1. 34 year old Caucasian female came to the doctor’s office this morning for an excision of a 4 cm diameter benign lesion on scalp. An adjacent tissue transfer of 21.3 sq cm was used to repair the primary and secondary defect sites. Code the procedure?

A. 11624, 12036-59
B. 11426, 13121-51, 13122-51
C. 11424, 14021-59
D. 14021

2. 4 weeks ago, Mr. Canon was treated for a Smith fracture he sustained while roller blading. He does not need any additional restorative treatment because the injury is healing. He has an appointment with his surgeon, Dr. Madow, for a planned replacement of the long arm cast with a short arm cast. Code today’s encounter?

A. 29075-76, 813.41, V53.7, V54.11
B. 29075-58, V53.7, V54.12
C. 99024, V53.7, V54.12
D. 29075, 29705-59, 99024, V53.7, V54.22

3. Alicia, an elderly woman suffers from bradyarrythmias and is here for a battery change for a dual chamber pacemaker. Thru the skin the pacemaker pocket is opened, the old generator is detached from the leads, and the new generator is attached to the leads, and the pocket is closed. Code the procedure?

A. 33228
B. 33228, 33233-51
C. 33233, 33213-51, 33241-51
D. 33235, 33233-51, 33213

4. At the ASC, a 5 year old boy was prepped and draped in sterile fashion for surgery to repair an initial incarcerated hernia. The anesthesiologist administered the anesthesia, which took effect quickly. After making an incision in the left inguinal area, the surgeon Dr. Crandall, started the operation. Shortly thereafter, the patient went into shock and the procedure was aborted. Operating room staff stabilized the patient and returned him to the recovery room. What codes will Dr. Crandall report?

A. 49507-52, 550.10, 998.09, V64.1
B. 49501-74, 998.09, 550.11, V64.1
C. 49507-74, 550.10, 998.00, V64.1
D. 49507-53, 550.10, 998.00, V64.1

5. 28 year old female pregnant for the 1st time with twins and has a history of hypothyroidism. 1 twin is born alive and delivered vaginally. The other twin is still born and delivered by C-Section because of malposition. The same OB-GYN doctor that delivered the baby also provided care during the pregnancy and during the 6 weeks following delivery. What codes will the doctor report for this patient?

A. 651.01, V27.3, V91.00, 59400, 59514-51
B. 652.61, 651.01, 656.41, 648.11, 244.9, V27.3, V91.00, 59510, 59409-51
C. 652.61, 651.01, 656.41, V32.01, V91.00, 59400, 59514-51
D. 651.01, 648.11, 244.9, V27.3, V91.00, 59510, 59409-51

6. Patient is 3 weeks status post surgery and is here for care of a programmable intrathecal drug infusion pump. The patient complains that the pump provides minimal pain relief. Thru the prior incision site the Dr. accesses the reservoir for an electronic evaluation. To address the pump’s minimal residual and the patient’s complaint of pain, the Dr. puts more medication into the pump and increased the rate of infusion. Code the procedure?

A. 95990
B. 95991
C. 62370
D. 62369

7. A 48 year old female underwent a partial cystectomy for bladder cancer. Long after the surgery she still experiences urinary incontinence and dysuria. Her primary care physician tells her not to worry because these symptoms will go away and can be managed with medication. The patient decides to seek a second opinion from an Urologist. The Urologist ROS focuses on urinary system during an expanded problem focused history. A detailed examination of the genitourinary system, groin, buttocks, and genitalia was performed. The MDM is of low complexity.

A. 99202
B. 99242
C. 99243
D. 99203

8. The OB-GYN doctor started a planned vaginal delivery for a patient with controlled TYPE II DB. Anesthesiologist administers and epidural to relieve the labor pains. The labor does not progress and the anesthesiologist administers anesthesia for a C-Section. Report the codes for the anesthesiologist.

A. 01960-P2, 01961-P2
B. 01967-P2, 01968
C. 01960, 01961
D. 01967-P2, 01968-P2

9. Nicole suffers from a blood dyscrasia and undergoes an automated blood count (hemogram) with automated differential WBC count. The lab equipment malfunctioned and the test had to be done twice that day. How will the laboratory report their codes?

A. 85025 x 2,
B. 85025,
C. 85027, 85004
D. 85025, 85025-91

10. Which of the following carries oxygenated blood?

A. pulmonary artery
B. pulmonary vein
C. right atrium
D. inferior vena cava

CCS Exam Questions

11. A patient’s principal diagnosis is COPD (496) (MS-DRG 192). Per the UHDDS and relevant clinical documentation, which of the following factors could impact the coding of COPD?

A. Patient has acute respiratory insufficiency
B. PFTs were abnormal
C. Patient has bronchitis with emphysema
D. Productive cough

12. A patient with a history of hypothyroidism has a term twin delivery. One live born twin delivered vaginally. One stillborn twin in a malposition delivered by C-Section. The number of amniotic sacs and placenta is undetermined. What is the correct diagnostic code assignment?

A. 651.01, V27.3, V91.00
B. 652.61, 651.01, 656.41, V32.01, V91.09
C. 651.01, 648.11, 244.9, V27.3, V91.00
D. 652.61, 651.01, 656.41, 648.11, 244.9, V27.3, V91.09

13. A patient with a history of ASHD underwent a right heart catheterization that revealed an occluded LC artery, a patent RC artery, and an occluded LD artery. The Dr. decided to perform a percutaneous transluminal coronary angioplasty to treat the occlusions. Patient was prepped with IV heparin, Abciximab, and intracoronary nitroglycerin. A double catheter coronary angiogram was obtained by Judkins Technique.

A. 00.66, 00.41, 37.21, 88.56
B. 37.21, 00.66, 00.41, 88.56, 99.10, 36.04
C. 00.66, 00.41, 37.21, 88.56, 99.10, 36.04
D. 37.21, 00.66, 00.41, 88.56

14. If the principal diagnosis is pneumonia, which of the following will optimize the MS-DRG if POA.

A. Malnutrition
B. SOB
C. Productive sputum
D. Hyponatremia

15. A patient fell and sustained injuries that required an emergency room visit. Based on the bill below, what is the total reimbursement for this patient? **NOTE: Info in the table may NOT reflect actual APC, PSI, and amount for the CPT codes listed.

A. $1,472.04
B. $1,272.01
C. $1,405.22
D. $1,240.55

16. Based on the table below, what is the case mix index?

MS-DRG	MS-DRG Wt.	# of Patients
MS-DRG 233 Coronary Bypass with Cardiac Catheterization W / MCC	7.2292	8
MS-DRG 198 Interstitial Lung Disease W/O CC/MCC	.7879	4
MS-DRG 243 Permanent Cardiac Pacemaker Implant W/CC	2.6204	3

A. 3.546
B. 4.600
C. 4.573
D. 4.590

17. While working in the Regis Hospital HIM Coding Dept., you have been asked to print a list of laparoscopic vaginal hysterectomies that have been miscoded. Which data source would be most efficient in completing this task?