6. A patient undergoes transfusion with his own blood, which was previously draw
6. A patient undergoes transfusion with his own blood, which was previously drawn and
stored. What is the correct qualifier?
a. Autologous
b. No qualifier
c. Nonautologous
d. Other substance
7. What is the correct character 6 choice for a pulmonary function test to check
respiratory flow?
a. Rate
b. Flow
c. Capacity
d. Respiratory
8. Which is an incorrect code?
a. 9WB0XBZ
b. 7W06X8Z
c. 7W06XBZ
d. 9WB5XKZ
9. A physician performs electromagnetic stimulation for incontinence. What is the correct
body part character?
a. Skin
b. Urinary
c. Circulatory
d. Musculoskeletal
10. What is the correct body region for a manipulation the surgeon performed on the neck?
a. Head
b. Lumbar
c. Cervical
d. Thoracic
11. What is the root operation the physician uses when qualifiers concerning “ray” procedures
are involved?
a. Removal
b. Alteration
c. Detachment
d. Reattachment
56 HM265 Inpatient Procedural Coding
12. An orthopedic surgeon performs a fracture reduction of a carpal fracture and applies
an internal fixation device, as well as a cast. How many codes will you report for this
encounter?
a. One—one code can accurately report the entire encounter
b. Four—one each for reposition, fixation, cast application and cast removal
c. Two—one for the reposition procedure and the fixation, and one for the cast application
d. Three—one for the reposition procedure, one for the fixation and one for the cast
application
13. Which modality is considered a manual technique?
a. Ice
b. Heat
c. Ultrasound
d. Manipulation
14. A patient is undergoing a whole blood transfusion in the cephalic vein when the vein
appears to collapse and infiltrate. The physician restarts the procedure using access
via the subclavian vein. How many codes will you report?
a. One
b. Two
c. Three
d. No codes, as the procedure was unsuccessful
15. Which is the correct substance character for an antibiotic?
a. Anti-infective
b. Antineoplastic
c. Local anesthetic
d. Other therapeutic substance
16. What is the correct character 2 choice for a pacemaker check?
a. Cardiac
b. Rhythm
c. Physiological Devices
d. Physiological Systems
17. What is the correct character 5 choice for a patient who is removed from the ventilator
after six hours?
a. 3
b. 4
c. 5
d. 6
Workbook 57
18. A Navy diver has one-time hyperbaric oxygen chamber treatment for the “bends.”
What is the correct root operation to report this procedure?
a. Phototherapy
b. Decompression
c. Atmospheric control
d. Ultraviolet light therapy
19. What is the correct root operation for phototherapy treatment of a newborn?
a. Pheresis
b. Phototherapy
c. Shock wave therapy
d. Ultraviolet light therapy
20. What is the correct qualifier when a patient presents for sperm sampling for use for
in vitro fertilization?
a. Sperm
b. Prostate
c. No qualifier
d. In vitro fertilization
Select the best ICD-10-PCS code(s) from the choices provided. Each item is worth 2 points.
21. Patient returns to the operating room for postoperative bleeding control, percutaneous
approach, after upper jaw tumor removal
a. 035R3ZZ
b. 0W344ZZ
c. 0W343ZZ
d. 0WQ43ZZ
22. Percutaneous endoscopic removal of radioactive seeds previously planted in left leg
for radiotherapy cancer treatment
a. 0YP941Z
b. 0YP931Z
c. 0YPB41Z
d. 0YPB31Z
23. An inpatient undergoes change and adjustment of a traction apparatus of the head twice
during hospitalization
a. 0WH043Z
b. 2W00X0Z
c. 0W20XYZ
d. 0WH04YZ
58 HM265 Inpatient Procedural Coding
24. Vectorcardiogram to measure electrical activity
a. 4A023N8
b. 4A02Z4A
c. 4A02X4A
d. 4A02X4Z
25. Donor patient pheresis for single plasma donation
a. 6A550Z2
b. 6A550Z3
c. 6A551Z3
d. 6A551Z2
26. Patient undergoes rotational chiropractic manipulation (long lever method) of the
lumbar vertebrae and long and short lever method for the thoracic vertebral region.
a. 7W03X2Z 7W02X2Z
b. 0SN0XZZ 0RN6XZZ
c. 9WB3XJZ 9WB2XGZ
d. 9WB3XGZ 9WB2XJZ
27. Laparoscopy of right wrist region, no findings to warrant further procedure
a. 0RJPXZZ
b. 0RJLXZZ
c. 0XJG4ZZ
d. 0XJH4ZZ
28. Patient with 45 hours of continuous controlled mechanical ventilation
a. 5A19054
b. 5A1945Z
c. 5A1955Z
d. 5A1935Z
29. Manually assisted vaginal delivery
a. 10D07Z7
b. 10E0XZZ
c. 10D000Z0
d. 10D000Z1
Workbook 59
30. Regina presents for a diagnostic amniocentesis at 16 weeks’ gestation.
a. 10904ZU
b. 10904ZD
c. 0W9F00Z
d. 0W9F0ZZ
31. Patient undergoes open transplant of his left toe to replace his missing left thumb
a. 0PRV07Z
b. 0LX80ZZ
c. 0XRM07P
d. 0XYK0ZZ
32. Open revision of malfunctioning infusion device of right lower leg
a. 0JHN0HZ
b. 0JHN0NZ
c. 0YW903Z
d. 0YW90YZ
33. Application of bandage dressing after burn treatment on the abdominal wall
a. 2W23X4Z
b. 2W33X4Z
c. 2W24X5Z
d. 2W23X5Z
34. The patient is admitted with respiratory failure, intubated and placed on CPAP
mechanical ventilation with continuous positive airway pressure, until day seven of
the hospitalization, when removed from respirator.
a. 5A09559
b. 5A09457
c. 5A09557
d. 5A09357
35. Chiropractic manipulation of the lumbar spine with the assistance of a traction device
a. 0SN0XZZ
b. 7W03X9Z
c. 9WB3XLZ
d. 9WB3XKZ
60 HM265 Inpatient Procedural Coding
36. Infant inpatient has multiple rectal temperature readings every four hours per day
for monitoring
a. 4A1Z7KZ
b. 4A0Z7KZ
c. 4A0ZXKZ
d. 4A1ZXKZ
37. Male patient has a levator muscle spasm and undergoes therapeutic rectal massage, which
alleviates the pain
a. 8E0VX1D
b. 7W04X9Z
c. 9WB4XKZ
d. 0KNMXZZ
38. Percutaneous thoracotomy for pneumothorax of left pleural cavity, no device left in place
a. 0W9B40Z
b. 0W9B30Z
c. 0W9B3ZZ
d. 0W9B4ZZ
39. Ms. White was admitted to the hospital and underwent a high cesarean section due to
breech presentation
a. 10D00Z0
b. 10A00ZZ
c. 10A04ZZ
d. 10A07Z6
40. Legally-induced, transvaginal abortion using vacuum extractor aspiration method
a. 10A07Z6
b. 10D07Z6
c. 10A08ZZ
d. 10A07ZZ
41. Scenario 1
The patient is a 32-year-old female who was diagnosed with metastatic thyroid cancer. She
was administered radioiodine 131. She is admitted to the facility for the required 3-day,
post-treatment isolation. Strict protective protocols will be followed.
a. 3E01XG4
b. 8E0HXY7
c. 8E0ZXY6
d. 3E0W3HZ
Workbook 61
42. Scenario 2
PREOPERATIVE DIAGNOSIS
Upper and lower back pain.
POSTOPERATIVE DIAGNOSIS
Upper and lower back pain
PRIMARY PROCEDURE
ACUPUNCTURE TREATMENT, LOW ENERGY.
PROCEDURE
We elected this treatment to place a back and front system, negative to positive, at 5.5 Hz. We
did many ashi points on her back, most of which were along the midspine. Then, we took the hua
tuo jia ji points from T1 through T7, and the patient seemed to tolerate this fairly well.
a. 8E0H30Z
b. 8E0K309
c. 8E0H309
d. 8E0K30Z
43. Scenario 3
PREOPERATIVE DIAGNOSIS
Neuropathy of the foot.
POSTOPERATIVE DIAGNOSIS
Neuropathy of the foot.
INDICATIONS FOR PROCEDURE
Patient presented for repeated lumbar sympathetic block. The last one gave her excellent
temporary benefit, but no long-term benefits. She now presents for her 2nd diagnostic injection.
PROCEDURE
With the patient prone, we prepped and draped the back in sterile fashion. After lidocaine
local infiltration, under fluoroscopic guidance, we advanced the 22-gauge, 6 inch needle via
the paramedian approach to the anterolateral border of the L3 vertebral body and injected the
Isovue-M 300 dye. We noted good cephalocaudal spread. However, most of the spread was from
L3 up to L2 with very little spread down to L4. We injected 10 mL of 0.25% Marcaine there, and
the patient had excellent temporary benefit from the injection, without complications. Patient will
return in a few weeks for a follow-up to assess the efficacy of the injection.
a. 8E0130Z
b. 8E014YZ
c. 3E0T3BZ
d. 3E0TXBZ
62 HM265 Inpatient Procedural Coding
44. Scenario 4
PROCEDURE
ELECTROENCEPHALOGRAM.
FINDINGS
This is an 18-channel digital EEG recording for an 80-year-old female with sudden onset of
altered mental status. She is reportedly on multiple medications at this time. Background
characterized by diffuse slowing and disorganization consisting of medium-voltage theta rhythm
at 4-6 Hz from all head areas. From anterior head areas, there is faster activity at beta range.
Eye movements and muscle artifacts are noted. EEG artifacts at 72 per minute were noted.
IMPRESSION
Moderately abnormal record due to diffuse slowing and disorganization of the background, with
slowing at theta range. The EEG indicates encephalopathic process. However, a structural lesion
cannot be ruled out and therefore clinical correlation is necessary.
a. 4A000BZ
b. 4A00X4Z
c. 4A02X4A
d. 4B00XVZ
45. Scenario 5
PREOPERATIVE DIAGNOSIS
Removal of drains.
POSTOPERATIVE DIAGNOSIS
Removal of drains.
PRIMARY PROCEDURE
REMOVAL OF BILATERAL #32-FRENCH CHEST TUBES WITH CLOSURE OF WOUND.
INDICATIONS FOR PROCEDURE
Patient, 45, is female and has been in the intensive care unit for over a month with bilateral chest
tubes for chronic draining pleural effusions. Her effusion has cleared, and she has been referred
for removal of tubes.
PROCEDURE
We prepped and draped the patient over both of her chest tube sites. We applied pressure over
the sites and closed the skin with interrupted #3-0 Ethilon sutures. We cleansed the skin and
applied Vaseline occlusive dressing over the sites. Then, we performed the same procedure on
the other side, and removed the chest tubes on full inspiration. Her vital signs remained stable
throughout the procedure.
a. 0BPQX1Z
b. 0BPQX0Z
c. 0WPBX0Z 0WP9X0Z
d. 0WPBXYZ 0WP9XYZ
Workbook 63
46. Scenario 6PRIMARY PROCEDURE
CERUMEN REMOVAL VIA WATER/PEROXIDE SOLUTION.
PROCEDURE
A 40-year-old male complains of left ear pain that just began tonight. He thinks he has foreign
body in his ear. Physical exam reveals hard impacted wax blocking the tympanic membrane on
the left. Following the irrigation procedure, the patient stated he felt much better and has normal
hearing after the wax removal.
a. 3E1B88Z
b. 3E1B78Z
c. 3E1B78X
d. 3E1B88X
47. Scenario 7
PREOPERATIVE DIAGNOSIS
Incisional hernia.
POSTOPERATIVE DIAGNOSIS
Incisional hernia.
PRIMARY PROCEDURE
OPEN INCISIONAL HERNIA REPAIR WITH MESH INSERTION.
INDICATIONS FOR PROCEDURE
Patient had previous midline prostate surgery. Upper end of the incision adjacent to the umbilicus
gave way, with an incisional hernia approximately 1.5 cm in diameter, which was painful.
PROCEDURE
The patient underwent general anesthesia in the OR. We clipped, draped and prepped the anterior
abdominal wall in the usual sterile manner and made the periumbilical incision to encompass
the previous prostate surgery incision. Fibrotic tissue from the prostate surgery scar was taken
down and we dissected until reaching the fascia. We opened the upper end of the prostate surgery
incision approximately 1.5 cm in diameter. We mobilized the hernia that was protruding into this
area and cleared the fascial edges. We retracted the umbilicus laterally and then disconnected this
from the fascia. We cleared the opening circumferentially in the subperitoneal plane in order to
cleanse the fat that was part of the hernia sac. We used small Ventralex mesh with a 3 cm overlap
from the fascia to insert into the peritoneal cavity, and cinched it with the straps with the rough
portion lying against the peritoneum and muscle. We then sutured the mesh with the #1 Nurolon
and M06 needle to get good pieces of the fascia and straps of the mesh. Circumferential suturing
was necessary to ensure adequate adherence of the mesh to the peritoneum, and good hemostasis
was noted. While suturing the mesh we made every effort to confirm there was no injury to the
bowel. Further, we developed a layer of subcutaneous fat and hernia sac, which we used to close
the opening of the mesh at that point. Next, we reattached the umbilicus to the fascia and closed
the skin with 4-0 Monocryl subcuticular sutures as well as application of Dermabond. Lastly, we
applied dressing and woke the patient, who tolerated the procedure well.
a. 0WUF0JZ
b. 0WQF0ZZ
c. 0WQF0ZZ 0WUF0JZ
64 HM265 Inpatient Procedural Coding
48. Scenario 8
The patient was already undergoing cardiopulmonary resuscitation, with bag mask and chest
compressions. I immediately began supervising the manual compressions. A brief consultation with
his nurse indicated that the patient was doing well, then suddenly vomited and afterwards his
heart rate dropped to 0. Upon arrival on the scene, the crash cart was being moved into position;
I helped the nurses attach the monitoring leads and defibrillation pads. Then, we assessed his
rhythm and found he was in ventricular fibrillation. I ordered cardioversion defibrillation at
120 joules, followed by 2 minutes of manual CPR. During 2 minutes of CPR, 1 of epinephrine
and 1 of atropine were administered. CPR was continued and another round of epinephrine and
atropine were administered. We continued the CPR for approximately 20 minutes with a total of
5 epinephrine, 3 atropine, 2 bicarb, 1 calcium and 1 magnesium administered. The patient had
positive ventilation during this time with bilateral breath sounds monitored at each rhythm check
in 2-minute intervals between CPR. After approximately 25 minutes, we noted a junctional rhythm
on the monitor and the patient had a weak pulse. His pulse was soon lost, and we continued CPR.
At the next evaluation between CPR, the patient was back in atrial fibrillation with a positive pulse
in his carotid, femoral and radial arteries. At this time, we transported him to ICU.
a. 5A12012
b. 5A2204Z 5A12012
c. 5A2204Z 5A19054
49. Scenario 9
PREOPERATIVE DIAGNOSIS
Left diabetic foot ulcer.
POSTOPERATIVE DIAGNOSIS
Left diabetic foot ulcer.
PRIMARY PROCEDURE
LEFT BELOW-THE-KNEE AMPUTATION.
INDICATIONS FOR PROCEDURE
Patient is 62 years old, diabetic and has developed left heel abscess. He has had a previous
calcaneal fracture and several previous debridements with placement of antibiotic beads. After
re-inspecting the wound last week, the plan is possible debridement and the patient desires
below-the-knee amputation.
PROCEDURE
The patient was placed in the appropriate supine position in the OR, and general anesthesia
was induced. We placed cast padding on his left proximal thigh and applied the tourniquet. We
prepped and draped his left lower extremity in the usual sterile fashion and made the transverse
incision around the midshaft of the tibia, creating a long posterior flap. We continued the flap to
the subcutaneous tissues with electrocautery technique. Note that tourniquet was inflated after
exsanguination of the limb. We then identified, clamped and cut the superficial peroneal nerve and
divided the anterior compartment. With the anterior neurovascular bundle identified, we clamped
and cut it, and took the plane between the deep and superficial compartments. The superficial
compartment was reflected posteriorly, and the tibial nerve and vessels identified, clamped and cut.
Workbook 65
Next, we elevated the periosteum of the tibia proximally, along with the fibula, cut the tibia with
the Gigli saw, beveled it anteriorly and smoothed it with rasp. We cut the fibula about 1.5 cm
proximal to this with the large bone cutter and divided the remaining posterior compartment.
We clamped and cut the peroneal bundle and passed the leg off the field. At this point, each
vascular bundle was double-ligated with 0 silk-stick tie and 0 silk-free tie. We also pulled the
nerves at length, injected them with 0.25% Marcaine with epinephrine, cut and later retracted
them proximally. We released the tourniquet and achieved good bleeding from the tissues along
with hemostasis via electrocautery. We closed the remaining fascia with #1 Vicryl and closed the
subcutaneous tissues with 2-0 PDS sutures using 2-0 Monocryl sutures in interrupted fashion.
Finally, we closed the skin with skin staples and applied Xeroform gauze 4 x 4 and a padded soft
dressing. The patient was placed in well-padded anterior and posterior slab splints with the knee
extended. Patient was then awakened, extubated and taken to recovery in stable condition. There
were no immediate complications, and he tolerated the procedure well.
a. 0Y6J0Z1
b. 0Y6J0Z2
c. 0Y6J0Z3
d. 0Y6G0ZZ
50. Scenario 10
PREOPERATIVE DIAGNOSIS
Carbon monoxide poisoning.
POSTOPERATIVE DIAGNOSIS
Carbon monoxide poisoning.
INDICATIONS FOR PROCEDURE
This patient, a 35-year-old female, went to bed at 10:00 p.m. at a friend’s home. She was found
lethargic the next morning by her sister. Three other individuals in the house were lethargic also,
and complained of headache the same morning. Her last memory was talking to her friend the
night before. She next remembered riding in the ambulance from a hospital.
DATABASE
Initial Carboxyhemoglobin level was 24% (normal <1.5%) and ABG 7.41/30/370 with O2 Sat 75%
on 100% FiO2.
PROCEDURE
The patient had 2 dives total under hyperbaric oxygen today. Neuropsychological assessment
on 1/18 revealed marked cognitive impairments with defects in anterograde memory, praxis,
associative fluency, attention and speed of information processing.
a. 6A150ZZ
b. 6A051ZZ
c. 6A151ZZ
d. 6AB50BZ