Exam 27: Coding and Surgical Procedures

The patient presented with jaundiced skin. This means that the skin appeared:

Marc will be having a kidney transplant due to end stage renal disease caused by malignant hypertension. The donor is his cousin Sidney. Under general anesthesia, Sidney undergoes a radical nephrectomy; the surgeon then does his backbench work to dissect and remove any fat and prepares the ureters, veins, and arteries. Next the surgeon performs a renal nephrectomy and allo-transplantation on Will. Select the appropriate CPT and ICD-10-CM codes.

Sally is a long-term alcoholic who has made the decision to receive treatment for her disease. However, before beginning her psychotherapy, Sally is required to undergo a behavioral health screening and alcohol assessment. Select the appropriate CPT and ICD-10-CM codes for these two procedures.

Preoperative Diagnosis: Cleft palate Postoperative Diagnosis: Cleft palate Operation: Repair of cleft palate Anesthesia: General Operation Description: A 3-year-old patient was diagnosed with cleft palate and was advised by the surgeon to complete the surgical procedure repairing the cleft palate. The risks were discussed and identified with the family. Consent was obtained and the operation performed. Select the appropriate CPT and ICD-10-CM codes for the anesthesia service for the procedure.

Sally, a 3-year-old girl, has been fitted with a cochlear implant due to profound deafness. She is seen today for aural rehabilitation. Sally worked with the audiologist today for 1.25 hours making good progress. 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.

A frozen section of the descending colon was examined intraoperatively by pathology and identified as Duke's B carcinoma. Select the appropriate CPT and ICD-10-CM codes.

A patient with pancreatic cancer was found to have a lung mass. A flexible bronchoscopy, transbronchial lung biopsy, brushing and washing were performed. The surgeon identified a left perihilar mass and mucosal abnormality in the posterior subsegment of the left upper lobe. The pathology finding was metastasis to the lung. Select the appropriate CPT and ICD-10-CM codes.

Preoperative diagnosis: Left perihilar mass Postoperative diagnosis: Left perihilar mass, mucosal abnormality in the posterior subsegment of the left upper lobe Procedure performed: Bronchoscopy, transbronchial lung biopsy and bronchial lung biopsy, brushing and washing Assistant: None Anesthesia: MAC Description of procedure: With the patient in the supine position, under monitored anesthesia care, the scope was introduced through the mouth, and the larynx and the laryngeal area were inspected. All of them were normal. The scope was then inserted through the trachea into the carina, which was sharp and clear. There was a moderate amount of thick-thin secretions that were suctioned through both right and left main bronchi. The scope was then directed into the right main bronchus, and then the right upper-lobe bronchus with its subsegments was inspected. All of them were normal. Right middle-lobe and right lower-lobe bronchi with their subsegments were also inspected and were normal. The scope was then directed into the left side, where the left main bronchus was normal. Left lower-lobe and middle-lobe bronchi with their subsegments were normal. The left upper-lobe bronchus, anterosuperior segment, showed an anterior subsegment to have a bulging in one of its subbronchi. Under fluoroscopy, biopsy forceps were inserted, and several pieces of lung tissue were obtained from the area of the left perihilar lesion. Then brushing was done in the same area. Washing was also done in the same area. Then, in a separate container, several pieces of bronchial tissue were taken from the area that was bulging, anterosuperior subsegment of the left upper-lobe bronchus. All specimens were submitted for cytology, pathology, and/or culture. The patient tolerated the procedure well, with no apparent complications. Chest x-ray is pending. Select the appropriate ICD-10-CM and CPT code(s):

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):

The Mohs micrographic technique is used for removal of complex or ill-defined skin cancers. During this procedure, the physician acts as:

A patient is placed on a ventilator as a result of a closed head injury with loss of consciousness due to a car accident. Select the appropriate CPT and ICD-10-CM codes for physician management on the initial and three subsequent days while the patient is in the hospital.

A 76 year old female is admitted for IV antibiotic therapy to treat pneumonia due to pseudomonas bacteria and a level 3 initial inpatient visit was provided. On days 2 and 3, the patient had not yet responded to treatment as noted after an expanded problem-focused exam and history. On day 4, the patient showed significant improvement and the physician recorded a problem-focused history and exam. On day 5, the patient was discharged to home and the physician spent 30 minutes in discharge day management. Select the appropriate CPT codes for the physician visits from the admit to the discharge.

Dr. Jones accompanied a newborn girl with respiratory failure who had been born 23 hours earlier from the community hospital to the university children's hospital. The ride takes 95 minutes. Dr. Jones provided critical care services to the infant during the ambulance ride. The patient was admitted to the neonatal ICU at the new facility. Select the appropriate CPT and ICD-10-CM codes.

Mrs. Carmichael sees her foot and ankle surgeon with open ulcerated areas on the left lower leg and a separate lesion on the right lower leg. The surgeon documents staphylococcal carbuncles which need debridement. He proceeds to excise the skin, subcutaneous tissue, and muscle of a 4.0 cm × 3.0 cm, or 12 sq. cm, lesion in the right lower leg, and an excision of skin and subcutaneous tissue in the left lower leg of 3.0 cm × 8.0 cm, or 24 sq. cm. Select the appropriate CPT and ICD-10-CM codes.

The patient was seen for I&D of simple carbuncle on the left thigh. Code this procedure with the appropriate ICD-10-CM and CPT code(s):

A 26-year-old male was seen in the emergency room for a laceration to his right ring finger when a glass window he was installing on his job as a construction worker broke. After exploring the wound, the surgeon found a 100% laceration to the ulnar digital neurovascular bundle, which was repaired. The flexor digitorum profundus nerve had a 25% transverse laceration, which was also repaired. The flexor digitorum superficialis nerve had a partial ulnar slip laceration, but no repair was needed because the majority of it was intact. Select the appropriate CPT and ICD-10-CM codes.

Which of the following HCPCS modifiers would be appended in order to report to the payer that an Advanced Beneficiary Notice is on file at the physician's office?

A patient with thyroid cancer had a thyroidectomy with a radical cervical lymphadenectomy. Select the appropriate CPT and ICD-10-CM codes.

Mrs. Carmichael sees her foot and ankle surgeon with open ulcerated areas on the left lower leg and a separate lesion on the right lower leg. The surgeon documents staphylococcal carbuncles which need debridement. He proceeds to excise the skin, subcutaneous tissue, and muscle of a 4.0 cm × 3.0 cm, or 12 sq. cm, lesion in the right lower leg, and an excision of skin and subcutaneous tissue in the left lower leg of 3.0 cm × 8.0 cm, or 24 sq. cm. Select the appropriate CPT and ICD-10-CM codes.