Exam 24: Coding for Surgical Procedures on Integumentary, Musculoskeletal, Respiratory, and Cardiovascular/Lymphatic Systems

Operation: Left transaxillary subpectoral mammoplasty with saline-filled implant. Preoperative diagnosis: Left hypomastia. Postoperative diagnosis: Left hypomastia. Anesthesia: General. Procedure: After first obtaining a suitable level of general anesthesia with the patient in the supine position, the breasts were prepped with Betadine scrub and solution. Sterile towels, sheets, and drapes were placed in the usual fashion for surgery of the breasts. Following prepping and draping, the anterior axillary folds and the inframammary folds were infiltrated with a total of 20 cc of 0.5 percent Xylocaine with 1:200,000 units of epinephrine. After a suitable hemostatic waiting period, transaxillary incisions were made, and dissection was carried down to the edge of the pectoralis fascia. Blunt dissection was then used to form a bilateral subpectoral pocket. Through the subpectoral pocket a sterile suction tip was introduced, and copious irrigation with sterile saline solution was used until the irrigant was clear. Following completion of irrigation, 250-cc saline-filled implants were introduced. They were first filled with 60 cc of saline and checked for gross leakage; none was evident. They were overfilled to 300 cc of saline each. The patient was then placed in the seated position, and the left breast needed 10 cc of additional fluid for symmetry. Following completion of the filling of the implants and checking the breasts for symmetry, the patient's wounds were closed with interrupted vertical mattress sutures of 4-0 Prolene. Flexan dressings were applied, followed by the patient's bra. She seemed to tolerate the procedure well. Choose the appropriate CPT and ICD-10-CM codes:

Gary sees Dr. G on Monday regarding his atrial fibrillation. Gary is a new patient, and Dr. G performs a medically appropriate history and examination, and moderate medical decision making. Dr. G decides to insert a permanent dual-chamber pacemaker. The pacemaker is inserted on Tuesday. Dr. G sees Gary in the hospital on Wednesday and discharges Gary on Thursday. Which of the following is the correct coding of Gary's visits and procedures for Monday through Thursday?

Operation: Left transaxillary subpectoral mammoplasty with saline-filled implant. Preoperative diagnosis: Left hypomastia. Postoperative diagnosis: Left hypomastia. Anesthesia: General. Procedure: After first obtaining a suitable level of general anesthesia with the patient in the supine position, the breasts were prepped with Betadine scrub and solution. Sterile towels, sheets, and drapes were placed in the usual fashion for surgery of the breasts. Following prepping and draping, the anterior axillary folds and the inframammary folds were infiltrated with a total of 20 cc of 0.5 percent Xylocaine with 1:200,000 units of epinephrine. After a suitable hemostatic waiting period, transaxillary incisions were made, and dissection was carried down to the edge of the pectoralis fascia. Blunt dissection was then used to form a bilateral subpectoral pocket. Through the subpectoral pocket a sterile suction tip was introduced, and copious irrigation with sterile saline solution was used until the irrigant was clear. Following completion of irrigation, 250-cc saline-filled implants were introduced. They were first filled with 60 cc of saline and checked for gross leakage; none was evident. They were overfilled to 300 cc of saline each. The patient was then placed in the seated position, and the left breast needed 10 cc of additional fluid for symmetry. Following completion of the filling of the implants and checking the breasts for symmetry, the patient's wounds were closed with interrupted vertical mattress sutures of 4-0 Prolene. Flexan dressings were applied, followed by the patient's bra. She seemed to tolerate the procedure well. Choose the appropriate CPT and ICD-10-CM codes:

Timmy, a 5-year-old, was playing with his toys and decided to stick a bead from his sister's necklace up his nose. The bead was lodged in his nasal passage, and after several unsuccessful attempts by his mother and father to remove it, they took him to the emergency room. After triaging the patient, the physician utilized a surgical instrument to help remove the bead from Timmy's nasal passage. Code the physician services:

The form of skin cancer that rarely metastasizes is known as:

Gavin presents to the hospital for an outpatient procedure for a diagnostic arthroscopy of the right knee. As the physician is performing the procedure, she identifies a medial meniscal tear and repairs it at that time. Choose the correct CPT and ICD-10-CM codes for this procedure:

The patient presents for a direct repair of an aneurysm and graft insertion without a patch graft for an aneurysm of the common iliac artery. Select the appropriate CPT code:

Timmy, a 5-year-old, was playing with his toys and decided to stick a bead from his sister's necklace up his nose. The bead was lodged in his nasal passage, and after several unsuccessful attempts by his mother and father to remove it, they took him to the emergency room. After triaging the patient, the physician utilized a surgical instrument to help remove the bead from Timmy's nasal passage. Code the physician services:

Which of the following is the area of the sinus that is located at the top of the nasal cavities between the eyes?

A 15-year-old patient has a surgical nasal endoscopy with biopsy of a nasal polyp. What is the correct CPT code for this procedure?

The patient underwent radical neck dissection with laryngectomy for carcinoma of the larynx and true vocal cords. Choose the correct codes:

Boris presents to the clinic today for completion of a series of injections into his shoulder for shoulder pain. The physician gives the patient an injection into the left shoulder. Choose the correct CPT and ICD-10-CM codes:

A female patient had breast cancer 3 years ago, underwent a radical mastectomy, and received radiation and chemotherapy. She has not had treatment in the last 20 months. How is the status of the cancer reported for the patient?

Michael, a 40-year-old male, presented for insertion of a permanent pacemaker by transvenous approach. A pocket was created for the insertion of the generator, and the electrodes were placed in the right atrium and ventricle. Michael is diagnosed with atrial fibrillation. Select the correct codes:

A 15-year-old patient has a surgical nasal endoscopy with biopsy of a nasal polyp. What is the correct CPT code for this procedure?

Sarah, a 24-year-old female, was walking her dog this morning, and when she wasn't paying attention, she tripped and fell over the curb. The patient states that she fell to the ground using her right hand and arm to brace herself. She states that she heard a "crunch"; the resultant x-ray indicated a compound fracture to the ulna of her right arm. With the patient under general anesthesia, the area was opened and irrigated. The shaft of the ulna was fractured and had to be repaired using screws to hold it into place. The surrounding tissue was repaired, irrigated, and closed in a usual manner. Select the correct CPT code for the repair of the ulna:

Jeremy presents to the clinic today for severe wrist pain. After Dr. Wilkins examines it, she diagnoses him with a ganglion cyst of the right wrist. Dr. Wilkins decides to give Jeremy a cortisone injection as a treatment plan. Code the correct CPT and ICD-10-CM:

Amara presents to the office today as an established patient to have irritated skin tags removed from her neck and shoulders. Dr. Rose prepped her for the procedure and removed 20 skin tags using liquid nitrogen. Select the appropriate CPT code(s) for Amara's visit today:

Operative Report Postoperative diagnosis: 1) Retained hardware, left foot. 2) Decreased range of motion, left ankle. Procedure: The patient was placed under general anesthesia; her left lower extremity was prepped and draped in a sterile fashion. A time-out procedure was performed. The patient then had a hardware removal performed on the transcutaneous K-wires, followed by examination of her ankle, which had approximately 5 to 10 degrees lacking of neutral. Gentle manipulation was performed, giving her dorsiflexion to 10 degrees. C- arm fluoroscopy was introduced to the field, taking confirmatory x-ray, and at this point the patient had a sterile dressing applied and was awakened from general anesthesia. Select the appropriate CPT codes:

The patient underwent radical neck dissection with laryngectomy for carcinoma of the larynx and true vocal cords. Choose the correct codes: