Exam 27: Coding and Surgical Procedures

Procedure performed: Fiber-optic bronchoscopy, bronchial biopsy, bronchial washings, and bronchial brushings Preprocedure diagnosis: Abnormal chest x-ray Postprocedure diagnosis: Inflammation in all lobes, pneumonia; with pleural placquing? consistent with possible candidiasis The patient was already on a ventilator, so the bronchoscope tube was introduced through the ET tube. We saw 2.5 cm above the carina of the trachea, which was red and swollen as was the carina. The right lung: All entrances were patent, but they were all swollen and red, with increased secretions. The left lung was even more involved, with more swelling and more edema and had bloody secretions, especially at the left base. This area from the carina all the way down to the smaller airways on the left side had shown white placquing consistent with possible candidiasis. These areas were brushed, washed, and biopsied. A biopsy specimen was also sent for tissue culture, as well as two biopsy specimens sent for pathology. Sheath brushings were also performed. The patient tolerated the procedure well and was sent back to the ICU. Select the appropriate ICD-10-CM and CPT code(s):

John, age 45, was seen in the office today for interim medical evaluation and management of his type II diabetes. The physician performed an expanded problem-focused history and examination. At the same visit, the physician also administered a flu shot, split virus 0.5ml, intramuscularly. Select the appropriate CPT and ICD-10-CM codes.

Jones had been seen by Dr. Stork throughout her second pregnancy, and he performed a cesarean delivery of twin girls. Select the appropriate ICD-10-CM and CPT code(s):

A 43 year old patient has an in situ malignant neoplasm of the left kidney. He is scheduled for a left nephrectomy with partial ureterectomy by open approach. Select the appropriate CPT and ICD-10-CM codes.

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.

Examination: Gastric-emptying study Reason for the examination: This is a study of elimination for gastroparesis, abdominal cramping, and pain. Interpretation: One millicurie of technetium-99m sulfur colloid was given through a gastrostomy tube in saline. The normal half-time of clearance of liquid material from the stomach is 12 minutes. The patient's clearance is 50 minutes, which is a fourfold increase in time and is compatible with a marked delay in gastric emptying. Select the appropriate ICD-10-CM and CPT code(s):

A 66-year-old female with CHF, atrial fibrillation, and type II diabetes was admitted with right pleural effusion demonstrated on x-ray, as well as shortness of breath and dyspnea on exertion. A video-assisted thoracic surgery (VATS) pleurodesis was performed. A 10-mm port was placed and the effusion was drained by placing a sucker into the port site. An additional anterior port was then placed in similar fashion and the effusion was drained with a sucker. A 32 curved chest tube was placed and secured with nylon. The other port site was also closed. Select the appropriate CPT and ICD-10-CM codes.

An elderly patient was admitted with malnutrition. He had suffered a stroke 2 years previously that left him with dysphagia. He was treated for the malnutrition with hyperalimentation. He was also diagnosed with hypokalemia. What are the correct codes?

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):

A 38-year-old insulin-dependent established patient called his physician complaining of having some rectal bleeding after using the bathroom. The physician agreed to meet the patient in the outpatient department of the hospital. The physician performed an expanded problem-focused history with a detailed examination. The patient is to have blood work and a stool culture and is to be scheduled for a lower GI series. The physician's diagnosis was Hematochezia etiology unknown. Select the appropriate CPT and ICD-10-CM codes.

The pathologist performed a gross and microscopic autopsy of the brain of a stillborn infant. Select the appropriate CPT code.

A 43-year-old male patient with obstruction of the bile ducts and cholangitis is seeing the gastroenterologist today for a biliary endoscopy. The gastroenterologist finds calculi in the bile duct and removes them. Select the appropriate CPT and ICD-10-CM codes.

Timothy presents at Dr. Smith's office today with multiple painful lumps on his left upper arm. His skin is warm, red, and swollen. Dr. Smith determines that these are abscesses of a staphylococcus nature and will need to be incised and drained to remove the pus. Using a scalpel, all 8 lumps were incised, packed, and dressed. Timothy is given a prescription and told to return in 7 days for a wound check. Select the appropriate CPT and ICD-10-CM codes.

With the patient under general anesthesia, the ENT used a surgical microscope to perform a myringotomy to release pressure and a tympanoplasty to repair the perforated eardrum of a 6-year-old boy with chronic ear infections who stuck the end of his glasses in his ear. Select the appropriate CPT and ICD-10-CM codes.

A wart is an example of a

Procedures: Craniotomy for a patient with benign clinoidal meningioma. The surgeon carried out a stereotactic osteoplastic craniotomy along with resection of clinoidal/sphenoid wing mass. For the microdissection an intraoperative microscope was used. Prior to decompressing the superior orbital fissure, the tumor was extirpated through the opticocarotid, carotid oculomotor, as well as prechiasmatic spaces. Select the appropriate CPT and ICD-10-CM codes.

Pre-op diagnosis: Left lung abscess Post-op diagnosis: Same Procedure performed: Left upper lobectomy with decortication and drainage Indications: The patient is a 56-year-old female with evidence of a left upper-lobe abscess seen on the MRI. She was admitted with tension pneumothorax, which was treated with double-lumen intubation and a chest tube. Procedure: The patient was brought to the operating room and placed in the supine position, with general intubation from the double-lumen tube. The patient was rolled onto the right lateral decubitus position, with left side up. A posterior lateral thoracotomy was performed. Adhesions were taken down sharply and bluntly and with cautery. Following this a standard artery first left upper lobectomy was carried out utilizing 0 silk and hemoclips. The left upper pulmonary vein was secured with a single application of the stapling machine. The posterior fissure was created with multiple applications of the automatic stapling machine and the bronchus secured with a single application of the bronchus stapling machine. Following this the wound was drained with three 24-French strium chest tubes and hemostasis obtained with spray Tisseel and surgical gauze. The bronchus was sealed with bio glue and the wound closed in layers. A sterile compression dressing was applied, and the patient was returned to the surgical intensive care unit after the double-lumen tube was changed to a single-lumen tube. The patient received 3 units of packed cells intraoperatively to maintain hemostasis. Sponge count and needle count correct × 2. Large abscess in the left upper lobe accounted for approximately 70% of the left upper-lobe parenchyma. Select the appropriate ICD-10-CM and CPT code(s):

The patient-responsible portion of a set amount per service or encounter is the definition of:

The patient undergoes repair of the renal pelvis to treat an ureteropelvic junction obstruction the patient has had since birth. An incision is made and an excision is performed on the (right) congenital kidney abnormality; a secondary pyeloplasty, solitary kidney or calycoplasty is performed on the left kidney. Select the appropriate CPT and ICD-10-CM codes.

A 45-year-old female presents to the oncology office today for chemotherapy treatment. The first listed diagnosis could would be: