20000 Series CPT Musculoskeletal System Practice Test

AAPC CPC Exam  20000 Series CPT Musculoskeletal System Practice Test: Try our free American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) Musculoskeletal System review questions and answers for free. In addition, you can also download the AAPC CPC Musculoskeletal System  Practice Test in PDF for better CPC certification.

20000 Series CPT Musculoskeletal System Practice Test

Q1. This 45-year-old male presents to the operating room with a painful mass of the right upper arm. General anesthesia was induced. Soft tissue dissection was carried through the proximal aspect of the teres minor muscle. Upon further dissection a large mass was noted just distal of the IGHL (inferior glenohumeral ligament), which appeared to be benign in nature. With blunt dissection and electrocautery, the 4-cm mass was removed en bloc and sent to pathology. The wound was irrigated, and repair of the teres minor with subcutaneous tissue was closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. What CPT® code is reported?

  1. 23076-RT
  2. 23066-RT
  3. 23075-RT
  4. 11406-RT
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 Answer Key: A

Rationale: The 4-cm mass was removed from the soft tissue of the shoulder. To access the mass, the provider had to go through the proximal aspect of the teres minor muscle. The mass was located distal to the inferior glenohumeral ligament (IGHL). Masses that are removed from joint areas as opposed to masses removed close to the skin require special knowledge and become more of an orthopedic concern due to joint involvement. Therefore, it is reported from codes within the musculoskeletal section. Code 23076 is used because dissection was carried through the proximal aspect of the teres minor. In the CPT® Index, look for Excision/Tumor/Shoulder directing you to 23071-23078.

Q2. The patient has a torn medial meniscus. An arthroscope was placed through the anterolateral portal for the diagnostic procedure. The patellofemoral joint showed grade 2 chondromalacia on the patellar side of the joint only, this was debrided with a 4.0-mm shaver. The medial compartment was also entered and a complex posterior horn tear of the medial meniscus was noted. It was probed to define its borders. A meniscectomy was carried out to a stable rim. What CPT® code(s) is reported?

  1. 29880
  2. 29870, 29877-59
  3. 29881, 29877-59
  4. 29881
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 Answer Key: D

Rationale: In the CPT® Index, look for Arthroscopy/Surgical/Knee. You are referred to 29871-29889. Review the codes to choose appropriate service. 29881 is the correct code since the tear was in the ―medial meniscus‖. A meniscectomy as well as debridement with a shaver (or chondroplasty) were performed. 29877 would not be reported as this is covered with code 29881. 29880 is not appropriate as the procedure would have had to be performed on both the medial and lateral compartments. The surgery started out as a ―diagnostic procedure,‖ but changed when the physician decided to perform surgical procedures on the knee, rather than only examining the knee for diagnostic purposes.

Q3. A 3-year-old is brought into the ER crying. He cannot bend his left arm after his older brother pulled it. The physician performs an X-ray to diagnose the patient has a dislocated nursemaid’s elbow. The ER physician reduces the elbow successfully. The patient is able to move his arm again. The patient is referred to an orthopedist for follow-up care. What CPT® and ICD-9-CM codes are reported?

  1. 24640-54-LT, 832.2, E927.0
  2. 24565-54-LT, 832.22, E929.8
  3. 24640-54-LT, 832.10, E927.8
  4. 24600-54-LT, 832.00, E928.8
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 Answer Key: A

Rationale: In the CPT® index, look up Elbow/Dislocation/Closed Treatment. You are referred to 24600- 24605, and 24640. Review the codes to choose appropriate service. 24640 is the correct code to report treatment of a dislocated nursemaid’s elbow with manipulation. Modifier 54 is used to report that the ED physician performed the surgical portion of the service only. The patient is referred to an orthopedist for follow-up care. Modifier LT is appended to indicate the procedure was performed on the left side.

In the ICD-9-CM Index to Diseases, look up Nursemaid’s/elbow. You are referred to 832.2. Review the code in the tabular section to verify accuracy. According to ICD-9-CM guidelines: A dislocation not indicated as closed or open should be classified as closed. In the ICD-9-CM Index to Diseases (Alphabetic Index) to External Causes of Injury and Poisoning, Section 3, look up Pulling,injury/due to/sudden strenuous movement. You are referred to code E927.0. Review the code in the Tabular List to verify accuracy.

Q4. A 50-year-old male had surgery on his upper leg one day ago and presents with serous drainage from the wound. He was taken back to the operating room for evaluation of a hematoma. His wound was explored, and there was a hematoma at the base of the wound, which was very carefully evacuated.The wound was irrigated with antibacterial solution. What CPT® and ICD-9-CM codes are reported?

  1. a. 10140-79, 998.12
  2. b. 27603-78, 998.59
  3. c. 10140-76, 998.9
  4. d. 27301-78, 998.12
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 Answer Key: D

Rationale: In the CPT® Index, look for Hematoma/Leg, Upper. You are referred to 27301. Verify the code for accuracy. Modifier 78 is appended to 27301 to indicate that an unplanned procedure related to the initial procedure was performed during the postoperative period. In the ICD-9-CM Index to Diseases, look for Complications/surgical procedures/hematoma. You are referred to 998.12. Review the code in the Tabular List for accuracy.

Q5. A 22-year-old female sustained a dislocation of the right elbow with a medial epicondyle fracture while on vacation. The patient was put under general anesthesia and the elbow was reduced and was stable. The medial elbow was held in the appropriate position and was reduced in acceptable position and elevated to treat non-surgically. A long arm splint was applied. The patient is referred to an orthopedist when she returns to her home state in a few days. What CPT® code(s) are reported?

  1. 24575-54-RT, 24615-54-51-RT
  2. 24576-54-RT, 24620-54-51-RT
  3. 24577-54-RT, 24600-54-51-RT
  4. 24565-54-RT, 24605-54-51-RT
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 Answer Key: D

Rationale: In the CPT® Index, look for Fracture/Humerus/Epicondyle/Closed Treatment. You are referred to code 24560-24565. Review the codes to choose the appropriate service. 24565 is the correct code to report an epicondyle fracture manipulated (reduced) without a surgical incision to perform the procedure. In the CPT® Index, look for Dislocation/Elbow/Closed Treatment. You are referred to 24600,24605. Review the codes to choose appropriate service. 24605 is the correct code because the patient was put under general anesthesia to perform the procedure. Modifier 54 is used to report the physician performed the surgical portion only. The patient is referred to an orthopedist for follow up or postoperative care. Modifier 51 is used to report multiple procedures were performed. Append modifier RT to indicate the procedure is performed on the right side.

Q6. A 45-year-old presents to the operating room with a right index trigger finger and left shoulder bursitis. The left shoulder was injected with 1 cc of Xylocaine, 1 cc of Celestone, and 1 cc of Marcaine. An incision was made over the A1 pulley in the distal transverse palmar crease, about an inch in length. This incision was taken through skin and subcutaneous tissue. The Al pulley was identified and released in its entirety. The wound was irrigated with antibiotic saline solution. The subcutaneous tissue was injected with Marcaine without epinephrine. The skin was closed with 4-0 Ethilon suture. Clean dressing was applied. What CPT® code(s) are reported?

  1. 26055-F6, 20610-76-LT
  2. 20552-F6, 20605-52-LT
  3. 26055-F6, 20610-51-LT
  4. 20553-F6, 20610-51-LT
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 Answer Key: C

Rationale: In the CPT® Index, look for Trigger Finger Repair. You are referred to 26055. Review the code to verify accuracy. In the CPT® Index, look for Injection/Joint. You are referred to 20600-20610. Review the codes to choose appropriate service. 20610 is the correct code since the shoulder was injected. Modifier F6 is used to report the right index finger that was repaired. Modifier LT is used to indicate the left shoulder joint. Modifier 51 is used to indicate multiple procedures were performed.

Q7. A patient presents with a healed fracture of the left ankle. The patient was placed on the OR table in the supine position. After satisfactory induction of general anesthesia, the patient’s left ankle was prepped and draped. A small incision about 1 cm long was made in the previous incision. The lower screws were removed. Another small incision was made just lateral about 1 cm long. The upper screws were removed from the plate. Both wounds were thoroughly irrigated with copious amounts of antibiotic containing saline. Skin was closed in a layered fashion and sterile dressing applied. What CPT® code(s) should be reported?

  1. a. 20680-LT
  2. b. 20680-LT, 20680-59-LT
  3. c. 20670-LT
  4. d. 20680-LT, 20670-59-LT
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 Answer Key: A

Rationale: When reporting the removal of hardware (pins, screws, nails, rods), the code is selected by fracture site, not the number of items removed or the number of incisions that are made. To report 20670 or 20680 more than once, there would need to be more than one fracture site involved. In this case, there is only one fracture site even though two incisions are made. We know the removal is deep because the screws were in the bone. In the CPT® Index, look for Removal/Implantation. The correct code is 20680. Modifier LT is appended to indicate the procedure is performed on the left side

Q8. A patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was performed and included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. What CPT® and ICD-9-CM codes are reported?

  1. 24579-RT, 29065-5-RT1, 812.52
  2. 24577-RT, 812.42
  3. 24579-RT, 812.42
  4. 24575-RT, 812.52
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 Answer Key: C

Rationale: As noted in ICD-9-CM Tabular List at the beginning of Chapter 17, a comminuted fracture is a closed fracture; therefore, a comminuted lateral condyle fracture is listed as 812.42. In the ICD-9-CM Index to Diseases, look up Fracture/humerus/external condyle directing you to 812.42. The fracture procedure code is found in the CPT® Index for Fracture/Humerus/Condyle/Open Treatment 24579. The manipulation is included in 24579. The application of the first cast is always bundled with the 24579 and not reported separately.

Q9. A patient presented with a closed, displaced supracondylar fracture of the left elbow. After conscious sedation, the left upper extremity was draped and closed reduction was performed, achieving anatomical reduction of the fracture. The elbow was then prepped and with the use of fluoroscopic guidance, two K- wires were directed crossing the fracture site and piercing the medial cortex of the left distal humerus. Stable reduction was obtained, with full flexion and extension. K-wires were bent and cut at a 90 degree angle. Telfa padding and splint were applied. What CPT® code is reported?

  1. 24535-LT
  2. 24538-LT
  3. 24582-LT
  4. 24566-LT
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 Answer Key: B

Rationale: This is a supracondylar fracture of the elbow repaired by percutaneous fixation. In the CPT® Index, look for Fracture/Humerus/Supracondylar/Percutaneous Fixation, 24538. Modifier LT is appended to indicate the procedure is performed on the left side.

Q10. A patient presented with a right ankle fracture. After induction of general anesthesia, the right leg was elevated and draped in the usual manner for surgery. A longitudinal incision was made parallel and posterior to the fibula. It was curved anteriorly to its distal end. The skin flap was developed and retracted anteriorly. The distal fibula fracture was then reduced and held with reduction forceps. A lag screw was inserted from anterior to posterior across the fracture. A 5-hole 1/3 tubular plate was then applied to the lateral contours of the fibula with cortical and cancellous bone screws. Final radiographs showed restoration of the fibula. The wound was irrigated and closed with suture and staples on the skin. Sterile dressing was applied followed by a posterior splint. What CPT® code is reported?

  1. 27814-RT
  2. 27792-RT
  3. 27823-RT
  4. 27784-RT
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 Answer Key: B

Rationale: In the CPT® Index, look for Fracture/Fibula/Open Treatment 27784, 27792, 27814. 27784 reports open treatment of a proximal fibular fracture or shaft fracture. The correct code is 27792, Open treatment of a distal fibular fracture which includes internal fixation. Modifier RT is appended to indicate the procedure is performed on the right side.

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