Exam 27: Coding and Surgical Procedures

Jerome, a 15-year-old male, is seen by the dermatologist today for treatment of his acne vulgaris. The physician uses liquid nitrogen to destroy lesions on the left side of his face. Select the appropriate ICD-10-CM and CPT code(s):

History: The patient is a 79-year-old male with dyspepsia and weight loss. A recent supraclavicular lymph node biopsy revealed signet-ring cell adenocarcinoma. Specimen site: Stomach Gross description: Received in formalin is a 10.0- × 6.5- × 3.2-cm segment of stomach, with a palpable firm 4.0- × 2.2-cm mass on the designated lesser curvature. The external surface of the specimen is unremarkable and inked black. The cut surfaces demonstrate the mass and adjacent firm areas of nodularity. The remainder of the gastric mucosa is unremarkable. Six lymph node candidates and representative sections of the stomach are submitted. Microscopic description: Microscopic examination was performed. See synoptic report. The uninvolved stomach shows chronic inactive gastritis with intestinal metaplasia. Diagnosis: Stomach (proximal): Invasive adenocarcinoma Comment: Signet-ring cell carcinomas are not typically graded but are high-grade and would correspond to grade 3. Select the appropriate ICD-10-CM and CPT code(s):

Arteriogram: Left Renal Artery Stenosis Procedure in detail: The procedure, indications, possible complications of an abdominal aortogram, and possible renal arteriogram were discussed with the patient. The patient agreed to have the procedure done and signed the consent. Under sterile technique with fluoroscopy control, a vascular sheath was introduced in the right common femoral artery using the Seldinger technique. Through this sheath, a 5-French pigtail catheter was introduced and placed at the proximal abdominal aorta. Flush aortogram followed, and a digital subtraction study of the abdominal aorta, by placing the catheter close to the renal artery origin, was performed. Evidence of mild atheromatous plaque disease involving the infrarenal abdominal aorta, causing focal dilation, is seen. No significant stenosis is noted at the aortic bifurcation. The celiac axis, including the splenic artery, gastroduodenal artery, and hepatic artery, is normal. On the right side, the renal artery is normal in caliber, without any significant stenosis. Segmental arteries are normal. Contrast nephrogram is also uniform. On the left side, there is segmental narrowing at the origin of the left renal artery. The narrowed segment is approximately 2 cm in length, with the narrowing more than 50% to 60% seen. No significant distal stenotic dilation of the renal artery is seen. Segmental arteries of the left renal artery are normal. Nephrogram of the left kidney is also normal. Since the digital subtraction study was done with stenosis analysis, left renal artery stenosis is in the range of 50% to 65%. Hence, a selective renal arteriogram was not performed. Impression: A 2-cm stenotic segment involving the origin of the left renal artery with stenosis in the range of 50% to 65% is noted. Segmental arteries of the left kidney are normal. Nephrogram of the left kidney is also normal. Select the appropriate ICD-10-CM and CPT code(s):

A procedure in which a surgeon reattaches a severed arm, hand, finger, toe, or foot is a(n)

Ted is at the ambulatory care center for an arthrotomy with Dr. Abraham today. Ted is a 23-year-old steel worker who has a foreign body in his carpometacarpal joint. The foreign body has created a severe infection and drainage will need to be done along with the removal of the foreign body. Dr. Abraham made an incision between the 3^rd and 4^th carpometacarpal joints and located the foreign body, which was a sliver of steel. The wound was then packed and dressed. The patient tolerated the procedure and was released with instructions to return to Dr. Abraham's office in 7 days. Select the appropriate CPT and ICD-10-CM codes.

Patient Infant Male Crowley I was present, at the request of the delivering physician, at the vaginal delivery at 5:07 p.m. of a male infant 29 weeks' gestation with a spontaneous cry. At the 1-minute mark the Apgar was 5, the decreases were in tone, grimace, and color. An Apgar of 8 was reached at the 5-minute mark, with decreases continued in grimace and tone. The infant was taken to NICU for further management. Upon examination, decreased breath sounds and increased work to breathe were noted. The infant was intubated with difficulty. The patient did tolerate this well. An umbilical artery catheter was placed without difficulty, and labs were ordered. A chest x-ray and abdominal films were done. Both UAC and the endotracheal tube are in proper placement. The OG has been advanced; the lung fields do show significant granularity. Blood gas is 8.32, PCO2 of 50, PO2 of 102 on a setting of 22/4 rate of 60, and 80% FiO2. PE: Patient currently is intubated. His weight is 1,706 grams; OFC is 30.5; length is 39.6 cm. Heart rate is in the 120s to 130s. Respiratory rate is 60 on the ventilator; O2 saturation is in the mid-90s. Blood pressure in right arm is 67/34, with a mean of 46, and in right leg is 67/32, with a mean of 44. Plan: Observation for sepsis Maternal hypermagnesemia. Admission to the NICU, continued mechanical ventilation. Select the appropriate ICD-10-CM and CPT code(s):

Ted is at the ambulatory care center for an arthrotomy with Dr. Abraham today. Ted is a 23-year-old steel worker who has a foreign body in his carpometacarpal joint. The foreign body has created a severe infection and drainage will need to be done along with the removal of the foreign body. Dr. Abraham made an incision between the 3^rd and 4^th carpometacarpal joints and located the foreign body, which was a sliver of steel. The wound was then packed and dressed. The patient tolerated the procedure and was released with instructions to return to Dr. Abraham's office in 7 days. Select the appropriate CPT and ICD-10-CM codes.

Which of the following combining forms is for the liver?

Preoperative diagnosis: Left hydrocele Postoperative diagnosis: Left hydrocele Procedure performed: Left hydrocelectomy Procedure description: The initial incision was made, and the left hydrocele was delivered out of the wound and incised. The hydrocele was emptied of about 500 mL and then incised completely. About 90% of the hydrocele sac was removed with the Bovie. The hydrocele sac was involuted and sewn to itself using running 3-0 Vicryl in the manner of Jaboulay. The testicle was replaced in the left scrotum, and the patient tolerated the procedure well. Select the appropriate ICD-10-CM and CPT code(s):

Albert Brown goes to get his RX filled for an outflare wedge to be placed in his left shoe. Select the appropriate HCPCS code.

Dr. Green works for a house-call physician service. She was called to evaluate a new patient, an 88-year-old bedridden woman who has developed a painful rash on her posterior left side of the trunk, extending from C6 to C7 around the right side and ending midline on the anterior trunk just below the sternum. The physician performs a detailed history and a detailed examination and medical decision making is of low complexity. She diagnoses the patient with shingles. Select the appropriate codes.

John underwent disarticulation at the knee as a result of a traumatic crushing injury to the right tibia and fibula caused by a motorcycle accident. Select the appropriate ICD-10-CM and CPT code(s):

Gross Description: Specimen labeled "sesamoid bone, first metatarsal, right" is received in formalin. Contains three irregular fragments of grey-brown, hard, bony tissue. Multiple fragments of brown-tan, rubbery, fibrocollagenous, soft tissue altogether measuring 2.8 x 1.7 x 0.8 cm. Specimen was decalcified and gross examination showed acute osteomyelitis, with foci of marrow fibrosis. Select the appropriate CPT and ICD-10-CM codes.

Patient Infant Male Crowley I was present, at the request of the delivering physician, at the vaginal delivery at 5:07 p.m. of a male infant 29 weeks' gestation with a spontaneous cry. At the 1-minute mark the Apgar was 5, the decreases were in tone, grimace, and color. An Apgar of 8 was reached at the 5-minute mark, with decreases continued in grimace and tone. The infant was taken to NICU for further management. Upon examination, decreased breath sounds and increased work to breathe were noted. The infant was intubated with difficulty. The patient did tolerate this well. An umbilical artery catheter was placed without difficulty, and labs were ordered. A chest x-ray and abdominal films were done. Both UAC and the endotracheal tube are in proper placement. The OG has been advanced; the lung fields do show significant granularity. Blood gas is 8.32, PCO2 of 50, PO2 of 102 on a setting of 22/4 rate of 60, and 80% FiO2. PE: Patient currently is intubated. His weight is 1,706 grams; OFC is 30.5; length is 39.6 cm. Heart rate is in the 120s to 130s. Respiratory rate is 60 on the ventilator; O2 saturation is in the mid-90s. Blood pressure in right arm is 67/34, with a mean of 46, and in right leg is 67/32, with a mean of 44. Plan: Observation for sepsis Maternal hypermagnesemia. Admission to the NICU, continued mechanical ventilation. Select the appropriate ICD-10-CM and CPT code(s):

Dr. Helter, a gastroenterologist, is placing a feeding tube for a patient with gastroparesis in the outpatient surgery department of Community General Hospital. After the long gastrointestinal tube feeding tube was inserted, a KUB was done to verify the position in the duodenum. Select the appropriate CPT and ICD-10-CM codes.

Preoperative diagnosis: Carcinoma of the lung with right neck metastasis Postoperative diagnosis: Carcinoma of the lung with right neck metastasis Operative procedures: Cervical esophagoscopy, microlaryngoscopy, and biopsy Procedure and findings: With the patient under general anesthesia, the 10I 14 × 23 Roberts esophagoscope was passed. It was noticed that the left piriform sinus was of normal appearance. There was edema of the free tip of the epiglottis. The scope was advanced through the left piriform sinus into the cervical esophagus, and the cervical esophagus and postcricoid area were essentially normal. Also, the upper cervical esophagus was normal. The scope was slowly withdrawn through the right piriform sinus. It was noticed that there was a tumor involving the anterior wall of the right piriform sinus, extending approximately 1 cm below the pharyngeal epiglottic fold. This tumor then also involved the lateral hypopharyngeal wall to a minor degree. The scope was removed. The Dedo microlaryngoscope was passed. It was now noticed that the above findings were further defined. It was noticed that there was an exit through the tumor involving the vallecula on the right side going into the base of the tongue for a distance of approximately 0.5 cm. This tumor was quite exophytic, and it extended laterally above the pharyngeal epiglottic fold, extending, therefore, approximately 0.75 cm to the lateral hypopharyngeal wall. It also involved heavily the medial wall of the right piriform sinus without crossing over onto the laryngeal surface of the epiglottic fold. The vocal cords were of normal appearance. The right vocal cord was fixed in the midline. Inferiorly the tumor extended onto the medial wall of the piriform sinus just about 0.5 cm below the level of the right vocal cord. The scope was suspended. These findings were confirmed, and under 10 × magnification, several biopsies were obtained. The scope was removed. The neck was carefully palpated. The endoscopy had been preceded by a tracheostomy. The patient was initially prepared with Betadine solution and draped in the usual manner. A horizontal incision was made approximately 2 cm above the sternal notch and carried through the subcutaneous tissue down to the strap muscles. The strap muscles were divided in the midline. The cricoid cartilage was identified, the trach ties were tied securely into place, and the cuff was inflated to a comfortable pressure. The patient then received further ventilation through the newly placed trach tube. The patient tolerated all procedures well. Select the appropriate ICD-10-CM and CPT code(s):

A 22-year-old patient presents to the physician's office with a migraine headache, stiff neck, and fever. Dr. Blue performs a lumbar puncture in the office and confirms the condition of meningitis. The patient tolerated the procedure well. Select the appropriate CPT and ICD-10-CM codes.

The patient was diagnosed with Graves' disease and underwent a total thyroidectomy. Select the appropriate ICD-10-CM and CPT code(s):

The patient underwent an examination of the esophagus, stomach, and duodenum. This procedure is a(n):

Preoperative Diagnosis: worsening effort angina with severe left ventricular failure. Postoperative Diagnosis: same Operative Procedure: endoscopic coronary artery bypass graft including harvesting of the saphenous vein X 3. Select the appropriate CPT and ICD-10-CM codes.