procedure: Due to extent of the patient’s burns and lack of sufficient

donor sites, his full-thickness burns will be excised and covered with
porcine grafts, and a split-thickness skin biopsy will be harvested for
preparation of autologous grafts to be applied in the coming weeks, when
available. After induction of anesthesia, extensive debridement of the full-
thickness burns was undertaken. Attention was first directed to the
patient’s face, neck, and scalp. A total of 500 sq cm in this area received
full-thickness burns. The eschar involving this area was excised down to
viable tissue. Hemostasis was achieved using electrocautery. Attention
was then turned to the trunk. A total of 950 sq cm in this area received
full thickness burns. The eschar involving this area was excised down to
viable tissue. Hemostasis was achieved. Attention was then turned to the
arms and legs. A total of 725 sq cm received full-thickness burns. The
eschar involving this area was excised down to viable tissue. Hemostasis
was achieved. Attention was then turned to the hands and feet. A total of
300 sq cm in this area received full-thickness burns. The eschar involving
this area was excised down to viable tissue. All involved areas were then
covered with porcine graft. Finally, a split thickness skin graft of 0.015
inches in depth was harvested using a dermatome from a separate donor
site. A total of 85 sq cm was recovered. What procedures codes would be
reported service?

(a) 15273, 15274×16, 15277, 15278×7, 15004, 15005 x 7, 15002-51,

15003 x 16, 15040

(b) 15120, 15121 x 7, 15277, 15278 x 16, 15004, 15005 x 16, 15002-51,
15003 x 7

(c) 15273, 15274 x 16, 15277-59, 15278 x 7, 15002-51, 15003 x 16,

15004-59-51, 15005 x 7, 15040 – 51

(d) 15273, 15274 x 17, 15277, 15278 x 16, 15004, 15005 x 7, 15002-51,
15003 x 16

Q.24 – The left breast was prepped and draped in a sterile fashion. An
incision from the 3 around to the 9 o’clock position on the areolar border
on its inferior aspect was made in the skin and extended to the
subcutaneous tissue. The breast mass was excised by sharp dissection.
The mass was found to be approximately 1.5 – 2 cm in maximum
dimension. Frozen section revealed clear margins. Haemostasis was
made adequate using electrocautery and the Argon beam coagulator.
After this was accomplished, the skin margins were reapproximated with
running inverted 3-0 Vicryl subcuticular suture. Select the procedure and
diagnosis codes.

(a) 19120, N63.0

(b) 19301, N63.0

(c) 19125, D24.1

(d) 19101, N64.59

Q.25 – This 37-year-old paraplegic has developed a sacral decubitus ulcer.

He is brought to the OR today for debridement of the pressure ulcer with
a split-thickness skin graft to cover the defect. The patient was placed
prone on the operative table after induction of adequate endotracheal
anesthesia. The sacral area was prepped and draped sterilely, and the
ulcer is inspected. The area is debrided extensively to healthy tissue.
Involved bone, including part of the coccyx, was also removed. Once the
area was clear of necrotic tissue, the site was prepared for a skin graft. A
split-thickness skin graft was harvested from the thigh with a dermatome.
Total graft size was 25 sq. cm. The graft was sutured in place using 6-0
Vicryl. The harvest site was closed primarily with skin staples. Dressings
were applied. Needle counts were correct x 2. The patient tolerated the
procedure well. Code the procedure(s).

Buy vitamins and supplements

(a) 15002, 15100-51

(b) 15937, 15100-51

(c) 15937

(d) 15937, 15100-51, 15002

Q.26 – The patient is a 32-year-old female who was discovered to have

breast cancer on the right side. She was treated with mastectomy
followed by chemotherapy and radiation therapy. She now elects to
proceed with reconstruction by TRAM flap. Code for the reconstruction.

(a) 19364
(b) 19361

(c) 19316

(d) 19367

Q.27 – A 55-year-old male presents in the office with an ingrown toenail

on the right and left foot. The procedure was discussed in detail and the
patient elected to have it performed. The right foot was prepped and
draped in sterile fashion. The right great toe was anesthetized with 50/50
solution of 2 percent lidocaine and .05 percent Marcaine. A mini-
tourniquet was placed around the toe for hemostasis. The lateral border
was incised and excised in total. Phenol was then applied, the toe was
then flushed. Tourniquet was released and dressing applied. At this time
the patient elected to only have one performed and will return in two
weeks for the left foot. Code the procedure.

(a) 11765

(b) 11750

(c) 11752

(d) 11740

Q.28 – Pre-Procedure Diagnosis: Basal cell carcinoma, left chin.

Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell
carcinoma of the left chin with a 4 cm closure. Procedure: The patient’s
left chin was examined. The site of intended excision was marked out.
The site was then prepped. The patient was then prepped and draped in
the usual fashion. A 15-blade scalpel was then used to make an incision
in the previously marked site. It was carried down to the subcuticular fat.
The lesion was then sharply dissected off underlying tissue bed using a
15-blade scalpel. It was tagged for pathologic orientation. The hyfrecator
was used for hemostasis. The wound edges were then undermined. The
wound was then closed by advancing the tissue surrounding the lesion
and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0
Prolene for the skin. The skin closure was in a running subcuticular
fashion. SteriStrips were then applied. What are the procedure and
diagnosis codes?

(a) 11644, 12052-51, C44. 319

(b) 11643, 12013-51, C44. 319

(c) 11444, 12052-51, D49.2

(d) 11443, 12013-51, D49.2

Q.29 – The physician removes a tumor from the patient’s neck using the
Mohs micrographic surgery technique. During the first stage, the
physician takes four tissue blocks and reviews them under a microscope.
The exam of the tissue blocks reveals a second stage is necessary to
remove areas where the tumor is still present. The physician removes two
additional tissue blocks. What are the appropriate CPT® codes for
reporting the procedure?

(a) 17311, 17312, 17315

(b) 17313, 17315

(c) 17313, 17314, 17315

(d) 17311, 17312

Q.30 – Using ultrasound guidance, the physician performed a
percutaneous needle core biopsy on a suspicious lump on the patient’s
right breast. This procedure was performed in the physician’s office. Code
this encounter.

(a) 19100-RT

(b) 19101-RT, 76942

(c) 19100-RT, 76942

(d) 19101-RT

Q.31 – Dr. Smith performed a cryosurgery to destroy three premalignant

lesions for a patient. Which code(s) should you report for this procedure?

(a) 17106

(b) 17260

(c) 17003 x 3

(d) 17000, 17003 x 2

Q.32 – Which codes should be reported for the following case?

Preoperative diagnosis: Lesion, left hand

Confirmed by pathology postoperative diagnosis: Primary malignant

carcinoma, left hand

Procedure performed: Excision of malignant carcinoma, left hand

Anesthesia: General; 40 ml of lidocaine was infiltrated into the wound
prior to making the incision Procedure:The patient was brought to the
operative suite where the left hand was prepped and dressed. A circular
incision was made to include the 1-cm lesion with narrowest margins of
0.6 cm with dissection down to subcutaneous tissue. Homeostasis was
obtained; the wound was closed with simple mattress sutures. The patient
tolerated the procedure well and was returned to the recovery room in
good condition with sterile dressing in place.

(a) 11603

(b) 11622

(c) 11423

(d) 11403

Q.33 – Nancy underwent a fine needle aspiration with FL guidance for a 2

lesion in the right breast. During the procedure, doctor found 3 suspected
lesions on left breast and did FNA with Ultrasonic guidance. Which codes
describe this procedure?

(a) 10007-RT, 10008-RT, 10005-59-LT, 10006×2-LT

(b) 10007-RT, 10008-LT, 10005-51-LT, 10006×3-LT

(c) 10007-RT, 10008-LT, 10005-50-LT, 10006×2-LT

(d) 10007-RT, 10008-LT, 10005-58-LT, 10006×2-LT

Q.34 – Which of the following procedures could be coded with a breast
reconstruction with free flap?

(a) Harvesting of the flap

(b) Microvascular transfer

(c) Closure of the donor site and inset shaping the flap into a breast

(d) None of the above

Q.35 – Barry underwent a complex incision and drainage due to a

postoperative wound infection, which required an extensive secondary
closure of the surgical site. Which codes describe this procedure?

(a) 13160, 10081- 59

(b) 10121, 12020-51

(c) 13160, 10180-51

(d) 10061, 12021-59

Q.36 – Stephanie discovered a lesion on her trunk and was referred to Dr.
Ralph, a trained Mohs surgeon, for treatment. Stephanie had no prior
pathology of this lesion; therefore, Dr. Ralph completed a diagnostic skin
incisional biopsy with frozen section prior to the surgery. After reviewing
the biopsy results, Dr. Ralph took the patient to the procedure suite and
performed a Mohs surgery that same day. Dr. Ralph’s final report
indicated the procedure required three stages, including five tissue blocks
in each stage. He had to take an additional four blocks in stage two to
verify margins and cell structure. Which codes should Dr. Ralph report for
this entire encounter?
(a) 17313, 17314 x 2, 17315 x 4, 11106-59, 88331-59

(b) 17313, 17314 x 2, 17315-59

(c) 17311, 17312 x 2, 17315

(d) 17311, 17312 x 4, 17315-59, 11106-51, 88331-51

Q.37 – Mark cut his hand and arm while working on his car. Dr. Bill applied
sutures to both the arm and hand wounds. An intermediate closure of 16
cm was placed in the arm and a simple closure of 3.6 cm was placed in
the hand. Which codes should Dr. Bill report?

(a) 12004, 12035-59

(b) 12035, 12042-59

(c) 12035, 12002-51

(d) 13132, 12036-51

Q.38 – A patient underwent an excision of a 2.1-cm diameter malignant

lesion on her nose. An 11.2sqcm adjacent tissue transfer was required to
repair the primary and secondary defect sites. How should you code this
procedure?

(a) 11643, 14061-59

(b) 14061

(c) 11646, 13152-51, 13153-51

(d) 11443, 12054-59

Q.39 – Glen required a replacement of his nonbiodegradable drug delivery

implant system. Glen was taken into the procedure suite where he was
prepped. Dr. Roberts injected a local anesthetic and made a 3.2cm
incision in the skin for removal of the previous cylinder. He then replaced
the cylinder and sutured the new device in place with a single running
stitch. The 3.2-cm trunk wound was closed with simple sutures. The
device was tested, with excellent results. The patient tolerated the
procedure well and was released from care with a sterile dressing in
place. How should this procedure be coded?

(a) 11983,12032-51

(b) 11977, 12032-59

(c) 11981, 11982-51, 11983-51, 12002-59

(d) 11983, 12002-51

Q.40 – Two malignant lesions on the scalp measuring 1.1 cm and 2.0 cm,
and one malignant lesion on the neck measuring 2.2 cm were destroyed.
Electrocautery was used for the first two lesions and laser was used for
the third lesion. The procedures should be coded as:

(a) 17276

(b) 17273, 17272

(c) 17273, 17272, 17272

(d) 17274, 17273

Q.41 – OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Possible basal cell carcinoma.

POSTOPERATIVE DIAGNOSIS: Basal cell carcinoma.

PROCEDURE PERFORMED: Excision lesion 4.3 cm x 2 cm Left thigh

FTSG from calf to thigh

ANESTHESIA: General by LMA.

DESCRIPTION OF PROCEDURE: After undergoing adequate general

anesthesia and after DuraPrep prepping the left thigh and draping with
cloth towels and drapes, 0.25 percent Marcaine with epinephrine, total of
30 cc, was used to anesthetize the skin.

A lesion slightly over 4 cm was observed on the patient’s left thigh. A

small portion was removed and sent for frozen section analysis. This
returned Basal Cell carcinoma. Per prior consent, we removed the
remaining lesion with a .75 surrounding margin. Due to size and location
of this lesion the decision was made to harvest a full thickness skin graft
from his left lower leg.

Lower leg was prepped and draped and 0.25 percent Marcaine was given.
Excision of 5 cm x 5cm full thickness graft was obtained and placed on
back table for prep. We returned to the thigh area. All edges were
trimmed and the graft was placed into the defect and sewn with a
running #3-0 Vicryl, the skin edges were approximated with a running
subcuticular #4-0 Vicryl and further sealed with Dermabond. Hemostasis
was well controlled. The wound was irrigated with normal saline.

What are the correct procedure code(s)?

(a) 11406, 15770, 12032

(b) 11606, 15220, 15221

(c) 11402, 15220

(d) 11602, 15220, 15221

Q.42 – Preoperative Diagnosis: Left axillary hidradenitis.

Postoperative Diagnosis: Left axillary hidradenitis.

Operation: Excision of hidradenitis.

Indications: The patient is a 62-year-old female with chronically infected

left axillary hidradenitis. Description of Operation: With the patient in
supine position and under general anesthesia, the left axilla was prepped
and draped in the usual sterile fashion. An elliptical skin incision was
made in the axilla to excise most of the hidradenitis tracts. The incision
was carried down through subcutaneous tissue. The underlying
subcutaneous tissue was excised. Bleeding points were controlled by
means of electrocautery. The wound was then irrigated with a dilute
antibiotic solution. The subcutaneous tissues were closed with a
continuous suture of 2-0 Vicryl. The skin edges were stapled together a
dry dressing was applied. The patient tolerated the procedure
satisfactorily. Sponge and needle counts were correct. The correct CPT®
code for this procedure:

(a) 11470

(b) 11450

(c) 11451

(d) 11462
43 – OPERATIVE REPORT : FIRST SURGICAL ASSISTANT: W. P., M.D

ANESTHESIA: Monitored anesthesia care with local anesthetic

PREOPERATIVE DIAGNOSIS (ES): Left chest wall mass

POSTOPERATIVE DIAGNOSIS (ES): Left chest wall mass

NAME OF OPERATION: Left chest wall mass excision

INDICATIONS FOR PROCEDURE: Mr. C is a 63-year-old gentleman who

presented to the outpatient clinic with a palpable left chest wall mass.
Clinical characteristics suggested a benign lipoma. However, because of
the very large size of the mass and the fact that it had increased in size
rapidly I recommended a complete excision for definitive diagnosis. He
presents today for that purpose.

OPERATIVE FINDINGS: The patient had a left chest wall mass excised
without difficulty. The mass measured approximately 7 centimeters and
had the benign appearance of a lipoma.
DESCRIPTION OF PROCEDURE: Mr. C was brought to the operating room
and placed supine on the operating room table. Because this was a
sedation case, no sequential compression devices were applied. However,
a single dose of Ancef 1 gram was administered intravenously 10 minutes
prior to the incision time. Sedation was then initiated with propofol and
Fentanyl and the patient was prepped and draped in the standard surgical
fashion. The left chest wall mass was palpated and an incision directly
over it along the Langer’s line was planned. This was infiltrated with a
mixture of 1 percent plain lidocaine and 0.5 percent plain Marcaine. The
incision was then made and carried down through the dermis with
electrocautery. We then opened the subcutaneous tissue of the skin and
immediately encountered an organized mass that has a benign
appearance of a lipoma. Using careful blunt and sharp dissection, we
were able to completely excise this mass around its entire circumference
leaving the capsule intact. Once we had the mass largely excised from
the anterior, superior, inferior, lateral, and medial approaches the mass
was everted from the chest wall. The mass was then removed from its
posterior attachments using electrocautery. The mass was then passed
off the field. Attention was then turned to the wound.

Aggressive hemostasis was obtained with electrocautery. The wound was

irrigated with copious amounts of sterile saline. A deep 3-0 Vicryl stitch
was then placed to reapproximate the pectoralis fascia. The deep dermal
layer was then reapproximated with interrupted 3-0 Vicryl stitches. The
skin was reapproximated with a running subcuticular using 4-0 Monocryl.
Dermabond dressing was applied. The patient tolerated the procedure
well, was awakened, and transferred to the recovery room.

The specimens removed include the left chest wall mass, which measured
7 centimeters. Estimated blood loss was minimal. Intravenous fluids were
700 milliliters of crystalloid. Sponge, instrument, and needle counts were
correct at the end of the case. The condition of the patient on discharge
from the operating room was stable.

SPECIMENS REMOVED: Left chest wall mass measuring 7 cm What is the

correct CPT® code?
(a) 11406

(b) 21555

(c) 19120

(d) 21552

ANSWERS:

1-D , 2-A , 3-D , 4-B, 5-C , 6-B , 7-C , 8-C , 9-

B, 10-C ,

11-C , 12-D , 13-A , 14-B , 15-C , 16-D , 17-A , 18-C , 19-

D , 20-C ,

21-C , 22-B , 23-C , 24-A, 25-B , 26-D , 27-B, 28-A , 29-

D , 30-C ,

31-D , 32-B , 33-A, 34-D, 35-C , 36-A , 37-C , 38-B,

39-D , 40-C

41-B , 42-B , 43-D