Ch. 9 Respiratory and Lymphatic Systems

Question 1

What CPT® code is reported for a frontal sinusotomy, nonobliterative, with osteoplastic flap, brow incision?

Answer 1

d. 31086

Response Feedback:
Rationale: In the CPT® Index look for Sinusotomy/Frontal Sinus/Nonobliterative directing you to code range 31086, 31087. Code selection is based on whether it is a brow incision or coronal incision; 31086 is the correct code.

Question 2

What CPT® code is reported for a major thoracotomy for post-op hemorrhage following an endoscopic upper lobectomy?

Answer 2

a.
32120

Response Feedback:
Rationale: In the CPT® Index, look for Thoracotomy/for Post-op Complications referring you to code 32120. Since post-op hemorrhage is considered a complication and occurred following an operation/surgery, code 32120 is the correct code to report.

Question 3

What ICD-10-CM code is reported for spontaneous pneumothorax?

Answer 3

a.
J93.83

Response Feedback:
Rationale: In the ICD-10-CM Alphabetic Index look for Pneumothorax/spontaneous NOS referring you to code J93.83. Verify code selection in the Tabular List.

Question 4

What CPT® code is reported for open decortication and parietal pleurectomy?

Answer 4

d. 32320

Response Feedback:
Rationale: In the CPT® Index look for Decortication/Lung/with Parietal Pleurectomy. This directs you to code 32320.

Question 5

What is the largest single mass of lymphatic tissue?

Answer 5

d. Spleen

Response Feedback:
Rationale: The spleen is the largest single mass of lymphatic tissue.

Question 6

What CPT® code(s) is/are reported for extensive excision of seven nasal polyps?

Answer 6

c. 30115

Response Feedback:
Rationale: In the CPT® Index look for Excision/Polyp/Nose directing you to 30110, 30115. The code descriptor for 30115 indicates polyp(s) and extensive. Thus, we would not report 30115 multiple times.

Question 7

What ICD-10-CM codes are reported for postoperative pulmonary edema due to fluid overload from an infusion?

Answer 7

d.
T80.89XA, J81.1, Y63.0

Response Feedback:
Rationale: In the ICD-10-CM Alphabetic Index look for Complication/infusion (procedure)/specified type NEC directing you to T80.89. In the Tabular List this subcategory code requires seven characters. T80.89XA is the correct code choice. Next look for Edema/lung directing you to J81.1. Because the edema is due to the fluid overload that is associated with an infusion given during the patient’s medical care look in the ICD-10-CM External Cause of Injuries Index for Misadventure(s) to patient(s) during surgical or medical care/excessive amount of blood or other fluid during transfusion or infusion directing you to Y63.0.

Question 8

A patient presents with wheezing and shortness of breath. After evaluating the patient, the provider determines the patient is suffering from an exacerbation of his asthma. The provider orders nebulizer treatments to be administered in his office. According to the ICD-10-CM guidelines for coding signs and symptoms, what is/are the correct ICD-10-CM code(s)?

Answer 8

a.
J45.901

Response Feedback:
Rationale: Because the type of asthma is not indicated, the correct code is J45.901. In the ICD-10-CM Alphabetic Index look for Asthma, asthmatic/with/exacerbation (acute) directing you to J45.901. The Tabular List verifies this code choice. Wheezing and shortness of breath are signs and symptoms of an exacerbation of asthma and not reported separately. According to the Official ICD-10-CM guideline I.B.4 or I.C.18.b, do not report signs and symptoms when a definitive diagnosis has been established.

Question 9

Most nasal passages have how many turbinates present on the lateral wall of each nasal cavity?

Answer 9

b. 3

Response Feedback:
Rationale: There are three turbinates on each side of the nose: superior, middle and inferior. These turbinates may become swollen and require surgery to restore airflow.

Question 10

What ICD-10-CM code is reported for COPD with acute bronchitis?

Answer 10

b.
J44.0, J20.9

Response Feedback:
Rationale: COPD stands for Chronic Obstructive Pulmonary Disease. In the ICD-10-CM Alphabetic Index, look for Disease/lung/obstructive (chronic)/with/acute bronchitis referring you to J44.0. Verification in the Tabular List confirms code selection and gives additional instruction to code also to identify the infection. The infection is reported with a code from category code J20 Acute Bronchitis. Because there is no indication of the infectious agent for the acute bronchitis, an unspecified code is used. Bronchitis/acute or subacute refers you to J20.9. There is also an Excludes2 note that lists category code J44.-, which indicates that a code from that category can be coded with J20.9.

Question 11

A patient is seen in the endoscopy suite for a diagnostic maxillary sinusotomy. During the sinusotomy, the provider observes some diseased tissue which needs to be removed. The provider decides to perform a maxillary antrostomy with tissue removal. Bleeding is controlled. The patient tolerated the procedure well. What CPT® code(s) is/are reported?

Answer 11

c. 31267

Response Feedback:
Rationale: According to the CPT® guidelines for coding of endoscopies, a surgical sinus endoscopy includes a sinusotomy and diagnostic endoscopy. In the CPT® Index look for Sinus/Sinuses/ Maxillary/Antrostomy and you are directed to code range 31256-31267. We see code 31267 represents a surgical maxillary antrostomy with maxillary tissue removal.

Question 12

An operative report lists excisional bilateral biopsies of deep cervical nodes and biopsy of right deep axillary nodes as the procedures performed. The pathology report comes back confirming lymphadenitis. What CPT® codes are reported?

Answer 12

c. 38510-50, 38525-51-RT

Response Feedback:
Rationale: In the CPT® Index look for Lymph Nodes/Biopsy and you are directed to a series of codes. Turn to codes 38500 and 38510-38530. Code 38510 represents the deep cervical nodes and the 50 modifier indicates that they were excised bilaterally. Next, look to code 38525. This code is appropriate for reporting the deep axillary nodes excised. The RT modifier indicates these lymph nodes were taken only from the right side and modifier 51 indicates multiple procedures performed at the same session.

Question 13

A 43 year-old female is seen in the emergency room with severe epistaxis. She said this is a common occurrence for her during the cold dry months of winter and this is why she is here for the third time this week. Extensive bilateral posterior cautery and packing is again required to control the hemorrhage.
What CPT® code is reported for the procedure? (Note: Do not code the E/M)

Answer 13

a.
30906-50

Response Feedback:
Rationale: Epistaxis is the term for nasal hemorrhage. In the CPT® Index look for Packing/ Nasal Hemorrhage and you are directed to code range 30901-30906. Code selection is determined by whether the procedure is posterior or anterior. This is posterior and is subsequent making the correct code 30906. Modifier 50 indicates this was done bilaterally.

Question 14

What ICD-10-CM code is reported for pyopneumothorax with fistula?

Answer 14

b.
J86.0

Response Feedback:
Rationale: In the ICD-10-CM Alphabetic Index look for Pyopneumothorax (infective)/with fistula referring you to code J86.0. You are able to confirm that J86.0 is for Pyothorax (pus in the pleural space) with fistula in the Tabular List. Py/o is the prefix for pus; pneumothorax is air in the pleural cavity. Not all words listed in the index are carried over into the code description in the Tabular List. J86.9 would be used if there were no mention of the fistula. The J95 category is for post procedural disorders of respiratory system.

Question 15

A 20 year-old patient is seen for 5 transbronchial lung biopsies of 2 separate lobes. One biopsy is taken in one lobe and 4 biopsies in another lobe. What CPT® code(s) is/are reported?

Answer 15

d.
31628, 31632

Response Feedback:
Rationale: Transbronchial biopsies are performed via a bronchoscopy. In the CPT® Index look for Bronchoscopy/Biopsy and we are directed to codes 31625-31629, 31632, 31633. Code 31628 represents a transbronchial biopsy of one lobe. A parenthetical statement under this code indicates to use code 31632 for any additional transbronchial biopsies on additional lobes. Code 31632 is reported once even when multiple biopsies are taken in a lobe.

Question 16

A patient with chronic pneumothoraces presents for chemopleurodesis. Under local anesthesia a small incision is made between the ribs. A catheter is inserted into the pleural space between the parietal and pleural viscera. Subsequently, 5g of sterile asbestos free talc was introduced into the pleural space via the catheter. What CPT® and ICD-10-CM codes are reported?

Answer 16

b.
32560, J93.81

Response Feedback:
Rationale: Chemopleurodesis is represented by codes 32560-32562. In the CPT® Index look for Pleurodesis/Instillation of Agent. Code 32560 is appropriate for the described actions taken to instill the talc used to treat recurrent pneumothorax.
Look in the ICD-10-CM Alphabetic Index for Pneumothorax NOS/chronic which directs you to code J93.81. Verification in the Tabular List confirms code selection.

Question 17

A patient with partial vocal cord paralysis requires bilateral removal of the arytenoids cartilage to improve breathing. The laryngoscope with operating microscope is inserted. Adequate visualization is established and the arytenoid cartilage is exposed by excision of the mucosa overlying it. What diagnosis and procedure codes are reported for this procedure?

Answer 17

a. 31561, J38.02

Response Feedback:
Rationale: In the CPT® Index look for Laryngoscopy/Fiberoptic/Operative/Arytenoidectomy, referring you to codes 31560, 31561. 31561 is appropriate for a direct operative laryngoscopy with arytenoidectomy using an operating microscope. There is a parenthetical note under code 31561 that states, “Do not report code 69990 in addition to code 31561”.
In the ICD-10-CM Alphabetic Index look for Paralysis/vocal cords/bilateral directing you to code J38.02 which is confirmed in the Tabular List.

Question 18

A surgeon performs a high thoracotomy with resection of a single lung segment on a 57 year-old who is currently a heavy smoker who had presented with a six-month history of right shoulder pain that radiates to the chest. An apical lung biopsy had confirmed lung cancer. What CPT® and ICD-10-CM codes are reported?

Answer 18

b.
32484, C34.10, F17.210

Response Feedback:
Rationale: A segment of the lung is removed. In the CPT® Index look for Removal/Lung/Single Segment which refers you to code 32484.
We have a confirmed diagnosis of apical lung cancer, a cancer in an upper lobe, which is code C34.10 (no indication of right or left lung). The term apical means the tip of a pyramidal or rounded structure, so apical lung cancer means the tumor/cancer is located at the top or upper lobe of the lung. We find this by looking in the Table of Neoplasms for Neoplasm, neoplastic/lung/upper lobe and select from the Primary Malignant column referring you to code C34.1-. Verification in the Tabular List indicates the code requires five characters. There is no indication which side of the lung has cancer, report code C34.10 for unspecified lung. There is also an instructional note under category C34 to use additional code for tobacco use. Code F17.210 is reported to indicate the patient is a smoker. Look for Dependence/drug NEC/nicotine/cigarettes which refers you to code F17.210. Verification in the Tabular List confirms code selection.

Question 19

A 40 year-old patient was complaining of continued shortness of breath. A biopsy was performed on a mass located on his left lung and sent to pathology. Results from pathology revealed that she has lung cancer. Patient is scheduled today to remove the cancer. A VATS is performed in removing a wedge section of the lung. What CPT® code is reported?

Answer 19

d.
32666

Response Feedback:
Rationale: In the CPT® Index look for VATS referring you to see Thoracoscopy. Look for Thoracoscopy/Surgical/with Therapeutic Wedge Resection referring you to 32666 and 32667. This is a therapeutic procedure because the patient is having the cancer removed. Code 32607 is reported when the physician is performing a wedge resection for a diagnostic biopsy to find out if the mass is cancerous.

Question 20

How are multiple moderate lacerations of the spleen, initial encounter coded in ICD-10-CM?

Answer 20

a.
S36.032A

Response Feedback:
Rationale: Look in the ICD-10-CM Alphabetic Index for Laceration/spleen/moderate which directs the coder to S36.031. However, in the Tabular List code S36.032 has inclusion terms that includes multiple moderate lacerations of spleen. Code S36.032 requires a 7 th character of A, D, or S.

Question 21

A 3 year-old girl is playing with a marble and sticks it in her nose. Her mother is unable to dislodge the marble, so she takes her to the provider’s office. The provider removes the marble with hemostats. What CPT® and ICD-10-CM codes are reported?

Answer 21

a.
30300, T17.1XXA

Response Feedback:
Rationale: Since the marble is a foreign body, look in the CPT® Index for Removal/Foreign Body/Nose which refers you to 30300.
For the ICD-10-CM code look in the ICD-10-CM Alphabetic Index for Foreign Body/entering through orifice/nose (passage) or nostril which refers you to code T17.1. Verification in the Tabular List indicates the code requires seven characters. The 5 th and 6 th characters would require a placeholder X and the 7 th character A for initial encounter.

Question 22

A 25 year-old male presents with a deviated nasal septum. The patient undergoes a nasal septum repair and submucous resection. Cartilage from the bony septum was detached and the nasoseptum was realigned and removed in a piecemeal fashion. Thereafter, 4-0 chronic was used to approximate mucous membranes. Next, submucous resection of the turbinates was handled in the usual fashion by removing the anterior third of the bony turbinate and lateral mucosa followed by bipolar cauterization. What CPT® codes are reported?

Answer 22

d.
30520, 30140-51

Response Feedback:
Rationale: Septum repair is a septoplasty. In the CPT® Index Septoplasty or Resection/Nasal Septum Submucous refers you to see Nasal Septum, Submucous Resection directing you to 30520. Under the code, there is a parenthetical statement to use 30140 for submucous resection of the turbinates. Modifier 51 is used to indicate multiple procedures.

Question 23

A 78 year-old patient with bilateral, lower lobe lung cancer has been in the hospital for seven days with a tunneled chest tube in place to drain fluid from the pleural space. The chest tube currently is inserted between the 4 th and 5 th intercostal space on the left side. There is a very bad infection at the insertion site. The provider removes this chest tube and inserts another chest tube between the 5 th and 6 th intercostal space on the left side to continue fluid drainage. The tube placed today is just the same as the one removed, only sterile. What CPT® and ICD-10-CM codes are reported?

Answer 23

d.
32550, 32552-51, T85.79XA, C34.31, C34.32

Response Feedback:
Rationale: Code 32552 represents the indwelling tunneled chest tube removal and code 32550 the insertion of a new indwelling catheter/tube. In the CPT® Index look for Catheterization/Pleural Cavity which directs you to 32550-32552. Read both codes to confirm the selections.
The infection is at the insertion site of the chest tube.
Look for Complication/prosthetic device or implant /infection or inflammation referring you T85.79. Verification in the Tabular List indicates seven characters is required for a complete code. Add placeholder X for the 6 th character and A, initial encounter, for the 7 th character. The ICD-10-CM code for the lung cancer is found in the Table of Neoplasms. Look for Neoplasm, neoplastic/lung/lower lobe and select from the Malignant Primary column directing you to code C34.3-. Verification in the Tabular List indicates the need for a 5 th character to identify right or left. The patient has bilateral lower lobe lung cancer there is no bilateral code choice, report code C34.31 for right and C34.32 for the left. (See ICD-10-CM guideline I.B.13.)

Question 24

A patient with laryngeal spasms undergoes therapeutic injection of the vocal cords. Topical anesthesia is administered to the oral cavity, pharynx and larynx. Using an operating microscope, a direct laryngoscope is inserted into the patient’s mouth. The interior larynx is examined and the surgeon injects the vocal cords at two sites with glycerin. What CPT® and ICD-10-CM codes are reported?

Answer 24

b.
31571, J38.5

Response Feedback:
Rationale: In the CPT® Index look for Laryngoscopy/Direct directing you to 31515-31571. 31571 is appropriate for the injection into the vocal cords using an operating microscope. There is a parenthetical instruction note that states, “Do not report code 69990 in addition to code 31571”.
In the ICD-10-CM Alphabetic Index look for Spasm(s), spastic, spasticity/larynx, laryngeal which directs you to code J38.5. Verify code selection in the Tabular List.

Question 25

A 55 year-old female smoker presents with cough, hemoptysis, slurred speech and weight loss. Chest X-ray done today demonstrates a large, unresectable right upper lobe mass, and brain scan is suspicious for metastasis. Under fluoroscopic guidance in an outpatient facility, a percutaneous needle biopsy of the right lung lesion is performed for histopathology and tumor markers. A diagnosis of small cell carcinoma is made and chemoradiotherapy is planned. What CPT® and ICD-10-CM codes are reported?

Answer 25

c.
32405-RT, 77002-26, C34.11

Response Feedback:
Rationale: In the CPT® Index look for Biopsy/Lung/Needle. This directs you to code 32405. Code 77002 is the appropriate code for the fluoroscopic guidance as indicated by the parenthetical statement under code 32405 and by reviewing the code descriptor for 77002. Modifier 26 is appended to report the professional component. RT modifier is to indicate the right lung was where the biopsy was performed.
We have a diagnosis of small cell carcinoma of the right lung which is code C34.11. In the ICD-10-CM Alphabetic Index look for Carcinoma which states see also Neoplasm, malignant, by site.
Look in the Table of Neoplasms for Neoplasm, neoplastic/lung/upper lobe and select from the Malignant Primary column directing you to C34.1-. Verification in the Tabular List requires a 5 th character to indicate laterality. Report C34.11 to indicate the right lung. The signs and symptoms are not coded because we do have a definitive diagnosis (ICD-10-CM guideline I.B.4 or I.C.18.a). Brain metastasis is suspected but not confirmed so it would not be reported. The chemotherapy is planned but not performed so it would not be reported either.