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Exam 27: Coding and Surgical Procedures

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Question 511

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History: A 73-year-old 81-kg male with a history of non-Hodgkin's lymphoma and moderate in situ adenocarcinoma of the prostate presents for transurethral resection of the prostate (TURP) . The preoperative evaluation reveals a history of smoking (60 pack-years) , normal ejection fraction and heart valves, and normal chest x-ray and EKG. No other significant findings. Procedure: He was taken to the operating room and monitored as per routine for cystoscopy and TURP. After appropriate preoxygenation, general anesthesia was uneventfully induced with fentanyl, propofol, and rocuronium. The patient was intubated, ventilated, and placed in the lithotomy position. The operative procedure was started without difficulty. After 90 minutes, the patient's temperature had dropped from 35.9°C at the beginning of the case to 32.9°C. Blood was sent to the lab due to the length of the surgery. The patient's vital signs were stable. Shortly thereafter the following values were sent back from the laboratory to the operating room: NA 109 mEq/L, K 4.7 mEq/L, CL 83 mEq/L, Glucose 83 mg/dl, Hct 34. The anesthesiologist informed the surgeon about the findings, and the surgery was then stopped. The patient was transferred to the surgical intensive care unit (SICU) . At arrival in the SICU: The patient was still intubated and sedated. The body temperature was 33.5°C. The laboratory measurements revealed NA 107 mEq/L, K 5.7 mEq/L, CL 79 mEq/L, CO2 109 mEq/L, ammonia level of 60 mmol/L, and serum osmolarity of 273. A radial arterial catheter and a central venous catheter were inserted, and rewarming with hot air (Bair Hugger) was initiated. Select the appropriate ICD-10-CM and CPT code(s) :

A) C85.83, D07.5, 00914, 99100
B) D07.5, Z85.72, 00914-53, 99100
C) C85.83, D07.5, 00910
D) C85.8, D07.5, 00912-53

E) A) and C)
F) All of the above

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Question 512

Multiple Choice

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Preoperative Diagnosis: puncture wound to the L. ventricle as a result of a stabbing presented with cardiac tamponade. Postoperative Diagnosis: same Operative Procedure: removal of knife from the left ventricle followed by on-pump exploratory cardiotomy and cardiorrhaphy. Patient survived procedure and was sent to ICU in critical condition. Select the appropriate CPT and ICD-10-CM codes.

A) 33305, S26.9, S21.93A, I31.4
B) 33315, S26.021A, S21.93A, I31.4
C) 33320, S26.021A, S21.93A, I31.4
D) 33315-80, S21.93A, I31.4

E) None of the above
F) A) and B)

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Question 513

Multiple Choice

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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 patient with chronic recurrent acute sinusitis and nasal polyps presented to the outpatient surgical center for endoscopic frontal sinus exploration with osteomeatal complex resection, anterior ethmoidectomy, and removal of nasal polyps. Select the appropriate CPT and ICD-10-CM codes.

The term meaning "many pregnancies" is:

The patient was seen by a psychiatrist for post-traumatic stress disorder. This visit was a psychiatric diagnostic evaluation which included a history, mental status examination, and recommendations. The evaluation and treatment plan were communicated to the family as the patient has requested their involvement in his care. Select the appropriate CPT and ICD-10-CM codes.

Select the appropriate CPT and ICD-10-CM codes for Marsupialization removing of multiple milia comedones due to severe acne.

The pathologist was called to perform postmortem examination including gross and microscopic examination on a stillborn infant including the brain. Select the appropriate CPT and ICD-10-CM codes.

The medical term for difficulty breathing is:

What is the symbol for a resequenced CPT code?

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.

History: The patient is a 79-year-old male with dyspepsia and weight loss. A recent supraclavicular lymph node biopsy revealed signet-ring cell adenocarcinoma. Specimen site: Stomach Gross description: Received in formalin is a 10.0- × 6.5- × 3.2-cm segment of stomach, with a palpable firm 4.0- × 2.2-cm mass on the designated lesser curvature. The external surface of the specimen is unremarkable and inked black. The cut surfaces demonstrate the mass and adjacent firm areas of nodularity. The remainder of the gastric mucosa is unremarkable. Six lymph node candidates and representative sections of the stomach are submitted. Microscopic description: Microscopic examination was performed. See synoptic report. The uninvolved stomach shows chronic inactive gastritis with intestinal metaplasia. Diagnosis: Stomach (proximal) : Invasive adenocarcinoma Comment: Signet-ring cell carcinomas are not typically graded but are high-grade and would correspond to grade 3. Select the appropriate ICD-10-CM and CPT code(s) :

Clinical history: Nevus, R pinna Postoperative diagnosis: Same Tissue/specimen: Skin of external ear nevus of R pinna Impression: Microscopic sections show the specimen shows a nevus identified as a melanoma. Select the appropriate CPT and ICD-10-CM codes.

What is the Level II HCPCS code for a non-covered item or service?

A 1-year-old has a nickel stuck in his esophagus found on x-ray. The doctor performs an esophagoscopy with use of balloon catheter to remove the nickel. Select the appropriate CPT and ICD-10-CM codes.

Preoperative Diagnosis: Kidney Mass Postoperative Diagnosis: Kidney Mass Operation: Kidney Biopsy Operation Description: A 20-year-old male was noted to have a kidney mass per the ultrasound results. Patient was advised to have a kidney biopsy of the mass. All risks understood and consent obtained. The patient was prepped in the outpatient surgical unit. A single needle biopsy was obtained of the kidney. The radiologist assisted the surgeon with the procedure. The kidney biopsy was sent to the pathology department. The patient entered the recovery room in stable condition. Select the appropriate CPT and ICD-10-CM codes for the service(s) of the surgeon only.

A patient underwent fine needle aspiration of a cyst on the L breast and another on the R breast. Both aspirates were properly labeled and sent to cytopathology for interpretation and report. Pathology report demonstrated cells consistent with fibrocystic breast disease; no malignancy was noted. Select the appropriate CPT and ICD-10-CM codes.

Joe Arrow came in to have a small lesion on his right cheek removed. After examination, his dermatologist decided to remove the 0.5 lesion by shaving. Select the appropriate CPT code(s) .

Preoperative Diagnosis: Tonsillitis Postoperative Diagnosis: Tonsillitis Operation: Tonsillectomy Anesthesia: General Operation Description: A 12-year-old patient is diagnosed with tonsillitis and was recommended to have a tonsillectomy. Family consented to the surgery and patient admitted. Patient was positioned supine for the procedure. The right, then the left tonsil was removed. The tonsillar area was irrigated; no bleeding before or after the suturing. The patient tolerated the procedure well. Select the appropriate CPT and ICD-10-CM codes.

A 54-year-old patient presented to the emergency room with a gunshot wound in the back exiting through the front. A CT scan shows some renal damage to the right kidney and a renal exploration is ordered. The surgeon has been called in and the patient is taken to surgery to examine the renal structure. Making an incision over the gunshot wound, the surgeon examines both the blood vessels and the kidney. The trauma has caused a hematoma to the kidney, which has not spread, so the surgeon closes and the patient is sent to the floor for observation. Select the appropriate CPT and ICD-10-CM codes.