Practice CPC Exam - Coding Certification Tips

1 Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American Medical Association. Practice CPC Exam Note: All answers have options of A-D answers. Please be sure to check the following page if all options are not printed on one page due to a page break. Unless otherwise stated, assume that all information provided was documented by a physician.

2 No outside materials may be used on this exam other than the CPT, ICD-9-CM and HCPCS Level II manuals. Integumentary 9 Questions 1. Patient presents with a stage III pressure ulcer of the sacrum and a stage III pressure ulcer of the upper back. Physician performs an 18 debridement of the sacrum down to and including the muscle. During the same session the physician also performed a 6 sq. cm. debridement of the back down to and including the muscle. How should these services be reported? a. 11011, 11011-59 b.

3 11043, 97597-59 c. 11043, 11046 d. 11043, 11043-59 c Per CPT Coding Guidelines for debridement you may combine sums of wounds that are the same depth. 2. Patient presents with ulcers of the ischium, left heel and upper back. The physician performs a 12 sq. cm. full thickness debridement of the ischium down to and including the muscle fascia. During the same operative session the physician also performs a 10 sq. cm. debridement of the upper back down to the muscle. The 4 sq cm heel ulcer was debrided down to the bone.

4 How should these services be reported? a. 11043, 11043-59, 11044-59 b. 11043, 11046, 11044-59 c. 11043, 11044-59 d. 11043, 11046 b Per CPT Coding Guidelines for debridement in multiple wounds, sum the surface area of those wounds that are the same depth, but do not combine the sums for different depths. Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American Medical Association.

5 3. The physician excised a 5mm excised diameter benign blue nevus from the patient s arm and performed a simple closure for a patient for which the physician reported CPT 11400. A month later (outside the postoperative period), the same patient as in the above question returned to her surgeon s office with a 2 cm malignant lesion on her arm. In order to ensure that the entire malignancy was removed, the surgeon excised the 2 cm lesion and 2 cm skin margin (1 cm above the lesion and 1 cm below the lesion).

6 This was the narrowest clinical margin required to adequately excise the lesion. How should this be reported? a. 11404 b. 11602 c. 11604 d. 11604-58 c Based on CPT guidelines, the reporting of the excision of a lesion is based on the greatest clinical diameter of the lesion plus the narrowest margins required for complete excision. See guidelines preceding the Excision of Benign Lesions (11400-11471) and Excision of Malignant Lesions (11600-11646) codes. Answer d is incorrect because the question stated that the service was provided outside the postoperative period.

7 4. A surgeon excised a benign 5 cm lesion from a patient s back. An adjacent tissue transfer was performed to repair the defect resulting from the lesion excision. The defect repaired encompassed 11 sq. cm (including both the primary and secondary defects). What are the correct code(s) for these services? a. 14001 b. 11406, 14001-51 c. 14000 d. 11406, 14000-51 a The excision of the lesion is bundled into the adjacent tissue transfer codes per the Guidelines. The procedure is reported based on the total size of the defect, not the size of the lesion.

8 5. A patient presents with an infected 3 cm sebaceous cyst on her right anterior lower leg. The surgeon decides to excise the cyst. Based on the operative report, the cyst was involving the non-muscle fascia. After excising the cyst the physician had to close the non-muscle fascia as well as the skin and subcutaneous tissues. What are the correct codes to be reported? a. 11423, 12002-51 b. 11403, 12032-59 c. 11404, 12042-51 d. 11403, 12032-51 d A sebaceous cyst is a cyst on the epidermis or in a hair follicle.

9 The guidelines for excision of benign lesions note that a cystic lesion is a type of benign lesion. The best way to locate the code in the index is to look up lesion, skin, excision, benign. The closure is reported separately because Copyright 2000-2012 HCPro, Inc. All rights reserved. These materials may not be duplicated without the express written permission of HCPro, Inc. (804-608-0385). No claim asserted to CPT or any materials copyrighted by the American Medical Association. it required an intermediate repair (see guidelines for lesion excision).

10 The modifier 51 is used because multiple procedures are being reported. 6. A patient presents for destruction of premalignant lesions. The patient had five lesions. What are the correct code(s) for these services? a. 17000, 17003 x 4 b. 17000, 17003 c. 11200 d. 17000 x 5 a The destruction of these premalignant lesions is reported based on the number of lesions destroyed. Code 17000 describes the destruction of the first lesion and 17003 x 4 describes the destruction of the remaining four lesions.