Ch. 8 Q & A Flashcards
Which vessel does the tip of a central venous catheter terminate in?
A. Basilic vein
B. Subclavian vein
C. Aorta
D. Pulmonary artery
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Which chamber of the heart is the most muscular?
A. Right atria
B. Left atria
C. Right ventricle
D. Left ventricle
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A patient with hypertension and chronic kidney disease, stage 5, is admitted by his primary care physician. What ICD-10-CM code(s) is/are reported?
A. I10
B. I12
C. I10, N18.5
D. I12.0, N18.5
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The patient is a 69-year-old white female with 10-year status post dual chamber pacemaker where the generator is at its end of life. The pacemaker generator is explanted, and the leads are then attached to the new generator. What is/are the CPT® code(s) for this encounter?
A. 33213
B. 33208
C. 33213, 33233
D. 33228
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A 38-year-old’s blood pressure was progressively trending downward, and it was determined that an emergent central venous access was needed for fluid resuscitation. A non-tunneled catheter was used to access the subclavian vein and secured into place to infuse medication. Due to the patient’s low blood pressure and anticipated need for vasopressor agents, a radial arterial line was also desired. The left radial artery pulse was easily palpable, and the skin was punctured by a needle, and the angiocatheter was placed in the left wrist. What are the CPT® codes for this encounter?
A. 36555, 36625-51
B. 36556, 36620-51
C. 36558, 36640-51
D. 36569, 36620-51
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Mrs. Doelle goes to the procedure room to have a permanent pacemaker implanted. She is given a mild sedative, and the area just under the right clavicle is prepped and draped in a sterile manor. An incision is made to create a pocket for the pulse generator. A venogram is shot through an indwelling antecubital IV, and a catheter is threaded from the pocket into the right subclavian vein. The catheter is then advanced into the right atrium under fluoroscopic guidance. Using the Seldinger technique the catheter is withdrawn over a guide wire, and a 32 FR Medtronic pacing wire is threaded back over the guide wire and into the right atrium under fluoroscopy. The guide wire is removed, and the pacing tip is screwed into the myocardium. Thresholds are tested for sensing and capture. The lead is then attached to the pulse generator and placed into the pocket. The picket is closed with interrupted 4-0 Prolene. What is/are the CPT® code(s) for this encounter?
A. 93288-26, 33249
B. 33206, 36140-51, 93288-26, 75820-26
C. 33206
D. 33206, 33212-51
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Using Xylocaine local anesthesia, aseptic technique, and ultrasound guidance for vascular access, a 21-gauge needle was used to aspirate the right cephalic vein of a 72-year-old patient. When blood was obtained, a 0.018 inch platinum tip guidewire was advanced to the central venous circulation. A 6 French dual lumen PICC was introduced through a 6 French peel-away sheath to the superior vena cava and right atrium junction, and after removal of the sheath, the catheter was attached to the skin with a STAT-LOCK device and flushed with 500 units of Heparin in each lumen. A sterile dressing was applied , and the patient was discharged in improved condition. Permanent ultrasound recordings were placed in the record. What is/are the CPT® code(s) for this encounter?
A. 36573, 76942-26
B. 36556, 76942-26
C. 36561
D. 36573
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After obtaining an aortogram and CT scan, a 45-year-old woman was found to have an infrarenal abdominal aortic aneurysm measuring at least 4.5cm in size that has not ruptured. It was felt that with the rapid recent expansion, she should have this aneurysm repaired. The infrarenal artery aneurysm was repaired at the level of the renal arteries to the aortic bifurcation. What is the CPT® code for this procedure?
A. 34702
B. 34701
C. 34706
D. 34707
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OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Sick sinus syndrome with bradycardia/tachycardia
POSTOPERATIVE DIAGNOSIS: Permanent DDDR pacemaker insertion
OPERATION PERFORMED: Pacemaker insertion
ANESTHESIA: Local with conscious sedation
COMPLICATIONS: None
ESTIMATED BLOOD LOSS: Minimal
ADJUNCTIVE PROCEDURES: Fluoroscopy
DESCRIPTION OF PROCEDURE: Following informed consent, the left subclavian artery was prepped and draped in the usual sterile manner. Following local administration of 1% Xylocaine anesthesia, the left subclavian vein was entered with an 18-gauge, thin-wall needle. J-wire was placed. Transverse incision was created and dissected at the pectoral fascia. A subcutaneous pocket was created, and one gauze sponge was placed in the pocket. A 7 French sheath introducer was placed leaving a J-wire in place. A Medtronic 5076 (serial number PJNZZZZXXX) bipolar lead was placed in right ventricle apex and measurements taken. This lead screwed into position. A second 7 French introducer was placed. A Medtronic 5076 (serial number PJNZZZZXXX) atrial lead positioned in the right atrial appendage using fluoroscopic guidance. Measurements were taken, and lead screwed into position. Both leads were then suture-ligated in position. The gauze sponge was extracted from the pocket. the pocket was irrigated with bacitracin solution. The leads were connected to a Medtronic Adapta (serial number PWBXXXXYYY) device. The device was placed in the pocket. The subcutaneous tissue was closed with one row of running 3-0 suture. Subcutaneous tissue was closed with one row of running 4-0 suture. A sterile dressing was applied. The patient tolerated the procedure well. Dermabond dressing was also applied. At the end of the procedure, the patient was returned to a room in good condition. Initial measures include an R-wave of 10.9mV with threshold 0.9 volts and resistance of 810 ohms of the V-lead. The atrial lead had a P-wave of 2.0mV, threshold 0.5 volts, resistance 1184 ohms. Initial settings include the AAIR-DDDR mode with a lower rate of 60, upper rate limit of 130, Paced AV intervals 150 and sensed 10 milliseconds. Pulse amplitude on both leads is 3.5 volts with a pulse width of 0.4 milliseconds. Atrial sensitivity is 0.5mV. Ventricular, 2.8mV.
What are the CPT® and ICD-10-CM codes for this procedure?
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OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Angina
POSTOPERATIVE DIAGNOSIS: Angina
PROCEDURE: Coronary artery bypass x2 with left internal mammary artery bypass to the left anterior descending; saphenous vein graft to the posterior descending branch of the right coronary artery; harvesting of saphenous vein.
ANESTHESIA: General endotracheal anesthesia.
INDICATIONS: As described in admission note.
DESCRIPTION OF PROCEDURE: Mr. Williams was taken to the operating room. After general endotracheal anesthesia, his entire chest and abdomen were prepped and draped and exposed in a sterile field. A midline sternotomy was performed. The left internal mammary artery was taken down from its retrosternal location. It proved to be a suitable conduit with the bypass. The saphenous vein was harvested. Once both conduits were felt to be suitable, the pericardium was opened, incised, and sutured to the skin edges. The patient was heparinized, and appropriate cannulas were placed. The patient was then placed on cardiopulmonary bypass at approximately 5.0L per minute. The heart was then mechanically arrested with a combination of antegrade and retrograde cold cardioplegia and topical saline.
With cardiac arrest now stable, the mid portion of the left anterior descending was identified and dissected free. In the epicardial fat, the posterior descending branch of the right coronary artery was also dissected free. Longitudinal arteriotomy was made in the posterior descending branch of the right coronary artery was also dissected free. Longitudinal arteriotomy was made in the posterior descending, and a segment of saphenous vein was sutured without difficulty. In like fashion, the left internal mammary artery was sutured to the left anterior descending at its mid position. The single proximal end of the right coronary graft was placed around the ascending aorta.
Once completed, the aortic cross-clamp was removed. the air was evacuated from the graft. The patient regained sinus rhythm immediately and appropriate ejection. A single set of pacing wires was placed on the inferior surface of the left ventricular wall. Two chest tubes were positioned. the patient was subsequently decannulated and hemodynamically remained stable, and eventually closure was accomplished with heavy stainless steel sternal wires in a figure-of-eight fashion. All wounds were covered with a dressing.
The patient was returned to the intensive care unit in satisfactory condition. He appeared to have tolerated the procedure without event.
What are the CPT® and ICD-10-CM codes for this procedure?
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