10,000 Series CPT Integumentary System Practice Test

10,000 Series CPT Integumentary System Practice Test: Try our free American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) Integumentary System review questions and answers for free. In addition, you can also download the AAPC CPC Integumentary System Practice Test in PDF for better CPC certification.

10000 Series Integumentary System

Q1. Patient presents to the emergency department with multiple lacerations due to a knife fight at the local bar. After examination, it was determined these lacerations could be closed using local anesthesia. The areas were prepped and draped in the usual sterile fashion. The surgeon documented the following closures: 7.6 cm simple closure of the right forearm; 5.7 cm intermediate closure of the upper right arm; 4.7 cm complex closure of the right neck; 10.3 cm intermediate closure of the upper chest. What CPT® codes are reported?

  1. 13132, 12035-59, 12004-59
  2. 13132, 12034-59, 12032-59,12004-59
  3. 13132, 12036-59
  4. 13152, 12035-59, 12004-59
View Correct Answer
 Answer Key: A

Rationale: Four lacerations are repaired. The lacerations are separated first by classification (simple, intermediate, complex); then by location. There is one simple closure which is 7.6 for the right forearm (12004). Next the intermediate closures are performed on the arm measuring 5.7 cm and the upper chest measuring 10.3 cm. Trunk (chest) and extremities (arm) are in the same classification and are both intermediate, so the lengths are added together to total 16 cm (12035). The last repair is a complex repair of the neck, 4.7 cm (13132). Subsection guidelines state to append Modifier 59 to indicate that multiple repair procedures are performed

Q2. Patient presents to the operative suite with a biopsy proven squamous cell carcinoma of the left ankle. A decision was made to remove the lesion and apply a split thickness skin graft on the site. The lesion was excised as drawn and documented as measuring 2.4 cm with margins. Using the Padgett dermatone the surgeon harvested a split-thickness skin graft from the left thigh, which was meshed 1.5 x 1 and then inset into the ankle wound using a skin stapler. Xeroform bolster was then placed on the skin graft using Xeroform and 4-0 nylon and the lower extremity was wrapped with bulky cast padding and double Ace wrap. The skin graft donor site was dressed with OpSite. The surgeon noted the skin graft measured 9cm² in total. What CPT ® and ICD-9-CM codes are reported?

  1. 15100, 11603-51, 173.72
  2. 15100, 173.72
  3. 15120, 13100-51, 216.7
  4. 15240, 11603-51, 173.72
View Correct Answer
 Answer Key: A

Rationale: The excision of the lesion is found by looking in the CPT® Index for Skin/Excision/Lesion/ Malignant, you are referred to code range 11600-11646. The lesion is on the ankle (leg) narrowing the code range to 11600-11606. The lesion is 2.4 cm making the correct code 11603. The guidelines for Excision – Malignant Lesions tell us to report reconstructive closure (15002-15261, 15570-15770) separately. In this case a split thickness skin graft was used. Look in the CPT® Index for Skin Graft and Flap/Split Graft which refers us to code range 15100-15101, 15120-15121. 15100 is the correct code choice. The diagnosis is squamous cell carcinoma. Look in the Neoplasm Table for skin/ankle and there is a note to ―see also Neoplasm, skin, limb, lower.‖ Skin/limb/lower gives us a subterm for squamous cell carcinoma (173.72.

Q3. Patient presents with a suspicious lesion on her left arm. With the patient’s permission the physician marked the area for excision. The lesion measured 0.9 cm. The wound measuring 1.2 cm was closed in layers using 4-0 Monocryl and 5-0 Prolene. Pathology later reported the lesion to be a sebaceous cyst. What codes are reported?

  1. 11401, 216.6
  2. 12031, 11401-51, 706.2
  3. 13121, 11401-51, 216.6
  4. 11402, 706.2
View Correct Answer
 Answer Key: B

Rationale: Understanding a sebaceous cyst is benign, look in the CPT® Index for Skin/Excision/Lesion/Benign referring you to code range 11400-11471. The lesion is coded based on size and location for 11401. The note also indicates the wound was closed in layers allowing for intermediate closure, also coded based on location and size, 12031. In the ICD-9-CM Index, look under Cyst/sebaceous; or Cyst/skin (sebaceous is a nonessential modifier). Both options direct you to 706.2. Verify in the Tabular List..

Q4. Operative Report:

Pre-Operative Diagnoses:

Basal Cell Carcinoma, forehead
Basal Cell Carcinoma, right cheek
Suspicious lesion , left nose
Suspicious lesion, left forehead

Post-Operative Diagnoses:

Basal Cell Carcinoma, forehead with clear margins
Basal Cell Carcinoma, right cheek with clear margins
Compound nevus, left nose with clear margins
Epidermal nevus, left forehead with clear margins

NDICATIONS FOR SURGERY: The patient is a 47-year-old white man with a biopsy-proven basal cell carcinoma of his forehead and a biopsy-proven basal cell carcinoma of his right cheek. We were not quite sure of the patient’s location of the basal cell carcinoma of the forehead whether it was a midline lesion or lesion to the left. We felt stronger about the midline lesion, so we marked the area for elliptical excision in relaxed skin tension lines of his forehead with gross normal margins of 1-2 mm and I marked the lesion of the left forehead for biopsy. He also had a lesion of his left alar crease we marked for biopsy and a large basal cell carcinoma of his right cheek, which was more obvious. This was marked for elliptical excision with gross normal margins of 2-3 mm in the relaxed skin tension lines of his face. I also drew a possible rhomboid flap that we would use if the wound became larger. He observed all these margins in the mirror, so he could understand the surgery and agree on the locations, and we proceeded.

DESCRIPTION OF PROCEDURE: All four areas were infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion of the forehead measuring 6-mm and right cheek measuring 1.3 cm as I had drawn them and sent in for frozen section. The biopsies were taken of the left forehead and left nose using a 2-mm punch, and these wounds were closed with 6-0 Prolene. Meticulous hemostasis was achieved of those wounds using Bovie cautery. I closed the cheek wound first. Defects were created at each end of the wound to facilitate primary closure and because of this I considered a complex repair and the wound was closed in layers using 4-0 Monocryl, 5-0 Monocryl and 6-0 Prolene, with total measurement of 2.1 cm. The forehead wound was closed in layers using 5-0 Monocryl and 6-0 Prolene, with total measurement of 1.0 cm. Loupe magnification was used and the patient tolerated the procedure well.

What ICD-9-CM codes are reported?

  1. 173.31, 232.3, 238.2, 216.3
  2. 173.31, 216.3
  3. 173.20, 173.40, 216.2, 216.3
  4. 172.30, 173.30, 238.2, 239.2
View Correct Answer
 Answer Key: B

Rationale: For basal cell carcinoma, forehead, look in the ICD-9-CM codebook for the Neoplasm Table, then for Skin/forehead and there is note to ―see also Neoplasm, skin, face.‖ Neoplasm, neoplasia/skin/face/basal cell carcinoma refers you to code 173.31. Next, is a basal cell carcinoma, right cheek which also directs you to ―see also Neoplasm, skin, face.‖ (173.31). Because both basal cell carcinomas are coded with the same diagnosis code, it is only reported once. In the Index to Diseases, Nevus/compound has a morphology code of /0. Nevus/dermal/and epidermal also has a morphology code of /0. As noted in the Note box under the main term Nevus, morphology codes with a /0 should be coded to ―Neoplasm, skin, benign.‖ In the Neoplasm Table, look for skin/nose and skin/forehead both code to skin/face. The code from the benign column is used (216.3). Verify code selection in the Tabular List.

Q6. Operative Report
Pre-Operative and Post-Operative Diagnosis:

Squamous cell carcinoma, left leg
Open wound, right leg
Personal history of squamous cell carcinoma, right leg

INDICATIONS FOR SURGERY: The patient is an 81-year-old white man with biopsy-proven squamous cell carcinoma of his left leg. I marked the areas for excision with gross normal margins of 5 mm, and I drew my planned skin graft donor site from his left lateral thigh. He also had an open wound of his right leg from a squamous cell carcinoma excised four months ago, the skin graft had not taken. We plan on re- skin grafting the area. The patient is aware of all of these markings, and understands the surgery and location.

DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. IV Ancef was given. I used plain lidocaine for his local anesthetic throughout the procedure until the skin grafts were inset. The anterior of his leg and the thigh were infiltrated with local anesthetic. Both upper extremities were prepped and draped circumferentially, which included the left thigh on the left side. I excised the lesion on his left leg as drawn into the subcutaneous fat. Hemostasis achieved with the Bovie cautery. I then excised the wound on his right leg to lower the bacterial counts. I took a 1-2 mm margin around the wound and excised the granulation tissue as well. Hemostasis was achieved using the Bovie cautery. I then changed gloves. A split-thickness skin graft was harvested from the left thigh using the Zimmer dermatome. This was meshed one and a half times one. By this time, the pathology returned showing the margins were clear.

Skin grafts were inset on each leg wound using the skin stapler. Xeroform and gauze bolster was placed over the skin graft using 4-0 nylon. The skin graft donor site was dressed with OpSite. The legs were further dressed with heavy cast padding and the double Ace wrap. The patient tolerated the procedure well.

PROCEDURES: Excision squamous cell carcinoma, left leg with excised diameter of 2.5 cm, repaired with a split-thickness skin graft measuring 5.1 cm² . Excisional preparation of right leg wound repaired with a split-thickness skin graft measuring 3.2 cm² .

What CPT® codes are reported?

  1. 15100, 11603-51-LT, 15002-5-RT1,
  2. 15100, 15100-51-LT, 11603-51-LT, 15002-51-RT
  3. 15100, 11403-51-LT, 15100-51-RT
  4. 15100, 11603-LT
View Correct Answer
 Answer Key: A

Rationale: The first excision is for a malignant neoplasm of the left leg measuring 2.5 cm (11603) and repaired with a split thickness skin graft measuring 5.1 sq cm. The second excision is a surgical wound preparation of an open wound to the right leg (15002) which was repaired with a split thickness autograft measuring 3.2 cm² . Split thickness autografts are added together for a total graft size of 8.3 cm² (15100). Becaluse the original surgery on the right leg was four months ago, this surgery is outside of any global period, so no additional modifier is needed. Modifier 51 is used to indicate multiple procedures.

Q7. The patient is here because the cyst in her chest has come to a head and is still painful even though she has been on antibiotics for a week. I offered to drain it for her. After obtaining consent, we infiltrated the area with 1 cc of 1% lidocaine with epinephrine, prepped the area with Betadine and opened the cyst in the relaxed skin tension lines of her chest, and removed the cystic material. There was no obvious purulence. We are going to have her clean this with a Q-tip. We will let it heal on its own and eventually excise it. I will have her come back a week from Tuesday to reschedule surgery. What CPT® and ICD- 9-CM codes are reported?

  1. 10040, 706.1
  2. 10060, 706.2
  3. 10061, 706.2
  4. 10160, 786.6
View Correct Answer
 Answer Key: B

Rationale: The physician performed an incision and drainage (I & D) of a cyst on the chest. To find the code, see the CPT® Index for Incision and Drainage/Cyst/Skin, you are directed to code choices 10040, 10600-10061. 10040 is for acne surgery. 10060-10061 are for I & D of a cyst. Only one cyst was drained making 10060 the correct code. In the ICD-9-CM Index to Diseases, look for Cyst/skin, code 706.2 is indicated. Verification in the Tabular List confirms code selection.

Q8. Patient has returned to the operating room to aspirate a seroma that has developed from a surgical procedure that was performed two days ago. A 16-guauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported?

  1. 10160-78, 998.13
  2. 10180-58, 998.12
  3. 10140-78, 906.3
  4. 10140-58, 729.91
View Correct Answer
 Answer Key: A

Rationale: The provider performed a puncture aspiration of a seroma (clear body fluid built up where tissue has been removed by surgery). In the CPT® Index, see Seroma, your only option is Incision and Drainage (or I & D)/Skin. This is not an incision and drainage, but a puncture aspiration. Code 10160 is the correct code for the puncture aspiration. Even though it does not specifically state ―seroma‖ it is the code to report. This is not a staged return to the operative suite for the puncture aspiration of the seroma. Modifier 78 is used because the patient is returning to the operative suite with a complication in the global period. The diagnosis is reported as a post-operative complication. In the ICD-9-CM Index to Diseases, Seroma indexes to 998.13. Verification in the Tabular List confirms code selection.

Q9. A 14-year-old boy was thrown against the window of the car on impact. The resulting injury was a star shaped pattern cut to the top of his head. In the ED, the MD on call for plastic surgery was asked to evaluate the injury and repair it. The total length of the intermediate repair was 5+ 4+ 4+ 5 cm (18cm total). The star like shape allowed the surgeon to pull the wound edges together nicely in a natural Y plasty in two spots. What CPT® code is reported for the repair?

  1. 14041
  2. 14040
  3. 13121
  4. 12035
View Correct Answer
 Answer Key: D

Rationale: Subsection Guidelines in the Adjacent Tissue Transfer or Rearrangement state that these codes are not to be used when the repair of a laceration incidentally results in a configuration such as a Y plasty. Look in the CPT® Index for Repair/Skin/Wound/Intermediate. Instructions in the subsection guidelines for Repair state to add up all the lengths when in the same repair classification and anatomical sites grouped together into the same code descriptor. Based on the documentation, the total length is 18 cm. An intermediate repair of this length on the top of the head would be reported with code 12035.

Q10. A 63-year-old patient arrives for skin tag removal. As previously noted in her other visit, she has 3 located on her face, 4 on her shoulder and 15 on her back. The physician removes all the skin tags with no complications. What CPT® code(s) should be reported for this encounter?

  1. 11201
  2. 11201, 11201-51
  3. 11200, 11201-52
  4. 11200, 11201
View Correct Answer
 Answer Key: D

Rationale: Look in the CPT® Index for Removal/Skin Tags. Based on the documentation, the total number of skin tags removed is 22. Code 11200 is reported for the removal of ―up to and including 15 lesions.‖ Notice the wording for 11201 ―… each additional 10 lesions, or part thereof.‖ The words ―part there of‖ in the code description means you do not need to have a complete total of 10 skin tags to report the add-on code. The add-on code can be reported if the additional skin tags are 10 and under; so it is not necessary to append modifier 52 to this add-on code.. Code 11201 is an add-on code and modifier 51 Multiple procedures exempt.

See also