Exam 27: Coding and Surgical Procedures

This is a new 35-year-old male who is experiencing a piercing ringing sound in his left ear that began 6 months ago. The ringing interferes with his daily life, and he has problems sleeping. The patient is taken to a testing suite for a bilateral tinnitus assessment; pitch frequency matching loudness and masking procedures are included. The findings of the testing indicate a positive determination of tinnitus, acute tinnitus. Follow-up masking therapy scheduled. Select the appropriate ICD-10-CM and CPT code(s):

An infant was born with a hole in the septum dividing the ventricles of the heart. A right heart catheterization was performed using a percutaneous catheter to repair the defect and implant an occlusive device. The outcome was successful. Select the appropriate CPT and ICD-10-CM codes.

A patient is diagnosed with sickle cell crisis and acute chest syndrome with respiratory failure. Select the correct ICD codes:

A 36-year-old female developed a sebaceous cyst on her left upper thigh. Lidocaine was injected to the area without complication. An elliptical incision around the cyst was made with a total excised diameter of .8 cm. After excision the wound was irrigated and the wound was closed with 3-0 Vicryl. Select the appropriate CPT and ICD-10-CM codes.

Tommy was climbing the tree in front of his house, fell, and sustained a greenstick fracture of the ulna of his left arm. The orthopedic surgeon performed a closed manipulation and applied a short arm cast. Select the appropriate ICD-10-CM and CPT code(s):

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):

When a condition is produced as a manifestation of another condition or a complication of a treatment, disease, or condition, more than one code is needed to clearly define the condition, injury, or disease. This is noted by which instructional note or notes in the ICD manual?

Which of the following represents the relationship between a PPO and an HMO under Medicare Advantage?

Which of the following terms is not associated with a closed fracture?

Dr. Medevial sees Daphnee age 45, for her annual preventative exam. Since Daphnee is an established patient, Dr. Medevial wants a CBC. The CBC is drawn by the nurse, but due to equipment failure, the tube will be sent to MetCare Labs for processing. MetCare labs will be paid directly by Dr. Medevial for the processing. Select the appropriate CPT and ICD-10-CM codes.

History: 76-year-old female with colonic mass Diagnosis: Invasive adenocarcinoma, 3.4 × 3.0 cm, involving muscularis propria All margins negative. No lymphatic invasion. No metastatic tumor identified. Gross description: Received fresh is a right colon, 32 cm in length. Upon opening of the specimen, there is a 3.4- × 3.0-cm nodular mass. 36 lymph nodes were retrieved. Representative sections are submitted. Microscopic description: Microscopic examination performed Select the appropriate ICD-10-CM and CPT code(s):

Preoperative diagnosis: Left hip pain and bilateral chest and back pain Postoperative diagnosis: Left hip pain and bilateral chest and back pain Procedures: Bilateral lumbar paravertebral sympathetic nerve block under ultrasound guidance. Left hip greater trochanter bursa injection. Procedure in detail: All questions were answered. His back was palpated to try to elicit areas of discomfort. This was quite difficult to do, since he said he hurt all over. Of note is that we had looked at his legs, and on his right leg he had an area of excoriation or erythema that was unusual for him, and he stated that his pain seemed to correlate with his edema and erythema of his legs. With this in mind, we turned our attention first to his left hip pain and asked him to move his left hip to where we could elicit a point of maximum tenderness. Point of maximum tenderness was elicited over what appeared to be the greater trochanter of the left hip area itself. We then injected what appeared to be the bursa of the left hip with 10 cc of 0.25% Marcaine with 20 mg of Depo-Medrol. He was then placed in a prone position with a pillow supporting his upper abdomen. In light of his symptoms down his legs, we felt that a lumbar paravertebral sympathetic nerve block was indicated at this time. We identified the spinous process of L2. The midpoint of the spinous process of L2 was marked. A line perpendicular to the spinous process of L2 was then drawn on his skin, and a point that was 1¾ inches from the midline was then marked. The skin at this point was anesthetized with 1.5% lidocaine using a 25-gauge B-bevel needle. This was then followed with a 22-gauge 3½-inch needle that was advanced under a slightly cephalic medial direction, approximately 85 degrees off midline. Under fluoroscopic guidance, the needle was advanced. On the first attempt on the left, we encountered the transverse process of L2. The needle was repositioned left of cephalic, and we were able to bypass the transverse process. The needle was advanced until we encountered the vertebral body of L2 under ultrasound guidance. We then obtained a lateral view and found that indeed we were at the level of the midbody of L2. With this needle felt to be adequately placed, we then injected 6 cc of 0.25% Marcaine with 20 mg of Depo-Medrol. The needle was left in place, and the stylet was replaced. We then turned our attention to the right-hand side because of the excoriation on his legs and the edema that he said he experiences with increased levels of his pain. The skin was once again marked 1¾ inches from the midline at the midlevel of the spinous process of L2. The skin was anesthetized with 1.5% lidocaine. This was then followed with a 22-gauge 3½-inch spinal needle that was advanced under fluoroscopic guidance. Of note, we made three or four passes in the attempt to approximate the needle next to the vertebral body of L2. Interesting to note is that in order to obtain the maximum view of the spinous process of L2, we were approximately 5 degrees to the right in terms of off midline. Once the 22-gauge 3½-inch spinal needle was placed on the right after several attempts, he did not complain of any paresthesias at this time. We then took a lateral view and found that our needle was not as deep as it should be. We then withdrew the needle, and on ultrasound guidance, using a lateral view, the needle was advanced until it was felt that we were at the appropriate depth. An AP view was then retaken, and we were found to be not at the body of L2 in terms of next to it. The needle was then removed and repositioned in a slightly medial fashion, and it was felt that we encountered bone. We then turned to the lateral view once again and found that we were at this time at the midbody of L2. This was felt to be adequately placed after three attempts. Then 6 cc of 0.25% Marcaine with 20 mg of Depo-Medrol was injected. The needle stylet was then replaced, and we then waited approximately 4 minutes for the Marcaine to set. We then removed the needles of both the right and the left sides, respectively, and pressure was applied at the skin to prevent any bleeding. He was then placed in the supine position and was discharged home in satisfactory condition. He was instructed to call if he had any changes in edema of his legs. Select the appropriate ICD-10-CM and CPT code(s):

A nonhealing burn should be coded as which type of burn?

CT Scan of the Abdomen and Pelvis History: Malignant testicular neoplasm Technique: Axial CT images of the abdomen and pelvis were obtained with intravenous and oral contrast. Findings: Images of the lung bases are normal. Images of the abdomen show the liver, spleen, gallbladder, pancreas, and adrenal glands to be normal. No mass is seen. There is no evidence of cholelithiasis. A retroaortic left renal vein is seen. No obvious mass or enlarged lymph nodes are noted in the retroperitoneum. Mesenteric structures appear normal. A prominent inferior vena cava is seen. Gas is identified in the left inguinal structures, likely representing previous left orchidectomy and removal of the inguinal ring. No enlarged lymph node is identified in the pelvis. Impression: Left retroaortic renal vein is seen. No adenopathy is noted within the abdomen or pelvis. No enlarged lymph node is seen; no mass is identified. Select the appropriate ICD-10-CM and CPT code(s):

A condition in which the placenta partially or fully covers the cervix, posing a risk that it may separate from the uterine wall during labor is

Mary underwent removal of 20 skin tags on her neck with use of ligature strangulation and cauterization. Select the appropriate ICD-10-CM and CPT code(s):

Procedure performed: Left-sided heart catheterization, selective coronary angiography, and left ventriculography Indication: Chest pain and abnormal Cardiolite stress test RESULTS Hemodynamics: The left ventricular pressure before the LV-gram was 117/1 with an LVEDP of 4; after the LV-gram it was111/4 with an LVEDP of 10. The aortic pressure on pullback was 111/17. Left ventriculography: The left ventriculography showed that the left ventricle was of normal size. There were no significant segmental wall motion abnormalities. The overall left ventricular systolic function was normal, with an ejection fraction of better than 60%. Selective coronary angiography: A. Right coronary artery: The right coronary artery is a medium- to large-size dominant artery that has about 80% to 90% proximal/mideccentric stenosis. The rest of the artery has only mild surface irregularities. B. Left main coronary artery: The left main has mild distal narrowing. C. Left circumflex artery: The left circumflex artery is a medium-size, nondominant artery. It gives rise to a very high first obtuse marginal/intermedius, which is a bifurcation medium-size artery that has only mild surface irregularities. The second obtuse marginal is also a medium-size artery that has about 20% to 25% proximal narrowing. After that second obtuse marginal, the circumflex artery is a small-size artery that has about 20% to 30% narrowing, a small aneurismal segment. D. Left anterior descending coronary artery: The left anterior descending artery is a medium-size artery that is mildly calcified. It gives rise to a very tiny first diagonal that has mild diffuse atherosclerotic disease. Right at the origin on the second diagonal, the LAD has about 30% narrowing. The rest of the artery is free of significant obstructive disease. The second diagonal is also a small-caliber artery that has no significant obstructive disease. Conclusion: Severe single-vessel atherosclerotic heart disease Select the appropriate ICD-10-CM and CPT code(s):

Jim went to the doctor for removal of his skin tags. The physician noted 32 skin tags on his back. Using a scalpel the physician removed all of the skin tags and gave Mr. Evans an antibiotic cream prescription to use for the next 7-10 days. Select the appropriate CPT and ICD-10-CM codes.

Preoperative diagnosis: Morbid obesity Postoperative diagnoisis: Morbid obesity Procedure performed: Abdominal panniculectomy Estimated blood loss: Throughout the procedure, approximately 20 Ml Anesthesia: General endotracheal anesthesia Indications for procedure: This is a 49-year-old female who previously underwent gastric bypass surgery and has lost 120 pounds, leaving a large lower pannus of the abdomen. This pannus needs to be resected. The nonoperative versus operative management options were discussed with the patient. The operative risks included bleeding, infection, hematoma, chance for further surgery as well as pain, and a resulting scar. The patient accepted the risks and consented to surgery. Procedure in detail: The patient was placed under general endotracheal anesthesia. The patient was draped in the proper manner, and the lower abdominal pannus was identified. It was preoperatively marked prior to going to the OR. The lower incision was made from the superior iliac crest with the middle being the pubic tubercle. That lower incision was then made. The pass was then elevated at the level of the anterior abdominal fascia and was elevated superiorly to the level of the inferior umbilicus. Then incisions were made on the umbilicus to the superior iliac crest, and the skin and subcutaneous pannus was passed off table as a specimen. The wound was then made hemostatic with the use of electrocautery. JP drains were placed. The abdominal skin flap was then brought to the inferior skin flap and sutured in place with 2-0 Vicryl sutures at the dermal level. The drains were then secured, and then the skin was closed with running 3-0 Monocryl suture. The wound was further dressed with Steri-strips, gauze, and abdominal binder. The patient tolerated the procedure well. All needle and instrument counts at the end of the procedure were correct, and the patient was taken to PACU in good condition. Select the appropriate ICD-10-CM and CPT code(s):

Anesthesia was provided for a 75-year-old patient who was having a biopsy performed on the salivary gland to determine the nature of a mass. He also had chronic essential benign hypertension. Select the appropriate CPT codes for the anesthesia service, as well as the ICD-10-CM codes.