Practice Exam

30000 SERIES
Question 1
A patient that has renal failure had a fistula that was deep and had multiple branches. The
physician has elected to perform a revision of the AV fistula by moving it to a new
location. Under local anesthesia the fistula in the right forearm was exposed from the
wrist up near the antecubital fossa. It was then tunneled to a more lateral location and
more superficial. Once it had been placed in the tunnel the anastomosis was sutured and
clamps removed. Which CPT code should be used?
A. 36821
B. 36832
C. 36823
D. 36833
Question 2
A 62-year-old female with bladder cancer requiring chemotherapy is getting a placement
of a PowerPort catheter. Insertion of large-bored catheter was accessed in the subclavian
vein. Then a pocket was created on the anterior chest wall to place the port, and then the
catheter was tunneled connecting the catheter to the port. The port was then accessed
through the skin, flushed and aspirated. What code should be used for this procedure?
A. 36569
B. 36560
C. 36556
D. 36561
Question 3
A 77-year-old patient who was found to have a huge aneurysm underwent a coronary
artery bypass graft. A median sternotomy was made and the left internal mammary artery
was harvested from the left chest wall. The saphenous vein was harvested from the left
leg and bypassed distally as it ran in the left ventricular muscle. Next, a second
saphenous vein segment was placed to the diagonal vessel and then the left internal
mammary artery was placed to the mid LAD. The LAD was bypassed in the mid aspect
of the LAD and good flow was measured in the graft. What CPT codes describe this
procedure?
A. 33533, 33518
B. 33510, 33517
C. 33534, 33518
D. 33511, 33517

Question 4
A patient that has a Mediport for chemotherapy infusion is no longer needed. The left
chest was prepped and an incision was made in the old scar and dissection carried down
to the port. The capsule around the port was incised and the port was removed. The
correct CPT code is:
A. 36589
B. 36582
C. 36590
D. 36576
Question 5
A 35-year-old was diagnosed with stage I ductal carcinoma in situ in her right breast. She
underwent a localized biopsy of sentinel lymph and axillary nodes in her right breast. An
incision was made with the scalpel, once the glandular tissue of the breast was
intercepted; dissection was carried down through the skin and subcutaneous tissue. One
to two centimeters of the breast tissue was dissected free to the lymph node. The incision
was carried deep to the right axilla and two sentinel and non-sentinel lymph nodes were
identified and excised. What procedure code should be used?
A. 38525
B. 38570
C. 38500
D. 38505
Question 6
A neonatologist attends the delivery of a 1000 gram infant who requires intubation for
respiratory distress as well as placement of both arterial and venous umbilical catheters.
What are the codes for these procedures?
A. 31500, 36420, 36620
B. 31601, 36406, 36660
C. 31603, 36420, 36625
D. 31500, 36510, 36660
Question 7
The patient is an 83-year-old female with a new onset of atrial fibrillation that has
developed into a tachy-brady syndrome. Her cardiologist decided to insert a pacemaker.
The left chest was incised and a subcutaneous pocket was formed above the fascia. The
left subclavian vein was accessed with an 18 gauge needle times two. The atrial and
ventricular leads were then placed through the sheaths, positioned and secured to the
pectoral fascia. The pacemaker leads were then connected to the pacemaker coiled and
placed in the previously made pocket. What CPT code describes this procedure?
A. 33213
B. 33217
C. 33208
D. 33206

Question 8
The patient is a 69-year-old white female with a 10 years status-post dual chamber
pacemaker where the generator is at end of life. The pacemaker generator was explanted
and the leads were then attached to the new generator. The correct CPT code is:
A. 33213
B. 33208
C. 33212
D. 33207
Question 9
A 29-year-old female in the hospital who has full blown AIDS has been put on a
ventilator due to her weakness and dyspnea. The physician suspects she has pneumonia
and performs a thoracoscopy. The contents of the chest cavity are inspected with an
endoscope and multiple areas of consolidation are seen in the right lung and biopsied.
Pneumocystis carinii pneumonia is diagnosed The correct CPT and ICD-9-CM codes
are:
A. 32601, 486, 042
B. 32602, 042, 136.3
C. 32606, 042, 136.3, V08
D. 32650, 136.3, 042
Question 10
A 45-year-olds blood pressure was progressively trending downward, and it was
determined that an emergent central venous access was needed for fluid resuscitation. A
non-tunneled catheter was used to access the subclavian vein and secured into place to
infuse medication. Due to the patient's low blood pressure and anticipated need for
vasopressor agents, a radial arterial line was also desired. The left radial artery pulse was
easily palpable, and the skin was punctured by a needle and the Angiocatheter was placed
in the left wrist. What are the codes for these procedures?
A. 36555, 36625-51
B. 36556, 36620
C. 36558, 36640-51
D. 36569, 36620
Question 11
A 45-year-old male with Stage III non-Hodgkins lymphoma showed pathologic cervical
nodes on the PET scan and a biopsy was recommended. A supraclavicular incision was
made, deepened down through the platysmal muscle and it required ligation of the
external jugular vein, and then deep to this structure were numerous large nodes;
approximately 3 to 3.5 cm in greatest dimension was removed. Once elevated, the hilar
aspect of the node was serially clipped with hemoclips to remove it. What code should be
used for this procedure?
A. 38720
B. 38520
C. 38724
D. 38510

Question 12
A patient with chronic maxillary sinusitis underwent a prior ethmoid surgery. A recent CT
scan reveals mucous membrane thickening, and an opaque sinus. An endoscope along
with a scalpel is used for a surgical removal of diseased tissue along with an antrostomy.
What code should be used for this procedure?
A. 31233
B. 31020
C. 31000
D. 31256
Question 13
A 30-year-old male had a PET scan showing an enlarged spleen. He had a negative upper
endoscopy, and so he is now referred for splenectomy. Under direct laparoscopic vision
dissection is carried down to the level of the spleen and splenic vessels are transected and
the spleen is excised. What procedure code should be used?
A. 38120
B. 38100
C. 38101
D. 38115
Question 14
A 22-year-old who was in a motor vehicle accident has a broken nose. An X-ray shows a
deviated septum causing airway obstruction. The deviated portion of the bony and
cartilaginous septum is excised by grafting the septum. Once this was done, the septum
was noted to be straight in the midline. Which CPT code should be used?
A. 30420
B. 30430
C. 30520
D. 30620
Question 15
A patient with advanced carcinoma of the lung undergoes a total pneumonectomy with
tracheal resection and broncho-tracheal anastomosis. Which procedure code should the
thoracic surgeon report?
A. 32440
B. 32442
C. 32445
D. 32480
Question 16
A patient with laryngeal cancer undergoes a therapeutic sectioning of the recurrent
laryngeal nerve on the right. Which procedure code should be reported?
A. 31368
B. 31360
C. 31595
D. 31599

Question 17
A patient presents to the emergency room with recurrent epistaxis. The otolaryngologist
on call cauterizes the mucosa of the left turbinate to control the hemorrhage. Which
procedure code should the physician select?
A. 30801
B. 30901
C. 30903
D. 30905
Question 18
A complete axillary lymphadenectomy was performed in a patient with metastatic disease
from a primary breast site. How should the breast surgeon report this surgery?
A. 38525
B. 38740
C. 38745
D. 38720
Question 19
A patient with a life-threatening diaphragmatic laceration requires resection and complex
prosthetic repair. Which procedure code should the general surgeon handling the case use
to report this treatment?
A. 39540
B. 39545
C. 39560
D. 39561
Question 20
A patient is disconnected from extracorporeal biventricular circulatory assistance. Which
CPT code should the thoracic surgeon use to report this procedure?
A. 33976
B. 33977
C. 33978
D. 33980

ANSWERS
Question 1
A two-year-old comes in for an initial WCE. Mom doesn't have immunization record. States that
the childs last shot was when he was 5 months old. Medical review and documentation of a new
patient supports one element of HPI, five elements of the ROS, and a complete Past, Family,
Social History. The examination was 8+ organ systems. The physician orders the immunizations
to be given in the office today. Immunizations given: #1 MMR #2 Varicella What CPT codes
should be reported?
A. 99391, 90471, 90710
B. 99202, 90707, 90716
C. 99382, 90471, 90472, 90707, 90716
D. 99212, 90471, 90472, 90707-51, 90716-51
View Rationale
Question 2
An established 45-year-old woman is seen today at her doctors office. She is complaining of
being dizzy and feels like the room is spinning. She has had palpitations on and off for the past
12 months. She reports chest tightness and dyspnea but denies nausea, edema, or arm pain.
She drinks two cups of coffee per day. Her sister has WPW syndrome. An extended five body
area examination is performed. This is a new problem for the physician. An EKG is ordered and
labs are drawn, and physician documents a moderate complexity MDM. Select the appropriate
CPT code for this visit:
A. 99203
B. 99214
C. 99215
D. 99204
View Rationale
Question 3
A 33 year-old-white male was admitted to the hospital on 12/17/XX from the ER, following a motor
vehicle accident, to have a splenectomy done. Patient is being discharged from the hospital on
12/20/XX. During his hospitalization he was experiencing pain and shortness of breath, but with
an antibiotic regimen of Levaquin, he improved. Physician performed final examination and
reviewed chest X-ray that revealed possible infiltrates and a CT of the abdomen that ruled out
any abscess. He was given a prescription of Zosyn. Patient told to follow up care with PCP or
return back to the hospital for any pain or bleeding. Physician spent 20 minutes. Select the
appropriate CPT code for 12/20 visit:
A. 99283
B. 99221
C. 99231
D. 99238
View Rationale

Question 4
A new patient wants to quit smoking. The patient has constant cough due to smoking and some
shortness of breath. No night sweats, weight loss, night fever, CP, headache, or dizziness. He
has tried the patches and nicotine gum, which has not helped. Patient has been smoking for 40
years and smokes 2 packs per day. Has a family history of emphysema. A limited three system
exam was performed. Physician discussed the pros and cons of medication used to quit smoking
in detail, counseling and education done for 20 minutes of the 30 minute visit. Prescription of
Chantrix and Tetracylcin was given. Patient to follow up in 1 month. We will consider chest X-ray
and cardiac work up iSelect the appropriate CPT code(s) for this visit:f not improved.
A. 99202
B. 99214, 99354
C. 99203
D. 99203, 99354
View Rationale
Question 5
The physician was notified to go to the hospital floor for medical management of a 56-year-old
patient admitted one day ago for aspiration pneumonia and COPD. No chest pain at present, but
still SOB and some swelling in his lower extremities. Was tachypenic yesterday; lungs reveal
course crackles in both bases, right worse than left. He is going to continue with intravenous
antibiotic treatment and respiratory support, reviewed chest X-ray and labs. Patient is improving
and a pulmonary consultation has been requested. What CPT code should be reported?
A. 99221
B. 99231
C. 99218
D. 99232
View Rationale
Question 6
Established patient presents to the office with a recurrence of bursitis in both shoulders. Range of
motion is good and full, but he has tenderness in the subdeltoid bursa. Both shoulders were
injected in the deltoid with 120mg Depo-Medrol. Select the appropriate CPT code for this visit:
A. 99212-25, 20610-50
B. 20610-50
C. 99211-25, 20610 x 2
D. 99212-25, 20550-50
View Rationale
Question 7
The physician admitted an 18-month-old infant from his office to rule out sepsis. Infant is crying
inconsolably. He has a large amount of gas in his bowel, no hematochezia associated with it. The
physician performs a comprehensive history, comprehensive exam, and a moderate decision
making. If afebrile, cultures are negative and inconsolable crying resolves in 48 hours, we will
discharge home. Watch very carefully vital signs, strict parameters. Select the appropriate CPT
code for this visit?

A. 99222
B. 99219
C. 99238
D. 99223
View Rationale
Question 8
Established patient presents to the clinic today for a follow-up of his hospitalization for
pneumonia. He was hospitalized for 6 days, on IV antibiotics. He was placed back on Singulair
and has been doing well with his breathing since then. An expanded problem focused exam was
performed. Records were obtained from the hospital and physician reviewed the labs and X-rays.
Was told to continue antibiotics for another two weeks to 20 days, and the prescription Keteck
was replaced with Zithromax. Patient to return to the clinic in two weeks for recheck of his
breathing and a re-X-ray at that time. What CPT code should be reported?
A. 99214
B. 99242
C. 99335
D. 99213
View Rationale
Question 9
An established 47-year-old patient presents with falling last night, slipping on water in her house.
She is complaining of back pain and no tingling or numbness. Physician documents that she has
full range motion of the spine, with discomfort. Her gait is within normal limits. Straight leg raising
is negative. She requested no pain killers and was recommended to use a hot water bottle.
Doctors Assessment: Back Strain What are the appropriate E/M and ICD-9-CM codes for this
service?
A. 99212, 847.9, E888.8, E849.0
B. 99212, 847.9, E885.9, E849.0
C. 99213, 846.9, E885, E849.0
D. 99213, 847.9, E888.9, E849.0
View Rationale
Question 10
A 75-year-old established patient is brought in by his son to have a physical screening done to be
enrolled in a group home. No new complaints. The patient has an established diagnosis of
Cerebral Palsy and Type II Diabetes and is currently on his meds. A comprehensive history and
examination is performed along with a moderate MDM. Blood work was ordered. PPD was done
and flu vaccine given. Patient already had a vision exam. No abnormal historical facts or finding
are noted. What CPT code should be reported?
A. 99397
B. 99387
C. 99214

D. 99215
View Rationale
Question 11
A 5-year-old is brought into the ER by ambulance, having been found floating in the pool for
unknown amount of time. EMS started CPR which was continued by the ER physician along with
an endotracheal intubation and placement of a CVP. The. ER physician spent 1 hour with the
critically ill patient. ER physician makes a notation that the 1 hour does not include the time for
the other separate billable services that took 30 minutes. What CPT codes should be reported?
A. 92950, 99291-25, 36556, 31603
B. 92950, 99291, 36556, 31500
C. 92950, 99291-25, 36556, 31500
D. 92950 99285-25, 36556, 31500
View Rationale
Question 12
A 90- year-old was in the ER with chest pressure and difficulty breathing. The patient is admitted
to the observation unit where she is given a nitro-drip. EKG, labs, and chest X-ray were ordered.
Patient spent the night in the observation unit. The next day the ER physician, now on call,
reviews the last set of lab orders and echocardiogram that was ordered. The tests come back
normal. MI protocol was ruled out. Patient is pain free and vitals are normal. Patient is being
discharged, is already on Lasix and Coumadin and was told to follow up with her cardiologist.
Select the appropriate CPT code for this visit:
A. 99285
B. 99217
C. 99233
D. 99238
View Rationale
Question 13
A 55-year-old established patient is coming in for a pre-op visit; he is getting a liver transplant due
to cirrhosis. The physician performs an expanded problem focused history, detailed examination,
and moderate MDM. Patient agrees with his physicians recommendations and the
transplantation will take place as scheduled. After the evaluation, the patient expresses a number
of concerns and questions for the prospective liver transplant. Physician spends an additional 30
minutes, excluding the time spent in doing the E/M service, in counseling and answering
questions regarding the surgery and discussing possible outcomes. What CPT codes should be
reported?
A. 99213, 99354
B. 99214, 99358
C. 99213, 99358
D. 99214, 99354
View Rationale

Question 14
A 90-year-old female was admitted this morning from observation status for chest pain to r/o
angina. Dr. of cardiology has come in to evaluate her performing a comprehensive history and
comprehensive exam. Her chest pain has been relieved with the nitroglycerin drip given before
admission and she would like to go home. Doctor has written out a couple of prescriptions to add
to her regimen. He had given her Isosorbide, and she is tolerating it well. He will go ahead and
send her home. Will follow up with her in a week. Patient was admitted and discharged on the
same date of service. What CPT code should be reported?
A. 99235
B. 99217
C. 99238
D. 99221
View Rationale
Question 15
A neonatologist was called to the delivery room by the OB unit to attend the birth of an infant 27week gestation. The newly born baby went into respiratory distress. The neonatologist intubated
the infant with bag ventilation and the placement of a venous umbilical catheter. What CPT
codes should be reported?
A. 99465-25, 31500, 36510
B. 99291-25, 31500, 36660
C. 99468-25, 31500, 36510
D. 99360-25, 31500, 36660
View Rationale
Question 16
Dr. X asks Dr. Y to look at a 65-year-old male who is in a nursing facility for decubitus ulceration.
Dr. Y is unable to obtain history due to current mental status. He obtains a detailed history from
Dr. Y since the patient is unable to provide a history. A detailed exam along with low MDM is
performed. Dr Y. recommends to Dr. X that the patient needs to go to the surgical suite for
debridement of the ulcerations. Since the patient is unstable at the moment due to elevated blood
pressure and a UTI, they decide to delay surgery and to keep monitoring patient until he
stabilizes. What CPT code should be reported?
A. 99304
B. 99234
C. 99253
D. 99243
View Rationale
Question 17
A 25 year-old male is brought in by the EMS to the ER for nausea and vomiting. Patient has
elevated blood sugars per EMS. Unable to get a history due to patients altered mental status.
The ER physician performed an eight organ system exam and a high level MDM. Patient was
transferred to ICU in stable condition. Total critical care time 25 minutes. What CPT code should
be reported?

A. 99285
B. 99291
C. 99236
D. 99223
View Rationale
Question 18
A 37-year-old female patient has been admitted to the OB unit due to severe pre-eclampsia. Fetal
monitor show increasing fetal distress. A pediatrician is requested by an obstetrician for standby
during the C-section. Total time of standby is 45 minutes. What CPT code should be reported?
A. 99360 x 2
B. 99360
C. 99026
D. 99464
View Rationale
Question 19
The patient presents to the ED after a car accident. The patient fell asleep while she was driving.
She states that for the past few weeks she will periodically fall asleep while she is driving. She
states she gets eight hours of sleep every night. She is not sure why this is happening. As a result
of the accident she has a contusion on her forehead and a slight headache. She denies blurry
vision, numbness, tingling, and nausea and vomiting. She denies alcohol or drug use. The
physician performs a detailed exam. He orders a CT scan and labs. He will also schedule a sleep
study to determine the cause for her falling asleep while driving. What is the CPT code for this
encounter?
A. 99283
B. 99284
C. 99285
D. 99291
View Rationale
Question 20
A physician makes a home care visit on a 63-year-old patient that is a hemiplegic having
insomnia for the last two weeks. Patient has been home bound for the last year. Last visit from
this physician was four months ago to control his DM. Physician performs an expanded problem
focused examination and low MDM. Physician then speaks with the spouse about the possibility
of placing the patient in a nursing facility. What CPT should be reported?
A. 99213
B. 99342
C. 99348
D. 99335