1. Medial and lateral meniscus repair performed arthroscopically.

a. 27447
b. 29868
c. 29882
d. 29883

2. A patient comes into the emergency department complaining of sever wrist pain after falling onto her out stretched hands. The physician evaluates the patient taking a detailed history, a detailed exam, and medical decision making of moderate complexity. Upon examination the physician notes that there is a small portion of bone protruding through the skin. After ordering xrays of the forearm and wrist the patient is diagnosed with an open distal radius fracture of the right arm. The physician provides an IV drip of morphine to the patient for pain and reduces the fracture. 5- 0 absorbable sutures were used to close the subcutaneous layer above the fracture and the surface was closed with 6-0 nylon interrupted sutures. Wound length was measured at 2.5 cm. It was then dressed with sterile gauze and the wrist was stabilized with a Spica fiberglass cast. The physician provided the patient with a prescription for Percocet for pain and instructions for her to follow up with her orthopedist in 7 days.

a. 99284-25, 25574-RT
b. 99284-57-25, 25605-54-RT, 12031
c. 99284-57, 25574-54
d. 99284-25, 25605-RT, 12031

3. A Scapulopexy is found under what heading

a. Incision
b. Excision
c. Introduction
d. Repair, Revision, and/or Reconstruction

4.A patient with muscle spasms in her back was seen in her physician’s office for treatment. The area over the myofascial spasm was prepped with alcohol utilizing sterile technique. After isolating it between two palpating fingertips a 25-gauge 5" needle was placed in the center of the myofascial spasms and a negative aspiration was performed. Then 4 cc of Marcaine 0.5% was injected into three points in the muscle. The patient tolerated the procedure well without any apparent difficulties or complications. The patient reported feeling full relief by the time the block had set.

a. 64400
b. 20552
c. 64520
d. 20553


5. OPERATIVE NOTE
PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4- C5 and C5- C6. POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4-C5 and C5- C6.
PROCEDURE PERFORMED:
1. Anterior discectomy, C5-C6.
2. Arthrodesis, C5-C6.
3. Partial corpectomy, C5.
4. Machine bone allograft, C5-C6.
5. Placement of anterior plate with a Zephyr C6.
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 60 mL.
OMPLICATIONS: None.
INDICATIONS: This is a patient who presents with progressive weakness in the left upper extremity as well as imbalance. He has a very large disc herniation that came behind the body at C5 as well and as well as a large disc herniation at C5-C6. Risks and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion, progressive spondylosis, and lack of improvement were all discussed. He understood and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. Preoperative antibiotics were given. The patient was placed in the supine position with all pressure points noted and well padded. The patient was prepped and draped in standard fashion. An incision was made approximately above the level of the cricoid. Blunt dissection was used to expose the anterior portion of the spine with carotid moved laterally and trachea and esophagus moved medially. I then placed needle into the disc spaces and was found to be at C5-C6. Distracting pins were placed in the body of C6. The disc was then completely removed at C5-C6. There was very significant compression of the cord. This was carefully removed to avoid any type of pressure on the cord. This was very severe and multiple free fragments noted. This was taken down to the level of ligamentum. Both foramen were then also opened. Part of the body of C5 was taken down to assure that all fragments were removed and that there was no additional constriction. The nerve root was then widely decompressed. Machine bone allograft was placed into C5-C6 and then a Zephyr plate was placed in the body C6 with a metal pin placed into the body at C5. Excellent purchase was obtained. Fluoroscopy showed good placement and meticulous hemostasis was obtained. Fascia was closed with 3-0 Vicryl, subcuticular 3-0 Dermabond for skin. The patient tolerated the procedure well and went to recovery in good condition.

a. 22554, 63081, 63082, 20931, 22845
b. 22551, 63081, 20931, 22840
c. 22551, 63081, 63082, 20931, 22845
d. 22554, 63081, 20931, 22840

6. A general surgeon and a neurosurgeon are performing an osteotomy on the L4 vertebral segment. The general surgeon establishes the opening using an anterior approach. While the neurosurgeon performs the osteotomy the general surgeon performs a discectomy. After completion the general surgeon closes the patient up.

a. General: 22224-59 Neurosurgeon: 22224-54
b. General: 22224-62 Neurosurgeon: 22224-62
c. General: 22224-66 Neurosurgeon: 22224-66
d. General: 22224 Neurosurgeon: 22224-80

7.A patient comes into his physician’s office with a prior diagnosis of a Colles type distal radius fracture. He complains that the cast he currently has on is too tight and is causing numbness in his fingers. The physician removes the cast and ensures the patient’s circulation is intact. He then reapplies a short arm fiberglass cast and checks the patient’s neurovascular status several times during the procedure. The patient is given instructions to follow-up with his orthopedist within seven days.

a. 25600-77
b. 25600-52
c. 29705, 29075
d. 29075

8. A patient is brought into the OR for a diagnostic arthroscopy of the shoulder. The patient has been complaining of pain since his surgery 4 months ago. The surgeon explores the shoulder and discovers a metal clamp which had been left in from the prior surgery. The surgeon removed the clamp and closed the patient up.

a. 29805, 23330
b. 29805, 29819
c. 29819-78
d. 29819

9. This 59 year-old female was brought to the operating room and placed on the surgical table in a supine position. Following anesthesia, the surgical site was prepped and draped in the normal sterile fashion. Attention was then directed to the right foot where, utilizing a # 15 blade, a 6 cm linear incision was made over the 1st metatarsal head, taking care to identify and retract all vita structures. The incision was medial to and parallel to the extensor hallucis longus tendon. The incision was deepened through subcutaneous underscored, retracted medially and laterally – thus exposing the capsular structures below, which were incised in a linear longitudinal manner, approximately the length of the skin incision. The capsular structures were sharply under scored off the underlying osseous attachments, retracted medially and laterally. Utilizing an osteotome and mallet the medial eminence of the metatarsal bone was removed and the head was remodeled with the Liston bone forceps and the bell rasp. The surgical site was then flushed with saline. The base and excised from the surgical site. There was no hemi implant used and Kirschner wire was used to hold the joint in place. Superficial closure was accomplished using Vicryl 5-0 in a running subcuticular fashion. Site was dressed with a light compressive dressing. The tourniquet was released. Excellent capillary refill to all the digits was observed without excessive bleeding noted.

a. 28296
b. 28292
c. 28899
d. 28298

10. 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?
a. 24575-54-RT, 24615-54-51-RT
b. 24576-54-RT, 24620-54-51-RT
c. 24577-54-RT, 24600-54-51-RT
d. 24565-54-RT, 24605-54-51-RT

11. 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® codes are reported?

a. 26055-F6, 20610-76-LT
b. 20552-F6, 20605-52-LT
c. 26055-F6, 20610-51-LT
d. 20553-F6, 20610-51-LT

12. 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?
a. 20680-LT
b. 20680-LT, 20680-59-LT
c. 20670-LT
d. 20680-LT, 20670-59-LT

13. 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® codes are reported?

a. 24579-RT, 29065-51-RT,  
b. 24577-RT
c. 24579-RT
d. 24575-RT

14. A 47-year-old patient was previously treated with external fixation for a Grade III left tibial fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Intrafragmentary compression was applied with three screws. The harvested bone graft was packed into the fracture site.
What CPT® codes are reported?
a. 27724-LT 
b. 27722-LT 


**END OF TEST**