Deck 14: Respiratory System

Question 1

What is the name of the surgical procedure for the rearrangement of the nasal septum?

A)bronchoplasty
B)pneumoplasty
C)septoplasty
D)rhinoplasty

Answer 1

septoplasty

Question 2

The term that describes destruction by removing, usually by cutting, is:

A)laser
B)ablation
C)biopsy
D)incision

Answer 2

ablation

Question 3

The procedure in which a scope is passed into the larynx so the physician can look at the larynx is what type of laryngoscopy?

A)indirect
B)inferior
C)direct
D)inferred

Answer 3

direct

Question 4

If the physician performs a lavage of the maxillary sinus, what is he/she doing?

A)washing the maxillary sinus
B)taking a biopsy within the maxillary sinus
C)opening the maxillary sinus
D)reshaping the maxillary sinus

Question 5

A chest tube may be used as an indwelling method of draining the accumulated fluid in the pleural space.

Question 6

Thoracentesis is performed to withdraw fluid from the pleural space for a variety of conditions including:

A)respiratory failure
B)atherosclerosis
C)renal failure
D)all of the above

Question 7

The name of the procedure in which mucus is removed from the sinuses by flushing a saline solution through the sinus cavities is ____ therapy. For example, the Proetz procedure (saline irrigation combined with suction).

A)dilatation
B)drainage
C)endoscopy
D)displacement

Question 8

A diagnostic endoscopic procedure is reported only when:

A)no surgical procedure is performed during the same operative session
B)a surgical procedure is performed during the same operative session
C)multiple surgical procedures are performed during the same operative session
D)no other code in that section applies

Question 9

When multiple therapeutic procedures are performed through a scope during the same operative session, only the major (most extensive) procedure should be reported.

Question 10

A "direct" laryngoscopic procedure means that the physician uses a tongue depressor to hold the tongue down and view the epiglottis with a mirror.

Question 11

All "sinus" codes are reported as bilateral procedures only.

Question 12

Select the term that describes a procedure in which a scope is placed into a body cavity.

A)indirect
B)open procedure
C)endoscopy
D)direct

Question 13

This surgical procedure is performed to reshape the nose.

A)bronchoplasty
B)pneumoplasty
C)rhinoplasty
D)septoplasty

Question 14

Endoscopic procedures are reported on the ____ place(s) to which the scope is advanced.

A)first
B)number of
C)farthest
D)surgical

Question 15

What is the method that a physician uses to control a nosebleed?

A)packing
B)ligation
C)cauterization
D)all of the above

Question 16

Because most third-party payers do not pay for cosmetic surgery, the physician must carefully document ____ to ensure reimbursement for noncosmetic procedures.

A)prognosis of the patient's condition
B)medical necessity
C)treatment plan
D)none of the above

Question 17

In what Surgery subsection would you find the code for the incision and drainage of a nasal abscess using an external approach to the abscess?

A)Integumentary System
B)Respiratory System
C)Evaluation and Management
D)Medicine

Question 18

A surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy.

Question 19

Which of the following terms does not describe the nasal turbinates?

A)exterior
B)superior
C)inferior
D)middle

Question 20

Thoracoplasty is a procedure that is performed to separate the inside of the chest cavity from the lung to permit the collapse of the lung.

Question 21

The physician uses an endoscope for a diagnostic evaluation of the nose. A polyp is identified and removed using forceps.
CPT Code: ____________________

Question 22

Excision of a cervical tracheal tumor.
CPT Code: ____________________

Question 23

Reshaping of the nasal septum to correct airway obstruction.
CPT Code: ____________________

Question 24

Three-year-old Hannah is playing with a marble and sticks it in her nose. Her mother is unable to dislodge the marble so she takes Hannah to the physician's office. The physician removes the marble with hemostats.
CPT Code: ____________________

Question 25

Removal of a lung cyst by major thoracotomy.
CPT Code: ____________________

Question 26

A physician performs an emergency transtracheal tracheostomy to remove a foreign object.
CPT Code: ____________________

Question 27

Plastic surgery to the nose (primary) without nasal septum involvement.
CPT Code: ____________________

Question 28

The term that describes obtaining a tissue sample is:

A)laser
B)ablation
C)biopsy
D)incision

Question 29

Pleural biopsy by percutaneous needle.
CPT Code: ____________________

Question 30

A 14-year-old boy presents at the Emergency Department experiencing an uncontrolled anterior nosebleed. The ED physician packs his nose with gauze and within 10 minutes the nosebleed stops.
CPT Code: ____________________

Question 31

Bilateral total lung lavage.
CPT Code: ____________________

Question 32

Simple excision of a nasal polyp.
CPT Code: ____________________

Question 33

Bronchoscopy with placement of catheter for intracavitary radioelement application.
CPT Code: ____________________

Question 34

Endoscopic biopsy of lung mass.
CPT Code: ____________________

Question 35

Thoracentesis without imaging.
CPT Code: ____________________

Question 36

Irrigation of the sphenoid sinus.
CPT Code: ____________________

Question 37

Which modifier would you use if polyps were removed from both the left and the right sides of the nose?

A)-50
B)-21
C)-47
D)-54

Question 38

The physician views the trachea using a bronchoscope placed through an established tracheostomy. The physician examines the conducting airways. The bronchoscope is removed.
CPT Code: ____________________

Question 39

Endoscopic lobectomy of a single lobe.
CPT Code: ____________________

Question 40

The physician removes fluid from the chest cavity by puncturing through the space between the ribs. Using an aspirating needle attached to a syringe, the physician carefully passes the needle over the top of a rib, punctures through the chest tissues, and enters the pleural cavity. With the end of the needle in the chest cavity, the physician withdraws the fluid from the chest cavity by pulling back on the plunger of the syringe.
CPT Code: ____________________

Question 41

Drainage of an abscess in the nose via internal approach.
CPT Code: ____________________

Question 42

PREOPERATIVE DIAGNOSIS: Right pneumothorax
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Placement of anterior chest tube
PROCEDURE: The patient was draped and prepped in the usual manner. The area was infiltrated with 1% lidocaine. A 1-cm incision was made in the second intercostal space about 7 cm to the right of the midline in the anterior chest and a 20-F chest tube was passed. Good tidal volume was confirmed. The chest tube was anchored using 1-0 silk. The area was dressed and the chest tube placed on suction. The patient tolerated the procedure well. Complications-none.
CPT Code: ____________________

Question 43

Jennifer Prescott, age 47, has developed chest pain and difficulty breathing. Jennifer has had several episodes of coughing up thick blood-tinged sputum. A diagnostic bronchoscopy is performed, with a specimen taken of the bronchial mass. The pathology report is positive for carcinoma.
CPT Code: ____________________

Question 44

Surgical thoracoscopy with excision of pericardial tumor.
CPT Code: ____________________

Question 45

Percutaneous introduction of a needle wire dilator to provide for insertion of an indwelling oxygen tube.
CPT Code: ____________________

Question 46

Diagnostic, rigid bronchoscopy for the evaluation of chronic hemoptysis.
CPT Code: ____________________

Question 47

Douglas O'Mally, 31, has been having difficulty breathing and has had long-standing sinusitis. It is decided that Douglas will have a sinus endoscopy with a right anterior and posterior total ethmoidectomy with removal of polyps.
CPT Code: ____________________

Question 48

Secondary rhinoplasty with major reconstruction of nasal tip to correct results of an initial rhinoplasty done elsewhere.
CPT Code: ____________________

Question 49

Location: Outpatient Hospital
BRONCHOSCOPY REPORT
INDICATION FOR THE PROCEDURE: Patient with chronic emphysema and chronic obstructive pulmonary disease and a significant smoking history.
PROCEDURE: Bronchoscopy procedure
PREPROCEDURE MEDICATIONS: Atropine 0.5 mg and codeine 60 mg intramuscularly, and then also hydroxyzine. Topical anesthesia was applied with cocaine mix along with the Lidocaine topically into the throat. He was lying supine in the fluoroscope unit and with video monitoring, the bronchoscope was introduced through the nose and into the upper airway. The vocal cords were visualized. There were no endobronchial lesions noted. The vocal cords were moving equally with phonation and respiration. The bronchoscope was introduced through the vocal cords and negotiated into the trachea; the left upper lingula and lower lobe branches were visualized. No endobronchial lesions were noted. The right main, middle, lower, and upper lobe bronchi up to subsegmental branches were visualized; no endobronchial lesions were noted either. The procedure was uneventful. He did not have any significant cough during the procedure.
CPT Code: ____________________

Question 50

Catheterization with bronchial brush biopsy.
CPT Code: ____________________

Question 51

Excision of tracheal tumor using cervical approach.
CPT Code: ____________________

Question 52

____________________ is a procedure in which the nose is reshaped internally or externally.

Question 53

Surgical thoracoscopy with pleurodesis.
CPT Code: ____________________

Question 54

Location: Outpatient Hospital
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Septal deviation.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE PERFORMED: Septoplasty.
OPERATIVE NOTE: The patient was admitted through the same-day surgery department and taken to the operating room and was administered general anesthetic by intravenous injection and was intubated endotracheally. His nose was decongested with 4 cc of 4% cocaine solution on nasal pledgets. A small amount of Afrin was also used. The patient was draped in the usual fashion. The packing was then removed and the left septum was injected with 1% lidocaine with epinephrine. A left hemitransfixion incision was created with a Beaver blade and a mucoperichondrial flap was elevated on this side; this was extended posteriorly over the perpendicular plate of ethmoid and vomer, extended inferiorly over a septal spur. We then separated the bony and cartilaginous septum to elevate it on the opposite side. We elevated on either side of the maxillary crest. A 4-mm osteotome was used to remove this. A portion of inferior cartilage was also removed. Once this was completed we laid the mucosa back into position and the septum was nicely reduced. We closed the caudal hemitransfixion incision with interrupted 3-0 Chromic suture. The septum was closed with 4-0 plain gut suture. Doyle splints were then placed on either side of the nose. The patient was then allowed to recover from the anesthetic and taken to the postanesthesia care unit in stable condition. There were no complications during this procedure.
CPT Code: ____________________

Question 55

The physician uses an endoscope for surgical access to decompress the optic nerve in the posterior orbit.
CPT Code: ____________________

Question 56

Total pulmonary decortication.
CPT Code: ____________________

Question 57

Flexible bronchoscopy with use of laser therapy to relieve stenosis.
CPT Code: ____________________

Question 58

Diagnostic, indirect laryngoscopy with vocal cord injection of Gelfoam.
CPT Code: ____________________

Question 59

Location: Inpatient Hospital
OPERATIVE REPORT
INDICATION: Cardiogenic shock and the need to initiate mechanical ventilation.
PROCEDURE PERFORMED: Intubation.
ANESTHESIA: Versed and fentanyl.
PROCEDURE: After the procedure was explained and consent was obtained from the patient's family, the patient was prepped for an endotracheal intubation. The patient was premedicated with Versed and fentanyl. After adequate anesthesia and analgesia was achieved, the patient's vocal cords were directly visualized with the aid of a laryngoscope using a Miller 3 blade. A size 8.5 endotracheal tube was then inserted and passed through the vocal cords atraumatically and without any difficulty. The CO₂ monitor did confirm correct placement of the tube. The cuff was then inflated and the tube secured around 22 cm at the lips.
The patient tolerated the procedure well. There were no acute complications. A chest x-ray had been ordered to confirm correct placement of the endotracheal tube.
CPT Code: ____________________

Question 60

Using an existing tracheostomy incision, the physician places a bronchoscope through the incision to view the airway (tracheobronchoscopy).
CPT Code: ____________________

Question 61

Match each term with the correct phrase below.
Lavage

A)removal by cutting
B)washing out an organ
C)destruction of tissue by burning
D)free flow or withdrawal of fluids

Question 62

Match each term with the correct phrase below.
Drainage

A)removal by cutting
B)washing out an organ
C)destruction of tissue by burning
D)free flow or withdrawal of fluids

Question 63

Match each term with the correct phrase below.
Intubation

A)repair of a damaged trachea
B)incision made over the larynx
C)creation of an opening into the trachea
D)establishment of an airway

Question 64

Match each term with the correct phrase below.
Tracheoplasty

A)repair of a damaged trachea
B)incision made over the larynx
C)creation of an opening into the trachea
D)establishment of an airway

Question 65

Match each term with the correct phrase below.
Laryngotomy

A)repair of a damaged trachea
B)incision made over the larynx
C)creation of an opening into the trachea
D)establishment of an airway

Question 66

Match each term with the correct phrase below.
Tracheostomy

A)repair of a damaged trachea
B)incision made over the larynx
C)creation of an opening into the trachea
D)establishment of an airway

Question 67

Match each term with the correct phrase below.
Cauterization

A)removal by cutting
B)washing out an organ
C)destruction of tissue by burning
D)free flow or withdrawal of fluids

Question 68

The code range ____________________ is for the control of nasal hemorrhage and is located in the Other Procedures category.

Question 69

Match each term with the correct phrase below.
Ablation

A)removal by cutting
B)washing out an organ
C)destruction of tissue by burning
D)free flow or withdrawal of fluids