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CPCSTUDY COURSEMy progress

CPC STUDY COURSE · 2026 EDITION

Three traumatic wounds with two repair groups

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-08 · Professional outpatient claim; Original Medicare unless stated otherwise

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Injury packet

Fictional patient Rowan Vale, age 41, receives active treatment after broken glass causes three distinct lacerations. The physician identifies a 4.0 cm right-forearm wound, a 3.0 cm left-forearm wound and a 2.6 cm right-lower-leg wound. Exploration documents no retained foreign body, fracture, tendon injury, nerve injury or wound infection.

Forearm repairs

After routine cleansing and local anesthesia, the physician closes each forearm wound with a single layer of sutures. Both involve the skin without a deeper layer requiring closure. The physician documents simple repairs. A small amount of tissue adhesive reinforces the sutured right-forearm closure; it is not the sole closure method.

Lower-leg repair

The right-lower-leg laceration requires closure of the subcutaneous layer followed by skin closure. The physician documents an intermediate repair measuring 2.6 cm, without the work required for a complex repair. No graft or adjacent tissue transfer is performed. Routine wound preparation is part of this treatment, not a separately documented excisional debridement.

Postrepair record

The physician gives dressing and wound-review instructions. There is no additional unrelated procedure in the packet. The worksheet concerns the repair services and wound diagnoses; it does not supply enough separate E/M documentation to choose an E/M level. Each site and length remains visible in the final procedure note.

Book and charge review

For the arithmetic portion, the licensed-entry review has confirmed that the two simple forearm repairs share an anatomical and complexity group. Verify that grouping in your own book. The intermediate lower-leg repair is a different complexity group. A draft charge list combines all 9.6 cm and adds adhesive-only closure. Correct the grouping and explain why the adhesive entry does not describe the performed work.

Your coding worksheet

  1. Identify the reason for this encounter and the supported diagnoses.
  2. List the services actually completed and the applicable code sets.
  3. Use your books to select final codes, units and any supported modifiers.
  4. Sequence the diagnoses and explain the relevant instruction.
  5. Review included work and any separate coverage question. Explain why the strongest alternative does not fit.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Write your answer

Use only this fictional record. Your entries stay on this page and disappear when you leave or reload. Do not enter real patient information.

Compare with the worked explanation
  1. Active wound repair supports initial-encounter characters. Verify S51.811A for the right forearm, S51.812A for the left forearm and S81.811A for the right lower leg. The record states no foreign body or infection; do not substitute those branches.
  2. Within the stated, book-verified simple-repair group, 4.0 plus 3.0 equals 7.0 cm. Preserve each individual site and length even when reporting uses a combined group.
  3. The 2.6 cm intermediate repair stays separate from the simple group. Do not let a shared encounter or the convenience of one total erase the difference in documented closure work.
  4. Select the complete current entries for each supported group and length. Review any required multiple-procedure or anatomical reporting instructions rather than assuming a modifier from the number of wounds alone.
  5. The right forearm was closed with sutures reinforced by adhesive. Under NCCI III J.1, adhesive added to sutures does not support the adhesive-only closure service.
  6. Do not infer a complex repair, foreign body, infection or separate debridement from the traumatic mechanism. The note supplies the actual tissue work. Apply applicable external-cause requirements without inventing further circumstances.

Reference sections: WPS L35498 documentation; NCCI III J.1; S51/S81; ICD I.C.19

Practice the linked chart questions

Review the lesson

Sources

  1. WPS Medicare / CMS Medicare Coverage Database — LCD L35498: Removal of Benign Skin Lesions. Revision effective October 30, 2025; currently in effect. Accessed 2026-09-10.
  2. CMS — Medicare NCCI 2026 Chapter III: Integumentary System. 2026. Accessed 2026-09-10.
  3. CDC NCHS — ICD-10-CM April1,2026 Index and Tabular XML. April1–September30,2026. Accessed 2026-09-12.
  4. CDC/NCHS and CMS — ICD-10-CM April 1 2026 Guidelines. FY2026 April. Accessed 2026-09-10.

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