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Z. CDAB 1 > Ch 7 Skin, Subcutaneous Tissue and Breast DIsorders > Flashcards

Ch 7 Skin, Subcutaneous Tissue and Breast DIsorders Flashcards

1
Q

What chapter is localized, noncontagious skin and subcutaneous infections classified to?

A

Chapter XII (12)

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2
Q

Diffuse spreading infection of the skin; organisms usually gram-positive cocci and staph aureus

A

cellulitis

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3
Q

T or F. Cellulitis infection by gram-negative bacteria is rare

A

T

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4
Q

Usually results from a break in the skin such as a puncture wound, laceration or ulcer; presents as an abrupt onset of redness, edema, pain, and heat in the infected area

A

cellulitis

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5
Q

If cellulitis isn’t explicitly diagnosed, is a code from category L03 still assigned?

A

No. Only assigned if cellulitis diagnosis is stated by the physician

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6
Q

What 2 codes are included when coding cellulitis?

A
  1. cellulitis code

2. additional option code if causative organism when known

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7
Q

What 2 codes are included when cellulitis is present in an open wound/wound management is applied?

A
  1. cellulitis code

2. code for open wound, complicated fifth character

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8
Q

Sequencing of the code for cellulitis depends on the _____

A

course of treatment

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9
Q

If cellulitis treatment involves oral antibiotics, sequence the ___ as the MRDx and add ___ as type 1/2

A

laceration MRDx

cellulitis type 1/2

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10
Q

If cellulitis treatment involves IV antibiotics, the ____ is sequenced as the MRDx and the ____ is added as a type 3

A

cellulitis MRDx

laceration type 3

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11
Q

If the laceration requires repair in the ____, standard diagnosis typing rules apply

A

operating room

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12
Q

If wound management isn’t applied, how is it typed?

A

type 3

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13
Q

When is T79.3 /Post traumatic wound infection, not elsewhere classified/ coded?

A

when an injury code does not indicate an infection at the site of injury

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14
Q

What 2 codes are included when cellulitis occurs with a skin ulce?

A
  1. ulcer
  2. cellulitis
    sequenced according to circumstances
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15
Q

Red lines streaking away from a cellulitic area signifying streptococcus has infected the subcutaneous lymphatic channels

A

lymphangiitis

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16
Q

Lymphangiitis is included in the codes for ____

A

cellulitis

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17
Q

When cellulitis occurs with an abscess, only the code for ___ is assigned

A

abscess

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18
Q

Is gangrenous cellulitis classified to cellulitis?

A

No. classified to /Gangrene, not elsewhere classified)

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19
Q

How are gangrenous cellulitis codes sequenced?

A
  1. injury

2. gangrene

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20
Q

T or F. Cellulitis can also describe conditions in other anatomical sites.

A

T

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21
Q

Viral skin infections such as herpes simplex, herpes zoster, mycoses and parasitic skin orders are coded to which code range?

A

A00-B99 /Certain infectious and parasitic diseases/

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22
Q

Decubitus ulcers are coded with the __ digit identifying the stage of the ulcer

A

4th digit

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23
Q

How are infected decubitus ulcer codes sequenced?

A
  1. decubitus ulcer code

2. drug resistant organism, clustered

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24
Q

On which forms does one find decubitus ulcer stage?

A

nurses notes; forms designed to record wound information

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25
Q

Type of decubitus ulcer in which eschar prevents determination of the depth of the ulcer

A

unstageable

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26
Q

Unstageable ulcers are more typically documented in the case of a ___ or ___ encounter

A

short stay; ER encounter

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27
Q

Ulcers due to varicose veins of the lower extremities

A

stasis ulcers

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28
Q

Ulcers classified to the circulatory system chapter rather than to the categories for conditions of the skin

A

stasis ulcers; coded to /Varicose veins of lower extremities/

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29
Q

Stasis ulcers having different course than varicose veins are classified to ___

A

L97.- /Ulcer of lower limb, NEC/; ignore index

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30
Q

T or F. Dermatitis and eczema are used interchangeably

A

T

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31
Q

T or F. Dermatitis caused by substances taken internally and dermatitis caused by substances in contact with skin are coded to different categories

A

T

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32
Q

When dermatitis is due to pharmaceutical substances/drugs, it must be determined if there was an ___ or ___

A

adverse effect (drug taken as directed) or as poisoning (incorrect use of drug)

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33
Q

How are codes sequenced if drugs presented an adverse effect?

A
  1. dermatitis

2. external cause code to indicate medication responsible

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34
Q

Where are external cause codes found?

A

last column of the drug table, binocular #3, /Adverse effect in therapeutic use/

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35
Q

Begins as a cyst in the sacrococcygeal region; presents as either an acute abscess or a chronic draining sinus

A

pilonidal disease

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36
Q

Treatment of an abscess includes ____ and ___

A
  1. drainage

2. removal of hair and skin debris

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37
Q

Marsupialization is a surgical abscess intervention classified to ___

A

1.YS.80.^^ /Repair, skin of abdomen and trunk/

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38
Q

Drainage in an abscess intervention is classified to

A

1.YS.52^^ /Drainage, skin of abdomen and trunk/

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39
Q

T or F. Dressing changes following marsupialization are coded.

A

T. Coded to Z48.0 /Attention to surgical dressings and sutures/

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40
Q

Cutaneous lupus is classified to which category?

A

L93 /Lupus erythematosus/, not /Systemic lupus erythematosus/

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41
Q

Although often described as a tumor, ___ and ___ are not classified as a neoplasm.

A

seborrheic and actinic keratosis

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42
Q

When is actinic keratosis classified to a neoplasm chapter?

A

When described as having “uncertain behaviour” or “intraepidermal squamous cell carcinoma”

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43
Q

What are one of two choices for coding cosmetic surgery?

A

Z41.1 /Unacceptable cosmetic appearance/

Z41.2 /Correction of previous surgery or trauma/

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44
Q

Occurs in patients with sagging abdominal tissue due to aging, pregnancies, weight loss etc; may seek services to remove excess skin and fat

A

abdominal laxity/panniculus

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45
Q

How is abdominal laxity performed for cosmetic reasons coded?

A
  1. MRDx Z41.1

2. Type 3 Cause (skin/fat/muscle)

46
Q

What is the difference between abdominal panniculus and abdominal laxity?

A

abdominal laxity is only for when skin and subcutaneous tissues are involved in interventions

47
Q

Removal of abdominal skin and fat only is coded to ____

A
  1. YS.78.^^ /Repair by decreasing size, skin of abdomen and trunk/, also described as liposuction/abdominoplasty/
    panniculectomy
48
Q

How is abdominal laxity in which abdominal muscles are weakened coded?

A

M62.88 /Other specified disorders of muscle, other site/

49
Q

Repair involving abdominal muscles, or panniculectomy, is classified to ___

A

1.SY.80^^ /Repair, muscles of the chest and abdomen/

50
Q

It is assumed on CCI that whenever tissue is removed, a ____ will be required

A

repair of the operative site

51
Q

The type of repair is determined by the ____ created by the tissue removal

A

size of the defect

52
Q

A separate code for repair is not required because the type of repair is identified in the ___ of the CCI code for the excision

A

qualifier fields

53
Q

T or F. Since repair is identified in the qualifier fields of CCI codes, do not assign a separate intervention code for the repair

A

T

54
Q

Operations on skin and subcutaneous tissue only with no mention of muscle or fascia is coded to ____

A

excision of skin, by site

55
Q

Excisions mentioning tendons, fascia or muscle is coded to ___

A

excision of soft tissue, by site

56
Q

Closure of traumatic or surgical wounds may be described as ___, ___, and ___

A

primary
delayed primary
secondary intention

57
Q

Immediate closure

A

primary closure

58
Q

Closure carried out for wounds too old for primary closure, particularly if infected, significantly contaminated, organic debris + animal bites involved

A

delayed primary closure

59
Q

Closure where wound is left to heal on its own

A

secondary intention

60
Q

An excision that goes deep enough to include bone is classified to ___

A

radical excision of bone

61
Q

Intervention used when a vascular supply is retained within the tissue being re-positioned

A

flap

62
Q

Type of graft where tissue is taken from one’s own body for placement into a new position on the body; has no vascular supply and is fully excised from procurement site

A

autograft or autologous tissue

63
Q

Autografts include what type of skin grafts?

A
  1. split thickness (STSG)

2. full thickness (STSG)

64
Q

Thin skin graft involving epidermis and none of the dermis or thick/immediate skin graft involving epidermis and some dermis

A

split thickness (STSG)

65
Q

Autograft involving entire thickness of the epidermis and all of the dermis

A

full thickness (STSG)

66
Q

For autografts, assign an additional code for ___ unless minor or from the same operative wound

A

procurement of the tissue

67
Q

Type of graft involving organ or tissue procured from another person (dead or alive); may or may not have vascular supply

A

homograft or allograft/allogenic organ/homologous tissue

68
Q

Type of graft involving organ or tissue procured from an animal source

A

xenograft or heterograft/heterologous graft/heteroplastic graft

69
Q

Type of flap where tissue is taken from patient from the immediate vicinity where repair is needed; has nerve and vascular supply

A

local flap or advancement flap/rotation flap/transposition flap/V-Y advancement flap/Z-plasty

70
Q

Local flaps are cut on three sides, leaving fourth side attached to its ___ and ___ supply

A

blood and nerve supply

71
Q

Do you assign additional codes to describe procurement for local flaps?

A

no

72
Q

Type of flap prepared like a local one but is procured from a site distant to where the repair is needed; may need to be split or tunnelled to the application site; fairly large defect left at procurement site

A

pedicled flap or distant/regional/composite/myocutaneou/

muscle rotation/muscle transposition/lastissimus dorsi myocutaneous/trans-rectus/abdominis muscle/TRAM

73
Q

For pedicled flap, a code is assigned to describe procurement of any ___ segments

A

intestinal

74
Q

Type of flap similar to pedicled flap but tissue is completely excised from procurement site; requires microscopic anastomosis of blood vessels and nerves

A

free flap or composite free/fasciocutaneous/fibular/ interpositional intestinal/random

75
Q

What are the coding rules for free flaps?

A
  1. assign procurement code

2. assign code if operating microscope is used /Imaging intervention/

76
Q

Assume that a composite tissue flap is ___ when not specified as free or pedicled by the health care provider

A

pedicled

77
Q

Type of graft/flap involving man-made materials to replace tissue in body; often encourage tissue regeneration and healing

A

synthetic tissue

78
Q

Type of graft/flap where tissue is derived from cultivation of cells (autologous) in the laboratory

A

cultured tissue

79
Q

A code for procurement of tissue must always be assigned when a separate incision is required to obtain tissue for a __ flap or an __ graft

A

free flap or an autograft

80
Q

Why are procurement of tissue codes mandatory for free flaps/autografts?

A

Important to track outcomes in relation to the donor and recipient site

81
Q

It is usually unnecessary to code procurement of ___ or ___ flaps since these interventions are considered enlargement of the surgical defect already created

A

local flap or pedicled flap

82
Q

Whenever an ___ segment is harvested, a procurement code must always be assigned

A

intestinal

83
Q

Tissue qualifier “__” means procurement code isn’t required

A

E

84
Q

When two or more tissue types are used in the same intervention, the qualifier selected is ____

A

combined sources of tissue

85
Q

When new skin is needed for reconstruction, the most common method used is a ___ or ___

A

skin graft or flap

86
Q

Method to grow new skin with a better match usually used in breast reconstruction, hair transplantation and scar revision

A

tissue expansion

87
Q

Procedure where balloon is placed under the skin next to the area where new tissue is needed; balloon gradually expands via saline/silicone injections until skin is stretched

A

tissue expansion

88
Q

Advantages of tissue expansion

A

same skin color, texture, small risk factor

89
Q

Disadvantages of tissue expansion

A

prolonged time, more than one operation, temporary deformity while expander in place

90
Q

When expanders are initially placed, search for ____ for CCI code

A

/implantation, device, skin/

91
Q

When returning for injections into the expander, search for ___ for CCI code

A

/management, device, skin/

92
Q

For returning patients needing expander injections, the MRDX would be ____

A

Z45.8 /Adjustment and management of other implanted devices/

93
Q

T or F. Growth, cyst and lump don’t necessarily refer to neoplastic disease.

A

T

94
Q

Cystic papillomatosis, adenosis or fibrosis are classified to ___

A

Benign mammary dysplasia

95
Q

The most common benign neoplastic lesion found in the breast

A

fibroadenoma, /Benign neoplasm of breast/

96
Q

This report provides specific info about the morphology of excised breast tissue and must be read carefully to ensure accurate code assignment

A

pathology report

97
Q

Breast cancer arising from the epithelial lining of the large or intermediate-sized ducts

A

ductal

98
Q

Breast cancer arising from the epithelium of the terminal ducts of the lobules

A

lobular

99
Q

Noninvasive intraductal, noninfiltrating intraductal, ductal carcinoma in situ and lobular in situ are classified to ___

A

carcinoma in situ

100
Q

If pathology report indicates both infiltrating carcinoma and ca in situ of ___ sites, separate codes are assigned

A

noncontiguous

101
Q

Lower inner quadrant of right breast

A

4: 00
5: 00

102
Q

Lower inner quadrant of left breast

A

7: 00
8: 00

103
Q

Primary malignancy in which there is more than one tumor of non-contiguous sites all of which have formed separately from one another; tumors likely to be in different quadrants of breast

A

multicentric

104
Q

Primary malignancy when more than one tumor arises from one original tumor; same quadrant of breast

A

multifocal

105
Q

T or F. Multicentric/multifocal tumors are classified separately

A

T

106
Q

What codes are mandatory when a patient has had a previous mastectomy and now has a new malignancy in their other breast?

A
  1. /Acquired absence of breast/

2. /Personal history of malignant neoplasm/

107
Q

For mastectomies, add a code for axillary node excision only if there is a _____

A

separate incision

108
Q

Tattoing of areola/nipple is found under ____

A

repair, nipple

109
Q

“Raised skin flaps” mean there was enough skin left to close the incision

A

T

110
Q

What is the MRDx for breast reductions?

A

N62, with functional pain coded as type 3

111
Q

If there is an abnormality that requires breast augmentation, what is the MRDx?

A

code for the abnormality

112
Q

Free flaps are also know as ___

A

TRAM flaps

Z. CDAB 1 (5 decks)

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