Exam 27: Coding and Surgical Procedures

Patient had a lesion removed from the third digit on the left hand. What would be the appropriate HCPCS modifier?

Jones is a patient with recurrent stage IV colon carcinoma of the sigmoid colon. He had previously undergone a laparoscopic low anterior resection (LAR). He was brought to the operating room today and under general anesthesia underwent a laparoscopic lysis of adhesions. The small bowel loops were found to be adherent to the anterior abdominal wall and also near the colostomy. These adhesions were lysed. There was one loop of small bowel that was adherent to the anterior abdominal wall of the RLQ, and this adhesion was not disturbed. Select the appropriate ICD-10-CM and CPT code(s):

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 patient with schizophreniform disorder, who participated in a partial hospitalization program, was seen for 30 minutes of individual psychotherapy and 10 minutes of medication evaluation and management, which required a problem-focused history and straightforward medical decision making. The physician spent 30 minutes face-to-face with the patient. Select the appropriate CPT and ICD-10-CM codes.

A 48-year-old female with a 20+ year smoking history is diagnosed with a pulmonary nodule growing in the left lower lobe of the lung. After discussion with her surgeon, the patient is brought to the OR for a laproscopic wedge resection of the nodule using VATS approach to obtain a frozen section. Following a pathology report of adenocarcinoma of the lung, a VATS lobectomy of the left lower lobe was performed. The patient tolerated the procedure and was sent to the surgical ICU in stable condition. Select the appropriate CPT and ICD-10-CM codes.

RBRVS is the method of physician reimbursement for _______ services.

A 62-year-old diabetic female underwent a Whipple procedure for carcinoma of the head of the pancreas. During the procedure, the patient was monitored by the CRNA. Select the appropriate CPT and ICD-10-CM codes.

The area between the lungs that contains the heart, aorta, venae cavae, esophagus, and trachea is the:

An 18-year-old female weighing 485 lbs. is presenting today for a laparoscopic gastric bypass and roux-en-y gastroenterostomy for morbid obesity. Since the patient has a BMI of 73.7, the gastroenterologist feels it is necessary to remove at least 175cm. 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):

A patient is sent to the radiology department with an indication of abdominal pain. A KUB is ordered. The coder inputs data that is then transferred to line 21 of the CMS-1500 form, showing ICD-10-CM code R10.11, and line 24 field C showing CPT 74018. Which of the following has the coder demonstrated?

Diagnostic esophagogastroduodenoscopy was performed for a patient with suspected ulcers. The endoscope was inserted in the pharynx and was passed all the way through to the jejunum, which revealed ulcers of the stomach, pylorus, and duodenum. The patient tolerated the procedure well and was sent home with prescriptions and a referral to a nutritionist. Select the appropriate CPT and ICD-10-CM codes.

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.

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):

The doctor performs a puncture aspiration of a soft tissue hematoma on the left thigh. Select the appropriate CPT and ICD-10-CM codes.

Jane, a 75-year-old female, was brought to the OR today for operative ablation of her paroxysmal atrial fibrillation via a combined Wolff-Parkinson-White atrio-ventricular node tissue ablation and reconstruction of the atria using the MAZE procedure. Cardiopulmonary bypass was not required. The patient tolerated the procedure well and was sent to ICU for continued monitoring. Select the appropriate CPT and ICD-10-CM codes.

Clinical Indication: Carcinoma of the right breast, mastectomy and chemotherapy completed with no recurrence; now presents with skeletal metastases. Procedure: Multiple tomograms of L. lung show no dominant nodules within the lung. Multiple osteolytic metastases are present in several of the ribs in posteriolateral aspect involving third, fourth, fifth, six, and seventh ribs. Small amount of pleural reaction is noted in the L costophrenic angle. Hilar shadows are unremarkable. Shadow for L breast is absent. Impression: No definite metastatic nodules in L lung. Multiple mixed osteolytic and osteoblastic changes in several ribs in the L chest probably due to metastatic neoplasm. Select the appropriate CPT and ICD-10-CM codes.

Joey, age 5, is taken to the OR today for removal of a small foreign body from his right nares. General anesthesia was required due to the significant level of anxiety displayed by the child, as well as the location of the small object. Select the appropriate CPT and ICD-10-CM codes.

A patient is referred for a renal ultrasound following transplantation of his right kidney 6 months ago. The patient's creatinine clearance is elevated and the scan is directed to the renal vein only. Select the appropriate CPT code.

The patient underwent a hemorrhoidectomy for removal of two columns of prolapsed internal hemorrhoids, third-degree, and resolution of a chronic anal fissure-fissurectomy. Select the appropriate ICD-10-CM and CPT code(s):