Exam 27: Coding and Surgical Procedures

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.

Preoperative Diagnosis: thoracoabdominal aortic aneurysm Postoperative Diagnosis: same Operative Procedure: Patient placed on bypass pump after which the surgeon repaired the aneurysm using a graft. Select the appropriate CPT and ICD-10-CM codes.

Ms. 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 surgeon performs an arthrodesis of the right wrist on a patient who suffers from chronic pain that is non-responsive to the corticosteroid injections. Select the appropriate CPT and ICD-10-CM codes.

Clinical history: Carcinoma of the breast with skeletal metastasis. Study performed: Total Body Bone Scan. Impression: Abnormal total body bone scan with abnormalities noted in the ribs and spine and possibly within the skull. Select the appropriate CPT and ICD-10-CM codes.

Patient was admitted with chest pain, R/O MI. The physician ordered the following laboratory tests: Comprehensive metabolic panel, CBC w/differential, Sedimentation rate, PT, troponin level, automated urinalysis w/microscopy. Select the appropriate CPT and ICD-10-CM codes for the laboratory tests.

A staph infection that responds to commonly used antibiotics is a(n)

Steve presents today for an epidural injection of a steroid, caudal to relieve his low back pain, radiating leg pain, and coccygodynia. Steve is placed in a prone position with a cushion below his stomach to arch his back. Local anesthetic is applied to numb the skin and tissue down to the surface of the sacral hiatus. After the needle is placed in the area, 1.5cm of contrast solution helps the physician see painful areas under fluoroscope. The steroid is injected in the epidural space. The needle is removed, bandage applied, and the patient is sent home. Select the appropriate CPT and ICD-10-CM codes.

June was admitted to the hospital with atrial fibrillation by her PCP, and cardiology was consulted at the time of admission. On the next day, the cardiologist made rounds and checked on Mary's progress. An expanded problem-focused interval history was obtained, and an expanded problem-focused exam was performed. Mary has been on IV therapy and is showing improvement. Select the code for the cardiologist encounter on the second day.

A 1-year-old patient has Down syndrome, complex heart disease consisting of atrioventricular septal defect and tetralogy of Fallot with pulmonary atresia, discontinuous pulmonary arteries and bilateral superior vena cava with a left cava draining to the coronary sinus and a right aortic arch. In this procedure, the septal defect was closed and both branches of the vena cava were anastomosed to the pulmonary artery. Select the appropriate CPT and ICD-10-CM codes.

Mrs. Jones is in the operating room today for repair of a nontraumatic tear of the rotator cuff of the right shoulder. The physician performs an arthroscopy subacromial decompression with an open repair of the rotator cuff. Select the appropriate ICD-10-CM and CPT code(s):

Which statement is NOT true concerning the guideline for reporting the Zika virus code A92.5?

Preoperative Diagnosis: Knee pain Postoperative Diagnosis: Juvenile Arthritis of the knee Operation: Arthroscopy of the right knee Operation Description: A 33-year-old patient was diagnosed with right knee pain. Patient is admitted to have an arthroscopy of the right knee. The risks were discussed with the patient and consent obtained. Select the appropriate CPT code for the anesthesia service, as well as the ICD-10-CM code.

A 65-year-old male with severe droopy upper eyelids that also have severe spider veins along with skin plaques presents to the ambulatory surgery center for a non-cosmetic blepharoplasty of his upper eyelids. The diagnosis was pseudoptosis causing visual impairment along with a severe case of acne rosacea. Select the appropriate CPT and ICD-10-CM codes.

The diagnostic statement "goiter, nodular nontoxic" would be coded as an unspecified nontoxic goiter, ICD-10 CM code E04.9, because the diagnosis does not describe the condition as diffuse, uninodular, multinodular, or other specified nontoxic goiter. This is an example of which abbreviation used in ICD?

Pre-operative Diagnosis: Tumor on muscle of right arm Post-operative Diagnosis: same After localized anesthesia, a percutaneous bore needle was used to pierce into the muscle to obtain a biopsy of the muscle tissue. Tissue sample will be sent to pathology. No complications resulted to the patient, and he left the office in good condition. Select the appropriate CPT and ICD-10-CM codes.

Preoperative Diagnosis: Phimosis Postoperative Diagnosis: Phimosis Operation: Circumcision Operation Description: A four-year-old male who had spraying of urine when voiding was diagnosed with phimosis. It seemed the urine collected in the foreskin when voiding. Risks of the operation, such as infection and bleeding were discussed. In addition, the options of a dorsal slit were reviewed. The family understood all risks and wanted to proceed with the operation. Consent was obtained. The patient was prepped and draped in the usual sterile fashion in the operating room. LMA general anesthesia applied. The extra foreskin was marked; 1x3 Gamco clamp used. Then, using 5-0 Monocryl, 4 stitches were placed and suturing was done. Hemostatis was good and dermabond applied. The patient was in good, stable condition and was brought to the recovery room. The entire procedure was completed as discussed with family. Select the appropriate CPT and ICD-10-CM codes.

Thoracic Aortogram with Cerebral Angiography History: The patient is an 82-year-old man with a thoracic aneurysm and carotid stenosis. Procedure: A 20-minute consultation was utilized explaining the risks, benefits, and alternatives of angiography. All the patient's questions were answered, and he had given informed consent prior to the procedure. The patient was premedicated with IM Demerol and Phenergan. Buffered lidocaine was used for local anesthesia. Sedation was not required. A 5-French pigtail catheter was advanced into the aorta via the right femoral artery with the standard Seldinger technique. With the tip of the catheter in the ascending aorta, an aortogram with digital subtraction technique was obtained in the left anterior projection. AP frontal view of the intracranial circulation was also obtained from an arch injection. The catheter was then exchanged over a guidewire for a 5-French Simmons II catheter. The carotid artery and left vertebral artery were selectively catheterized and injected with contrast for digital subtraction filming. In the right common carotid, it was initially difficult to get a stable catheter position, and various combinations of guidewires and a Simmons III catheter were used to obtain selective catheterization. After all images were reviewed, the catheter was removed, and direct pressure was applied to the puncture site until complete hemostasis was achieved. Total contrast load was 132 cc of Isovue. Fluoroscopy time was 41.5 minutes. Findings: The ascending aortic arch is dilated and has a more normal diameter just after the left subclavian catheter, and then the descending thoracic aorta enlarges again. There is no evidence of intimal dissection. The origins from the arch are patent. The right carotid bifurcation is slightly irregular; however, no hemodynamically significant stenosis is observed in the right internal carotid. The right external carotid is open. The left external carotid is completely occluded. The left internal carotid has 75% reduction of its cross-sectional area near its origin. On selective injections, it is interesting to note that the right anterior cerebral artery does not fill from the right carotid injection, but both anterior cerebral arteries fill from the left carotid injection. Vertebral arteries are patent. The left vertebral artery is larger. No obvious intracranial abnormality is observed. Impression: There is 75% stenosis of the left internal carotid. Complete occlusion of the left external carotid. Very mild irregularity of the right internal carotid. Widely patent right external carotid. Both vertebral arteries are patent. Select the appropriate ICD-10-CM codes.

Delineation of deep structures using sound waves is a(n):

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.