Ch. 7 Q & A Flashcards
The term “pneumomediastinum” describes what condition?
A. Inflammation of the mediastinum
B. Puncture of the alveoli of the lungs
C. Presence of a cyst or tumor in the mediastinum
D. The presence of air in the mediastinum
D. The presence of air in the mediastinum
RATIONALE: The prefix “pneumo-“ means air. Pneumomediastinum is air in the mediastinum.
A respiratory disease characterized by overexpansion and destruction of the alveoli is identified as:
A. Cystic fibrosis
B. Pneumoconiosis
C. Emphysema
D. Respiratory distress syndrome
C. Emphysema
RATIONALE: Emphysema is the loss of lung function due to overexpansion and destruction of the alveoli. Since alveoli are the primary units for the exchange of oxygen and carbon dioxide in the lungs, breathing becomes increasingly rapid, shallow, and difficult.
A 35-year-old was diagnosed with stage I ductal carcinoma in situ in her right breast. She underwent a localized biopsy of sentinel lymph and axillary nodes in her right breast. An incision was made with the scalpel, once the glandular tissue of the breast was intercepted; dissection was carried down through the skin and subcutaneous tissue. One to two centimeters of the breast tissue was dissected free to the lymph node. The incision was carried deep to the right axilla and two sentinel and non-sentinel lymph nodes were identified and excised. What CPT® code is used to report this procedure?
A. 38525
B. 38570
C. 38500
D. 38505
A. 38525
RATIONALE: In the CPT® Index, look for Lymph Nodes/Excision. Review the code to choose appropriate service. The correct code is 38525. The patient had an incision made (open surgery) to remove (dissected free and excision) the lymph node and axillary nodes.
A 29-year-old female in the hospital who has AIDS has been put on a ventilator due to her weakness and dyspnea. The physician suspects she has pneumonia and performs a thoracoscopy. The contents of the chest cavity are inspected with an endoscope and multiple nodules are seen in the right lung and biopsied. Pneumocystis carinii pneumonia is diagnosed. What CPT® code is used to report this procedure?
A. 32601, B59
B. 32608, B20, B59
C. 32606, B20, B59, Z21
D. 32650, B59, B20
B. 32608, B20, B59
RATIONALE: In the CPT® Index, look for Thoracoscopy/Diagnostic/with Biopsy. Review the codes; the correct code is 32608 because the lung nodules were biopsied. According to ICD-10-CM guidelines I.C.1.a.2., if a patient is admitted for an HIV-related condition, the principal diagnosis is B20, followed by additional diagnosis codes for all reported HIV-related conditions. Patients previously diagnosed with any HIV illness (B20) should never be assigned to R75 or Z21 (ICD-10-CM guidelines I.C.1.a.2.f.). For this scenario, Pneumocystis carinii fungus causes pneumonia in AIDS patients, meeting the guidelines of it being an AIDS- or HIV-related condition. In the ICD-10-CM Alphabetic Index, look for AIDS, referring you to B20. Next, look in the ICD-10-CM Alphabetic Index for Pneumocystis carinii pneumonia, referring you to B59. Review codes in the Tabular List.
A 45-year-old male with Stage III non-Hodgkin’s lymphoma showed pathologic cervical nodes on the PET scan. A biopsy was recommended. A supraclavicular incision was made, deepened down through the platysma muscle. Ligation of the external jugular vein was performed and, deep to this structure, numerous large nodes, approximately 3 to 3.5cm in greatest dimension, were seen. Once elevated, the hilar aspect of one of the nodes was serially clipped with hemoclips to remove it. What code would accurately report this procedure?
A. 38720
B. 38520
C. 21550
D. 38510
D. 38510
RATIONALE: In the CPT® Index, look for Biopsy/Lymph Nodes/Open. Review the codes; the correct code is 38510. The physician is removing only cervical nodes deep in the neck, not muscles, glands, arteries, and veins (cervical lymphadenectomy).
A patient with chronic maxillary sinusitis underwent a prior ethmoid surgery. A recent CT scan reveals mucous membrane thickening, and an opaque sinus. An endoscope and scalpel are used to surgically remove the diseased tissue, and an antrostomy is performed. What code accurately describes this procedure?
A. 31233
B. 31020
C. 31000
D. 31267
D. 31627
RATIONALE: In the CPT® Index, look for Antrostomy/Sinus/Maxillary. Review the codes; the correct code is 31267. An endoscope is used to perform a maxillary antrostomy, and diseased tissue is removed.
A 22-year-old was in a motor vehicle accident and has a broken nose. An X-ray shows a deviated septum causing airway obstruction. The deviated portion of the bony and cartilaginous septum is excised by grafting the septum. The septum is noted to be straight in the midline. What CPT® code(s) is/are used to report this service?
A. 30420
B. 30462
C. 30520
D. 30620, 15120
C. 30520
RATIONALE: The physician performs a septoplasty using a graft. In the CPT® Index, look for Septoplasty referring you to 30520. this code includes replacement with a graft.
A patient with a life-threatening diaphragmatic laceration requires resection and complex prosthetic repair. Which procedure code should the general surgeon handling the case use to report this treatment?
A. 39501
B. 39540
C. 39560
D. 39561
D. 39561
RATIONALE: In the CPT® Index, look for Diaphragm/Resection. review the codes; code 39561 reports a resection of the diaphragm performed with a complex repair using prosthetic material.
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS:
1. Inferior turbinate hypertrophy 2. Deviated nasal septum with nasal obstruction
POSTOPERATIVE DIAGNOSIS:
1. Inferior turbinate hypertrophy 2. Deviated nasal septum with nasal obstruction
PROCEDURE: Septoplasty with inferior turbinate reduction
COMPLICATIONS: None
ESTIMATED BLOOD LOSS: 20cc
HISTORY: This is a 17-year-old young man who came to see me in the office with difficulty breathing through his nose. He states he used to breathe fine through his nose until about three years ago when he broke it. Since then, he has had a lot of problems with nasal obstruction.
Physical exam did reveal a severely deviated nasal septum to the left and this, coupled with inferior turbinate hypertrophy, is giving him 100 percent on the left side. It was my recommendation that he undergo a septoplasty with inferior turbinate reduction. The procedure, risks, and benefits were discussed with him and his aunt in the office. They were agreeable to the surgery.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative waiting area and taken back to the operating room where he underwent general anesthesia. Approximately 6cc of 1% Lidocaine with epinephrine were injected into the septum and the inferior turbinates bilaterally. Afrin-soaked pledgets were placed in each side of the nose and left there for about five minutes. These were then removed. A right-sided hemitransfixion incision was made in the anterior septum and a mucoperichondrial and mucoperiosteal flapwas then raised on the left side. I came back to the bony-cartilaginous junction and raised a mucoperichondrial flap on the right side. I removed the deviated portions of the bony septum which were quite extensive mainly to the left and then coming more anterior. He had a severe deflection of the left side of the cartilaginous septum. This was removed. He also had a very prominent maxillary crest on the left side which I needed a hammer and chisel to remove. After doing all of this, the patient did have a straight nasal septum, so a 4-0 chromic was then sewn in a mattress-type fashion back and forth across the septal flap to eventually close the hemitransfixion incision. The Boies elevator was used to medialize and lateralize the inferior turbinates. The turbinate bipolar cauterization was used to reduce the size of the inferior turbinates bilaterally. Once that was done, the patient had a nice open nasal airway. Doyle splints with antibiotic ointment were placed in each side of the nose and sewn in place using a single nylon stitch anteriorly. A small amount of blood was suctioned from the nasopharynx. The patient was awakened and taken to the postoperative recovery room in stable condition.
What are the CPT® and ICD-10-CM code(s) for this service?
- 30520, 30801-59, J34.2, J34.3
RATIONALE: The first procedure is to reshape the nasal septum due to a deviation of a bone causing airway obstruction. In otorhinolaryngology, submucous resection is cutting out or removing a portion of a deviated nasal septum after first laying back a flap of mucous membrane, which is replaced or repositioned after the operation. In the CPT® Index look for Nasal Septum/Submucous Resection or Septoplasty, referring you to code 30520. The reduction of the inferior turbinates is inclusive to the septoplasty.
The second procedure performed is to remove inferior hypertrophic nasal turbinates, which are also obstructing the nasal airway. In the CPT® Index look for Cauterization/Turbinate Mucosa/Electrocautery or Turbinate Mucosa/Cauterization. The correct code is 30801 because the procedure was performed using bipolar cautery. Modifier 59 is appended to show both services were for different purposes. 30801 would be inclusive to 30520 if the 30801 is performed to control bleeding.
The first diagnosis is found in the ICD-10-CM Alphabetic Index, by looking for Deviation (in)/nasal septum, referring you to code J34.2.
The second diagnosis in the Alphabetic Index by looking for Hypertrophy/nasal/turbinate, referring you to code J34.3. Verify the codes in the Tabular List.
OPEERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Recurrent right-sided epistaxis
POSTOPERATIVE DIAGNOSIS: Recurrent right-sided epistaxis
PROCEDURE: Right maxillary antrostomy with biopsy and right internal maxillary artery ligation
COMPLICATIONS: None
ESTIMATED BLOOD LOSS: 5cc
HISTORY: This is a 71-year-old male with a problem with recurrent epistaxis. He did have a widely deviated nasal septum which I did repair about a month ago, but despite that he is still having one to two nosebleeds a week, which are fairly severe. Because of that I did recommend to him that he undergo an internal maxillary artery ligation. The procedure, risks, and benefits were discussed with him in the office and he is agreeable to the surgery.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative waiting area and taken back to the operating room where he underwent anesthesia. Approximately 3cc of 1% Lidocaine with epinephrine were injected into the right inferior turbinate, the right middle turbinate, and the uncinate process on the right. Afrin-soaked pledgets were then placed on that side of the nose and left there for about five minutes. Theses were then removed and a zero-degree nasal endoscope was placed on the right side of the nose. I used a Freer to medialize the middle turbinate and then I was able to locate the maxillary ostia on the right side. Following this posterior, I did end up using a thru-cut forceps to widen the opening slightly to get me closer to the posterior wall of the maxillary sinus on the right side. Tissue was sent away for pathology. It did appear to be inflamed. I then used the Freer to raise a mucosal flap from the lateral wall. Once I was able to get to the posterior portion of the maxillary sinus, I was immediately able to see the right internal maxillary artery. I did isolate this in front of, above, and below the artery itself. There appeared to be good hemostasis. The zero-degree nasal endoscope was removed. I did inspect the rest of the right side of the nose and left side of the nose. There appeared to be a few prominent blood vessels, namely on the lateral side of the nose, involving the inferior turbinate. I did cauterize these areas giving them good hemostasis. Again, just a small amount of blood was suctioned from the nasopharynx. The patient was awakened and taken to the postoperative recovery room in stable condition.
What are the CPT® and ICD-10-CM code(s) for this service?
31267, 30920-51, R04.0
RATIONALE: For reporting the first procedure code, the operative note documents that an endoscope was placed in the nose to the maxillary sinus. Look in the CPT® Index for Endoscopy/Nose. You will see two sets of codes; one for diagnostic, meaning the physician only looked in the nose and did not perform any surgical procedures during the exam. The operative note documents that tissue was removed from the maxillary sinus, making this procedure a surgical one, referring you to codes 31237-31297.
The maxillary sinus codes are 31256 and 31267, because tissue was removed within the maxillary sinus, report code 31267.
for reporting the second procedure code, the operative note documents that the right internal maxillary artery was isolated and ligated (tied or bound) with three clips to stop the nosebleed. Look in the CPT® Index for Ligation/Artery/Maxillary, referring you to code 30920. Modifier 51 is appended to this code because there was more than one procedure being performed during the same surgery session.
For the diagnosis code, look for Epistaxis in the ICD-10-CM Alphabetic Index, referring you to code R04.0. Verify the code in the Tabular List.
