CH.9 Review

Question 1

Fracture caused by disease, not trauma

Answer 1

PATHOLOGIC FRACTURE

Question 2

Connects muscle to a bone

Answer 2

TENDON

Question 3

Displacement of a bone from its normal location

Answer 3

DISLOCATION

Question 4

Attempted reduction of a fracture by application of manually applied force

Answer 4

MANIPULATION

Question 5

Nonhealing fracture

Answer 5

NONUNION

Question 6

Fracture that protrudes outside the skin; also identified as compound or as a puncture

Answer 6

OPEN FRACTURE

Question 7

Fracture that DOES NOT protrude outside the skin; also identified as comminuted, greenstick, spiral, or simple.

Answer 7

CLOSED FRACTURE

Question 8

Shaft of a long bone

Answer 8

DIAPHYSIS

Question 9

The part of the skeleton that consists of the skull, spinal column, ribs, and sternum

Answer 9

AXIAL SKELETON

Question 10

Connects two or more bones or cartilage

Answer 10

LIGAMENT

Question 11

Ends of a long bone

Answer 11

EPIPHYSIS

Question 12

The part of the skeleton that makes body movement possible and consists of upper and lower extremities

Answer 12

APPENDICULAR SKELETON

Question 13

Treatment that involves the use of wires, pins, or screws that are placed through or within the fracture site

Answer 13

INTERNAL FIXATION

Question 14

Incorrect healing of a fracture

Answer 14

MALUNION

Question 15

Inflammation of the bone and joint

Answer 15

EXTERNAL FIXATION

Question 16

Thinning of the bone tissue and loss of bone density

Answer 16

OSTEOARTHRITIS

Question 17

Treatment that involves skeletal pins attached to an external mechanism

Answer 17

PATHOLOGIC FRACTURE

Question 18

This lies beneath the layer of subcutaneous tissue of the integumentary system, lines extremities, and holds together groups of muscles:

Answer 18

DEEP FASCIA

Question 19

Skeletal muscles make motion such as walking possible and are:

Answer 19

BOTH STRIATED MUSCLES AND VOLUNTARY MUSCLES

Question 20

What is the correct code for an open repair of an acute ruptured rotator cuff?

Answer 20

23410

Question 21

Report the appropriate code(s) for the following procedures:

Diagnostic knee arthroscopy of the right knee, followed by surgical arthroscopy with synovectomy in both medial and lateral components of the right knee.

Answer 21

29876

Question 22

This type of joint is movable and also called a ball-and-socket joint:

Answer 22

SYNOVIAL AND HINGE JOINT

Question 23

When the description of a code includes the term complicated, it can refer to:

Answer 23

INFECTION AND DELAYED HEALING

Question 24

What is the appropriate code for arthrocentesis of the shoulder?

Answer 24

20610

Question 25

__________is the attempted reduction or restoration of a fracture or joint dislocation to its normal alignment by the application of manually applied force.

Answer 25

MANIPULATION

Question 26

When an arthroscopy is performed at the same time as an arthrotomy, which modifier would be appended?

Answer 26

51

Question 27

A muscle that is like a striated muscle in appearance but similar to a smooth muscle in action is a:

Answer 27

MYOCARDIAL MUSCLE

Question 28

CASE STUDY - Process 1: CPT Preoperative diagnosis: Cervical spondylosis, central stenosis C5–C6 Postoperative diagnosis: Cervical spondylosis, central stenosis C5–C6 Procedure: Anterior cervical arthrodesis anterior body C5–C6 using PEEK cages and DynaTran 18-mm Stryker plate, autologous local bone, and putty Anesthesia: General anesthesia The patient was placed in a supine position on the operating table with an interscapular roll. The anterior aspect of the neck was prepped and draped in a sterile fashion. Interoperative fluoroscopy was used to center our incision over the C5 through C6 interspace. A transverse incision was made across the sternocleidomastoid on the right side, and the incision was carried down through the subcutaneous tissues, controlling bleeding with unipolar cautery. Initially, retraction was done using a small Weitlaner, and the anterior border of the sternocleidomastoid was identified. I followed a plane medial to this and medial to the carotid artery but lateral to the esophagus and trachea. I followed this plane until the prevertebral space was identified and the longus colli muscles were divided in the midline. The self-retaining blades of the Trimline retractor were placed underneath this muscle, and then we placed a marker at the C4–C5 level, which was the most inferior, still visible identifiable disc space. From here I counted down to the C4–C5 level and proceeded with a minimal anterior cervical discectomy and decompression at C5–C6. The ventral osteophytes were removed using a Leksell rongeur, and then the disc was incised using a 15-blade knife in the interspace distracted using the Caspar distraction system. The discectomy was performed; the disk was quite collapsed using a combination of curettes and Midas Rex drill. The discectomy and bony removal was followed posteriorly until the posterior longitudinal ligament was identified. This was opened and removed, and then working carefully over the dura, bilateral foraminotomies were performed. After verifying that the spinal cord was well decompressed in the midline, the roots out laterally, the area was irrigated with an antibiotic saline solution. I then selected a 6-mm in height PEEK cage, which was filled with some local bone that had been harvested as part of our bony removal combined with autologous bone putty. The cage was then tapped into position and distraction was released. I then selected an 18 mm in length DynaTran translational plate, and this was secured with two variable-angle screws into C5 and two into C6. Once the screws were partially in position, the translational stops were removed and the screws were secured beyond the backup stops for all screws. The muscles were reapproximated with 2-0 Vicryl, a 2-0 Vicryl subcutaneous closure including the platysma, and a running 4-0 Vicryl subcuticular stitch in the skin. Based on the documentation, what are the correct codes for this case?

Answer 28

22551, 22845, 22853

Question 29

CASE STUDY - Process 2: ICD-10 Preoperative diagnosis: Cervical spondylosis, central stenosis C5–C6 Postoperative diagnosis: Cervical spondylosis, central stenosis C5–C6 Procedure: Anterior cervical arthrodesis anterior body C5–C6 using PEEK cages and DynaTran 18-mm Stryker plate, autologous local bone, and putty Anesthesia: General anesthesia The patient was placed in a supine position on the operating table with an interscapular roll. The anterior aspect of the neck was prepped and draped in a sterile fashion. Interoperative fluoroscopy was used to center our incision over the C5 through C6 interspace. A transverse incision was made across the sternocleidomastoid on the right side, and the incision was carried down through the subcutaneous tissues, controlling bleeding with unipolar cautery. Initially, retraction was done using a small Weitlaner, and the anterior border of the sternocleidomastoid was identified. I followed a plane medial to this and medial to the carotid artery but lateral to the esophagus and trachea. I followed this plane until the prevertebral space was identified and the longus colli muscles were divided in the midline. The self-retaining blades of the Trimline retractor were placed underneath this muscle, and then we placed a marker at the C4–C5 level, which was the most inferior, still visible identifiable disc space. From here I counted down to the C4–C5 level and proceeded with a minimal anterior cervical discectomy and decompression at C5–C6. The ventral osteophytes were removed using a Leksell rongeur, and then the disc was incised using a 15-blade knife in the interspace distracted using the Caspar distraction system. The discectomy was performed; the disk was quite collapsed using a combination of curettes and Midas Rex drill. The discectomy and bony removal was followed posteriorly until the posterior longitudinal ligament was identified. This was opened and removed, and then working carefully over the dura, bilateral foraminotomies were performed. After verifying that the spinal cord was well decompressed in the midline, the roots out laterally, the area was irrigated with an antibiotic saline solution. I then selected a 6-mm in height PEEK cage, which was filled with some local bone that had been harvested as part of our bony removal combined with autologous bone putty. The cage was then tapped into position and distraction was released. I then selected an 18 mm in length DynaTran translational plate, and this was secured with two variable-angle screws into C5 and two into C6. Once the screws were partially in position, the translational stops were removed and the screws were secured beyond the backup stops for all screws. The muscles were reapproximated with 2-0 Vicryl, a 2-0 Vicryl subcutaneous closure including the platysma, and a running 4-0 Vicryl subcuticular stitch in the skin. Based on the documentation, what are the correct ICD-10-CM codes for this case?

Answer 29

M47.12, M48.02

Question 30

CASE STUDY - Process 3: Modifiers Preoperative diagnosis: Cervical spondylosis, central stenosis C5–C6 Postoperative diagnosis: Cervical spondylosis, central stenosis C5–C6 Procedure: Anterior cervical arthrodesis anterior body C5–C6 using PEEK cages and DynaTran 18-mm Stryker plate, autologous local bone, and putty Anesthesia: General anesthesia The patient was placed in a supine position on the operating table with an interscapular roll. The anterior aspect of the neck was prepped and draped in a sterile fashion. Interoperative fluoroscopy was used to center our incision over the C5 through C6 interspace. A transverse incision was made across the sternocleidomastoid on the right side, and the incision was carried down through the subcutaneous tissues, controlling bleeding with unipolar cautery. Initially, retraction was done using a small Weitlaner, and the anterior border of the sternocleidomastoid was identified. I followed a plane medial to this and medial to the carotid artery but lateral to the esophagus and trachea. I followed this plane until the prevertebral space was identified and the longus colli muscles were divided in the midline. The self-retaining blades of the Trimline retractor were placed underneath this muscle, and then we placed a marker at the C4–C5 level, which was the most inferior, still visible identifiable disc space. From here I counted down to the C4–C5 level and proceeded with a minimal anterior cervical discectomy and decompression at C5–C6. The ventral osteophytes were removed using a Leksell rongeur, and then the disc was incised using a 15-blade knife in the interspace distracted using the Caspar distraction system. The discectomy was performed; the disk was quite collapsed using a combination of curettes and Midas Rex drill. The discectomy and bony removal was followed posteriorly until the posterior longitudinal ligament was identified. This was opened and removed, and then working carefully over the dura, bilateral foraminotomies were performed. After verifying that the spinal cord was well decompressed in the midline, the roots out laterally, the area was irrigated with an antibiotic saline solution. I then selected a 6-mm in height PEEK cage, which was filled with some local bone that had been harvested as part of our bony removal combined with autologous bone putty. The cage was then tapped into position and distraction was released. I then selected an 18 mm in length DynaTran translational plate, and this was secured with two variable-angle screws into C5 and two into C6. Once the screws were partially in position, the translational stops were removed and the screws were secured beyond the backup stops for all screws. The muscles were reapproximated with 2-0 Vicryl, a 2-0 Vicryl subcutaneous closure including the platysma, and a running 4-0 Vicryl subcuticular stitch in the skin. Which modifier should be appended to the CPT code for this case?

Answer 30

NONE