Ch. 6 Q & A Flashcards
Muscle is attached to bone by what method?
A. Tendons, ligaments, and directly to bone
B. Ligaments and aponeuroses
C. Tendons, aponeuroses, and directly to bone
D. Tendons, ligaments, aponeuroses, and directly to bone
C. Tendons, aponeuroses, and directly to bone
RATIONALE: Tendons are white bands attaching muscle to bone. Aponeuroses are flat, wide bands holding muscle to the bone covering. Muscle is attached directly to bone. Ligaments attach bones to bones.
What is affected by myasthenia gravis?
A. Neuromuscular junction
B. Muscle belly
C. Muscle/bone connection
D. Bone
A. Neuromuscular junction
RATIONALE: Myasthenia gravis is characterized by weakness and muscle fatigue of muscles under voluntary control. It is an autoimmune disorder caused by abnormal destruction of the acetycholine receptors at the neuromuscular junction.
A patient is given Xylocaine, a local anesthetic, by injection into the thigh above the site to be biopsied. A small-bore needle is then introduced through the skin into the muscle, about 3 inches deep, and a muscle biopsy is taken. What is the CPT® code reported for this service?
A. 20205
B. 20206
C. 20225
D. 27324
B. 20206
RATIONALE: In the CPT® Index, look for Biopsy/Muscle referring you to 20200-20206. the biopsy is taken through the skin, or percutaneously. Although the biopsy is deep, it is performed percutaneously, which is reported with 20206.
This 45-year-old male presents to the operating room with a painful mass of the right upper arm. General anesthesia is induced. Soft tissue dissection is carried down through the proximal aspect of the teres minor muscle. Upon further dissection a large mass is noted just distal of the IGHL, which appears to be benign in nature. With blunt dissection and electrocautery, the 4 cm mass is removed en bloc and sent to pathology. The wound is irrigated, repair of the teres minor with subcutaneous tissue is then closed with triple-0 Vicryl. The skin is closed with double-0 Prolene in a subcuticular fashion. What is the correct CPT® code reported for this service?
A. 23076-RT
B. 23066-RT
C. 23075-RT
D. 11406-RT
A. 23076-RT
RATIONALE: A 4 cm mass was removed from the soft tissue of the shoulder. To access the mass, the provider had to go through the proximal aspect of the teres minor (muscle). the mass was located distal to the inferior glenohumeral ligament (IGHL). Masses that are removed from joint areas as opposed to masses removed close to the skin require special knowledge and become more of an orthopaedic concern due to the joint involvement. It is coded from codes within the orthopaedic section. Code 23076 is used because the mass was deep (distal to the IGHL) dissecting down through the teres minor muscle.
The patient has a torn medial meniscus. An arthroscope was placed through the anterolateral portal for the diagnostic procedure. The patellofemoral joint showed some grade 2 chondromalacia on the patella side of the join only, and this was debrided with the 4.0 mm shaver. The medial compartment was also entered, and a complex posterior horn tear of the medial meniscus was noted. It was probed to define its borders. A meniscectomy was carried out back to a stable rim. Select the appropriate CPT® code(s) for this service.
A. 29880, 29879-59
B. 29881, 29877-59
C. 29880
D. 29881
D. 29881
RATIONALE: In the CPT® Index, look for Arthroscopy/Surgical/Knee. Review the codes to choose the appropriate service. The correct code is 29881 because the tear was in the “medial meniscus” and a meniscectomy was performed. Shaving and debridement of the patellofemoral joint is included in the primary procedure, as indicated by the code descriptor, even though they were different compartments of the knee. The surgery had started out as a “diagnostic procedure,” but that changed when the physician decided to perform surgical procedures on the knee, rather than only examining the knee for diagnostic purposes.
A 3-year-old is brought into the ER crying. He cannot bend his left arm after his older brother pulled it while they were rough housing. The physician looks at the X-ray and makes a diagnosis of dislocated nursemaid’s elbow. The ER physician reduces the elbow successfully. The patient is able to move his arm again. The patient is referred to an orthopedist for follow-up care. What CPT® and ICD-10-CM codes are reported?
A. 24640-54, S53.032A, X50.9XXA, Y93.83
B. 24565-54, S53.032A, X50.9XXA, Y93.83A
C. 24640-54, S51.009A, X50.9XXA, Y93.83
D. 24600-54, S53.006A, X50.9XXA, Y93.83A
A. 24640-54, S53.032A, X50.9XXA, Y93.83
RATIONALE: In the CPT® Index, look for Elbow/Dislocation/Closed Treatment. Review the codes to choose the appropriate service. The correct code is 24640 to report a child with a dislocated nursemaid’s elbow and the physician manipulated (reduced) it successfully. Modifier 54 is used to report that the physician performed the surgical portion of the service. The patient is referred to an orthopedist for follow-up care. In the ICD-10-CM Alphabetic Index, look for Nursemaid’s Elbow referring you to S53.03-. In the Tabular List, code S53.032 is selected because the left arm is affected. This code requires a 7th character. Character A is selected because this is an ED visit (initial encounter). In the ICD-10-CM External Cause to Injuries index, look for Pulling, excessive referring you to X50.9. the complete code is X50.9XXA. Next is reporting the activity. Look in the External Cause to Injuries Index for Activity/rough housing and horseplay referring you to Y93.83. 7th characters are not applied to activity codes. There is no further information on the place of occurrence or the activity status, so these codes are not reported.
A 50-year-old male had surgery on his upper leg one day ago and is presenting with serious drainage from the wound. He returns to the operating room for an evaluation of the hematoma resulting from the surgery. His wound is explored and there is a hematoma at the base of the wound, which is very carefully evacuated, and the would irrigated with antibacterial solution. What CPT® and ICD-10-CM codes are reported?
A. 10140-79, M96.840
B. 27603-78, S80.10XA
C. 10140-76, M96.89
D. 27301-78, M96.840
D. 27301-78, M96.840
RATIONALE: In the CPT® Index, look for Hematoma/Leg, Upper referring you to 27301. Verify the code in the main body of the Category I codes for accuracy. Modifier 78 is appended to 27301 to indicate that an unplanned procedure related to the initial procedure was performed during the postoperative period. In the ICD-10-CM Alphabetic Index, look for Hematoma/postoperative (postprocedural) and you are directed to see Complication, postprocedural, hematoma, by site. Look for Complication/postprocedural/hematoma/musculoskeletal structure/following musculoskeletal surgery M96.840. Verify code selection in the Tabular List.
A 45-year-old presents to the operating room with a right index trigger finger and left shoulder bursitis. The left shoulder is injected with 1 cc of Xylocaine, 1 cc of Celestone, and 1cc of Marcaine. An incision was made over the A1 pulley in the right distal transverse palmar crease, about an inch in length. This is taken through the skin and subcutaneous tissue. The A1 pulley is identified and released in its entirety. The wound is irrigated with antibiotic saline solution. The subcutaneous tissue is injected with Marcaine without epinephrine. The skin is closed with 4-0 Ethilon suture. Clean dressing is applied. What are the codes for these procedures?
A. 26055-F6, 20610-76-LT
B. 20552-F6, 20605-52-LT
C. 26055-F6, 20610-51-LT
D. 20553-F6, 20611-59-LT
C. 26055-F6, 20610-51-LT
RATIONALE: In the CPT® Index, look for Trigger Finger Repair referring you to 26055. Review the code to verify accuracy. Modifier F6 is used to report the finger that was repaired. In the CPT® Index look for Injection/Join. Review the codes to choose appropriate service. The correct code is 20610, because the shoulder is getting the injection without ultrasound guidance. Modifier LT is used to indicate the side of the body the joint injection was performed. Modifier 51 is used to indicate a multiple procedure was performed.
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Unstable left distal radius fracture.
POSTOPERATIVE DIAGNOSIS: Unstable left distal radius fracture.
PROCEDURE: Closed reduction and percutaneous pinning with manipulation of left distal radius fracture.
ANESTHESIA: General
INDICATIONS: Patient is a very pleasant 14-y/o young man who is here for evaluation. I had seen him in clinic earlier today and he had a bicycle wreck with an unstable distal radial ulnar joint and unstable fracture. I discussed with him and his mother, preoperatively, the risks and benefits, and they wish to proceed with surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position on the operating table. General anesthesia was induced. Antibiotics were given preoperatively. The left arm was prepped and draped in the usual standard orthopedic fashion. Landmarks were identified; closed reduction maneuver was performed with traction and reproduction of the deformity and then reduction. A near anatomic reduction was afforded, visualized with multiplanar C-arm fluoroscopic imaging. I then placed two 6.2 K-wires percutaneously, one through the radial styloid and one through confirmed good placement of the implants and a near anatomic reduction. A sterile dressing and sugar-tong splint was applied. The patient was awakened from anesthesia and taken to the recovery room in stable condition postoperatively. There were no operative complications. Estimated blood loss was minimal. All counts were correct.
What are the CPT® and ICD-10-CM codes for this procedure?
25606-LT, S52.502A, V19.9XXA
RATIONALE: The physician manipulated fracture, then placed a K-wire percutaneously to stabilize the fracture. Look in the CPT® Index for Fracture/Radius/Percutaneous Fixation referring you to code 25606. LT is used to indicate the fracture is of the left wrist. Manipulation and reduction is included in this code and not reported separately. For the ICD-10-CM code, look in the Alphabetic Index for Fracture/radius/distal end. you are directed to see Fracture, radius, lower end. Look for Fracture/radius/lower end referring you to S52.50-. In the Tabular List, S52.502 is selected for the left radius. A 7th character is required. The documentation does not state if the fracture is open or closed. According to ICD-10-CM guidelines, I.C.19.c, a fracture not indicated as open or closed is reported as closed. This is an initial encounter because it is a surgical procedure. The 7th character A is reported. Refer to ICD-10-CM guidelines I.C.19.c.1, for further definitions of the 7th characters. The patient was seen previously in the clinic earlier that day. The activity, place of occurrence, and external cause code follows the life of the injury (ICD-10-CM guidelines I.C.20.a.2.). Look in the ICD-10-CM External Cause of Injuries Index for Accident/pedal cycle accident NOS indicates we are at the right code. V19.9 requires a 7th character. Two X placeholders are used for the 5th and 6th characters to keep the 7th character in the seventh position. A is the correct 7th character.
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Right clavicle infection from retained deep hardware.
POSTOPERATIVE DIAGNOSIS: Right clavicle infection from retained deep hardware.
PROCEDURE PERFORMED: Removal of hardware, clavicle, deep.
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient had a previous clavicle ORIF and is now here for hardware removal from symptomatic problems indicating infection. We discussed the above-mentioned surgery, along with the potential risks and complications, and the patient understood and wished to proceed.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating suite and placed on the operating table in supine position. He was administered preoperative antibiotics, general anesthetic followed by intubation by the anesthesia team. Extremity was positioned, prepped, and draped in typical sterile fashion. The previous incision was re-opened down to the clavicle. The plate was found where it was freed up both medially and laterally. All the screws were removed, including the interfrag screws. Plate was taken out. We then used a rongeur to clean up the edges of the soft tissue. There were no prominent bone areas. We then irrigated the wound thoroughly, closed the deep tissue with 2-0 Vicryl, followed by closure of the superficial layer using 2-0 Monocryl and a running 3-0 Monocryl stitch. Sterile dressing was placed. A 0.25% Marcaine with epinephrine was injected around the incision site. A sterile dressing was placed. The patient was awakened and taken to the recovery room in stable condition.
What are the CPT® and ICD-10-CM codes for this procedure?
20680-RT, T84.69XA
RATIONALE: The procedure indicates removal of previously implanted hardware in the clavicle. Look in the CPT® Index for Removal/Implant referring you to CPT® codes 20670 and 20680. The difference between the two CPT® codes is whether the implant is superficial or deep. In this case, both a plate and screws were removed. There is also indication the hardware was deep. The correct procedure code is 20680, with an RT modifier to indicate the right clavicle. The patient’s previous procedure was an open reduction and internal fixation (ORIF) indicating the hardware is internal fixation. For the diagnosis, look in the ICD-10-CM Alphabetic Index for Complications/orthopedic/device or implant/fixation device referring you to see Complication, fixation, device, internal. Complication/fixation device, internal (orthopedic)/infection, and inflammation/specified site NEC T84.69-. In the Tabular List, a 7th character is required. According to ICD-10-CM guidelines I.C.19.a., 7th character A is reported for active treatment for the infection with removal of internal fixation device. Subcategory T84.6 has a note to use an additional code to identify infections. Because the type of infection is not identified, we do not have further information to report a code for the infection.
