Q&A CPC practice exams help

[RobertaP]

I spoke with Laureen today, thank you for taking time to call me. She suggested I post a question with an example for tonight. If it is too late may we do it next Thursday October 29? I am in need of understanding how to quickly remove the words that I do not need to get to the correct code for the CPC exam. I am using this as an example.
The possible answers are
A. 33208
B. 33249, 76000-26
C. 33241, 33243, 33249
D. 33249


OPERATION: Dual chamber transvenous implantable pacing cardioverter-defibrillator system implantation with leads. INDICATIONS: A 68-year-old, white man has significant underlying ischemic cardiomyopathy with EF of 25 percent, prior infarcts, remote history of syncope, and at a high risk for malignant ventricular arrhythmias. He has had a recent T wave alternans test which was clearly abnormal. He has had episodes of resting bradycardia, also noted. He meets Madit II criteria for insertion of a transvenous implantable pacing cardioverter-defibrillator (ICD). PROCEDURE: After informed consent had been obtained, the patient was brought to the outpatient hospital lab in the fasting state. The left anterior chest was prepped and draped in a sterile fashion. Intravenous sedation and local anesthetic were given. After local anesthetic, a 5 cm incision was made at the left deltopectoral groove. With blunt dissection and cautery, this was carried down through the prepectoralis fascia. The cephalic vein was identified and ligated distally. Through the venotomy, a subclavian venogram was performed to provide a roadmap. The atrial and ventricular leads were then advanced into the vessel to the level of the right atrium under fluoroscopic guidance. The ventricular lead was maneuvered to the right ventricular outflow tract, and then through the RV apex where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in diaphragmatic capture. The atrial lead was maneuvered to the anterolateral right atrial wall where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the pre-pectoralis fascia with interrupted 2-0 Tycron sutures. 10 volt pacing did not result in diaphragmatic capture. A subcutaneous pocket was created with good hemostasis achieved. The pocket was subsequently irrigated with solution of Bacitracin. The generator was connected to the lead, and then placed in the pocket with no tension on the lead. The deep fascial layer was closed with interrupted 2-0 Vicryl suture. The subcutaneous closure was made with running 3-0 Vicryl suture. Subcuticular closure was made with running 4-0 Vicryl suture. Steri-strips were applied. Ventricular fibrillation was induced with a T wave shock. This was successfully sensed and terminated with a 15 joule shock to sinus rhythm. High voltage impedence was 39 ohms. Dry dressing was placed over the wound. The patient returned to the floor in stable condition without apparent complications. Which of the following codes accurately describes the basic procedure summarized in this report?

 

[Paul A]

I only read the operation section and I came up with D. I looked up code 33249 as it was the only one code that was in more than 1 answer. The description was Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber. That matches the description in the first sentence. I glanced through the guidelines real quick and saw no mention of radiology codes so i ignored B.

 

[RobertaP]

It is all of the words in the CPC exam question that I am wondering how to get through quickly.

 

[Paul A]

That's the tough part for me. I stink at abstracting. I actually plan on putting any long narrative questions as 1 or 2 dot questions for a different pass.

Disclaimer. I have not taken the test yet, Most of this is stuff I have read or remember from the course and various YouTube videos, advice from coworkers etc

Probably the first thing on the long narratives is too look at the last sentence. For instance you could gave a full page OP report and all they care about is the Anesthesiologist, the primary surgeon, radiologist or pathologist etc, that may make it so you don't need to read the narrative at all.

On this one it asked what the basic procedure was. All of that information was in the OPERATION: section. The procedure section was just a bunch of step by step, getting patient consent, anesthesia application (if the last sentence was asking about anesthesia you would look here). Size of incision, types of suture material, etc.

If it asked about diagnosis I would have looked in the INDICATIONS: section

Make sure you also look up the answers before you even start reading the scenario.