Chapter 13: CPT Surgery II

Endoscopic anterior and posterior (total) ethmoidectomy, left, with left maxillary antrostomy.

31255, 31255-51-LT

Endoscopic frontal nasal exploration with removal of tissue from left frontal sinus and diagnostic endoscopy of left turbinates.

31276-LT

Total laryngectomy with radical neck dissection.

31365

Total laryngectomy with bilateral radical neck dissection.

31365, 38720-59

Emergency department physician places endotracheal tube for a patient in respiratory distress.

31500

Complicated tracheotomy tube change (prior to establishment of fistula tract).

31502

Types of injury codes include ____ or ____ fractures and ___ injuries.

open, closed, joint

Nasal endoscopy with biopsy.

31237

Endoscopic treatment of a nosebleed.

31238

Patient received a cortisone injection to a single trigger point, which consisted of the trapezius, deltoid, and latissimus dorsi muscles.

20553

Patient sustained a stab wound to the right neck during a domestic dispute and underwent wound exploration. The stab wound was extended, and examination of surrounding bones, connective tissue, muscles, and nerves revealed normal findings. No foreign bodies were found. The area was debrided and irrigated. Coagulation of minor subcutaneous and muscular blood vessels was achieved with electrocautery. The wound was cleaned and closed with 3-0 Vicryl.

20100

The physician performed an exploration, penetrating wound, neck.

20100

Patient underwent exploration of a penetrating wound of the chest, which involved surgical exploration and enlargement of the wound, debridement, removal of a foreign body, and ligation of subcutaneous tissue.

20101

Needle biopsy, soft tissue, thorax.

20206

Open bone biopsy, superficial, left femur.

20240

Patient underwent aspiration of ganglion cyst, right wrist.

20612-RT

A patient diagnosed with joint contracture of the right ankle underwent application of a multiplane external fixation device.

20692-RT

A patient severed his right index finger while using a chain saw. He underwent successful replantation of the index finger, which included metacarpophalangeal (MCP) joint to insertion of flexor sublimis tendon.

20816-F6

Fascia lata graft was harvested using a stripper.

20920

Electrical stimulation procedure was performed to aid bone healing, invasive type.

20975

Arthrotomy of temporomandibular joint, right and left sides.

21010-50

Excision of two facial bones (due to bone abscesses).

21026

Impression and custom preparation of speech aid prosthesis.

21084

Sliding osteotomy genioplasty, single piece.

21121

Reconstruction midface, LeFort II with anterior intrusion.

21150

Patient underwent reconstruction of the entire forehead and supraorbital rims, requiring grafts, to correct a congenital skeletal deformity. After administration of general anesthesia, scalp and upper eyelid incisions were made to access the surgical site. The forehead bones were reshaped and repositioned, and bone allografts were inserted to augment the forehead and supraorbital rims. Incisions were closed after wires were inserted as fixation devices to maintain the proper shape of the facial bones.

21179

Osteotomy of mandible, segmental.

21198

Malar augmentation with prosthetic material.

21270

Closed treatment of orbit fracture, with manipulation.

21401

Closed treatment of maxillary alveolar ridge fracture.

21440

Open treatment of mandibular condylar fracture.

21465

Deep incision with opening of bone cortex, thorax.

21510

Partial excision of rib.

21600

Sternal debridement.

21627

Hyoid myotomy and suspension.

21685

Closed treatment of sternum fracture.

21820

Patient underwent biopsy of superficial soft tissues of the back.

21920

Biopsy, soft tissue of flank, deep.

21925

Excision of tumor, subcutaneous soft tissue of back, 2.5 cm.

21930

The physician removed a 4-cm malignant soft tissue tumor, including adjacent tissue, from the patient's flank. Radical resection was performed to remove the tumor and adjacent tissue. The 5-cm surgical wound was repaired with complex closure.

21935, 13101-51

Patient underwent osteotomy and discectomy of a single cervical spine vertebral segment. Anterior approach was used.

22220

Physician performed "spinal manipulation under anesthesia," cervical, thoracic, and lumbar spine.

22505

Patient underwent structural allograft as part of an arthrodesis, posterior technique, craniocervical (occiput-C2).

22590, 20931

Physician performed arthrodesis using posterior technique of atlas-axis (C1-C2) with internal spinal fixation by wiring the spinous processes.

22595, 22841

Patient underwent arthrodesis at L4-L5 interspace. Posterior interbody technique laminectomy was performed. Discectomy was also performed to prepare the vertebral interspace for fusion.

22630

Patient underwent posterior arthrodesis of L2-L3 for spinal deformity, with casting. Morselized autogenous iliac bone graft was harvested through a separate skin incision.

22800, 20937

The physician performed an excision of a 4-cm subfascial abdominal wall tumor and the surrounding tissue. Incision was repaired in multiple layers with sutures.

22900

The physician removed subdeltoid calcareous deposits, left shoulder joint, by incising the raised area over the calcium deposits and removing the calcareous deposits.

23000-LT

The physician performed removal of a deep foreign body, left shoulder.

23333-LT

The physician performed a forequarter interthoracoscapular amputation, right shoulder.

23900-RT

Excision of 2-cm malignant tumor from subcutaneous tissue around right elbow.

24075-RT

Patient who sustained left elbow trauma developed an elbow contracture that required manipulation under anesthesia.

24300-RT

Percutaneous medial tenotomy for treatment of tennis elbow, right.

24357-RT

Injection procedure performed to prep patient for right wrist arthrography.

25246-RT

Anterior ethmoidectomy via intranasal approach.

31200

Patient underwent closed treatment of fractured tip of the right radius at distal end, which included application of a short-arm cast.

25600-RT

Percutaneous skeletal fixation of left Colles fracture.

25606-LT

Patient underwent removal of a metal sliver from the index finger, right hand. The surgeon made an incision between the first and second bones of the right index finger. Joint exploration revealed the presence of a metal sliver, which was removed.

26080-F6

Left palmar fasciectomy with Z-plasty.

26121-LT

Proximal hamstring release.

27097

Partial hip replacement with bipolar arthroplasty to treat right hip fracture.

27125-RT

Patient underwent incision and drainage of bursa, right knee. Needle was inserted into bursa and fluid was drained from the sac, which was located deep within the knee's soft tissue.

27301-RT

Complete 1 × 1 × 0.5-cm excision of subcutaneous tumor, posterior left thigh.

27327-LT

Excision of 2-cm bone cyst with autograft of harvested femur graft, left, which was performed during the same operative session.

27357-LT

Removal of a foreign body deep in the left thigh.

27372-LT

Decompression fasciotomy of the lateral and posterior compartments, right knee.

27498-RT

A 13-year-old male sustained a fractured right femur during a soccer game and underwent open treatment with insertion of two screws and two pins. After administration of general anesthesia, an incision was made over the fracture site and a metal rod was inserted through the bone's shaft to stabilize it. The rod was secured with screws, and the leg was placed in a cast.

27506-RT

Patient underwent knee replacement surgery four months ago. Today "manipulation of the left knee under general anesthesia" was performed to flex the knee joint and increase its range of motion.

27570-LT

Incision and drainage of infected bursa, left ankle.

27604-RT

Percutaneous repair of ruptured Achilles tendon, right.

27650-RT

Partial ostectomy to surgically correct bunionette involving the right fifth metatarsal head.

28110-RT

Distal Chevron osteotomy, right.

28296-RT

Patient's left long-arm cast was removed after getting wet, the site was evaluated, and another long-arm fiberglass cast was reapplied. The same physician who applied the first cast removed the wet cast and applied the new cast.

29065-LT

Physician treated flexion contracture of right small finger proximal interphalangeal joint by applying a cast to stabilize the joint.

29086-F9

Patient sustained nondisplaced fracture of distal left ulna, and emergency department physician applied a molded splint for immobilization and protection of the fracture. Patient was referred to orthopedic specialist.

29125-LT

A two-year-old patient underwent reapplication of a long-leg cast to the left femur, which extended from the thigh to the toes. The patient sustained femur fracture four weeks ago when initial reduction was performed and application of long-leg cast was applied. Today that cast was removed and replaced with a long-leg cast due to the patient's age, to ensure optimal bone healing.

29345-LT

Patient with diabetic neuropathic ulcers had rigid total contact leg cast applied, left.

29445-LT

Patient underwent open reduction of left tibia fracture four weeks ago, which was a global surgery period of 90 days. Today the orthopedic surgeon cut a hole in the patient's short-leg cast, left, to check for incisional infection due to patient complaints of pain. No infection was noted.

29730-LT

Arthroscopic superior labrum anterior/posterior (SLAP) lesion tear repair, right shoulder.

29807-RT

Patient underwent arthroscopic Mumford procedure of distal 1 cm of left clavicle.

29824-LT

Diagnostic arthroscopy, left elbow, with synovial biopsy.

29830-LT

Patient underwent diagnostic arthroscopy of the left elbow due to unexplained pain. The surgeon inserted arthroscope into the left elbow joint to determine presence of disease or injury.

29830-LT

Left knee diagnostic and surgical arthroscopy with partial medial meniscectomy.

29881-LT

Patient underwent arthroscopic repair of large osteochondritis dissecans lesion and talar dome fracture with internal fixation, right.

29892-RT

Surgical arthroscopy of the metacarpophalangeal joint on the right with debridement.

29902-RT

Patient with cricoid split (break in the circular cartilage of the larynx) undergoes laryngoplasty.

31587

Emergency transtracheal tracheostomy of 18-month-old child.

31603

Bronchoscopy with bronchial alveolar lavage.

31624

Flexible bronchoscopy to remove a piece of food inhaled into the left bronchus.

31635-LT

Bronchial brush biopsy via transglottic catheterization.

31717

Percutaneous needle biopsy, pleura.

32400

Emergency department physician performed a tube thoracostomy for hemothorax, inserting a tube for drainage.

32551

Diagnostic thoracoscopy with lung biopsy (left side) and surgical thoracoscopy with segmental lobectomy (left side) (both procedures performed during same operative session).

32663-LT

Patient with severe respiratory system complications due to chronic obstructive pulmonary disease underwent unilateral lung transplant (right side) procedure to remove one diseased lung, on the right, and replace it with a healthy lung from a recently deceased donor. Donor lung also required repair of intrathoracic blood vessel. Transplant physician performed donor pneumonectomy including cold preservation from cadaver donor, backbench standard preparation of cadaver donor lung allografts, and single lung transplant without cardiopulmonary bypass.

32851, 32850, 35216, 32855

Total lung lavage, right.

32997

Catheterization with bronchial brush biopsy. Which CPT code is assigned? a. 31717 b. 31725 c. 31623 d. 31720

a. 31717

Surgical thoracoscopy with excision of a pericardial cyst. Which CPT code is assigned? a. 32661 b. 32604 c. 32658 d. 32659

a. 32661

Reconstruction of complete shoulder (rotator) cuff avulsion, chronic, right side. Which CPT code(s) are assigned? a. 23420-RT b. 23130-RT, 23420-RT c. 23410-RT d. 23130-RT, 23420-51-RT

a. 23420-RT

Incision and drainage of deep abscess, right forearm. Which CPT code is assigned? a. 25028-RT b. 25031-RT c. 10060 d. 24310-RT

a. 25028-RT

Calcaneus ostectomy for removal of spurs, left foot. Which CPT code is assigned? a. 28119-LT b. 28111-LT c. 28118-LT d. 28116-LT

a. 28119-LT

Which is the surgical fixation of arytenoidal cartilage and/or surrounding muscles? a. Arytenoidopexy b. Arytenoidostomy c. Arytenoidotomy d. Arytenoidectomy

a. arytenoidpexy

Initial cautery to control posterior nasal hemorrhage. Which CPT code is assigned? a. 30906 b. 30905 c. 30903 d. 30901

b. 30905

A 3-year-old child undergoes direct laryngoscopy for aspiration of fluid. Which CPT code is assigned? a. 31520-63 b. 31515 c. 31525 d. 31520

b. 31515

C3-C4 anterior discectomy with decompression of spinal cord and nerve root, including osteophytectomy performed by two primary surgeons. Which CPT code(s) are reported by Surgeon A? a. 63075, 63075 b. 63075-62 c. 63075-62, 63075-62 d. 63075

b. 63075-62

Codes for treatment of fractures and joint injuries are classified according to type of ___ and stabilization.

manipulation

Which is performed to puncture a joint for fluid removal or medication injection? a. Arthroscopy b. Arthrocentesis c. Arthrodesis d. Artificial ankylosis

b. arthrocentesis

Which is a type of open fracture treatment? a. Traction b. Internal fixation c. Closed reduction d. Stabilization

b. internal fixation

Which is considered part of the ethmoid bone and, if removed during endoscopic polypectomy or endoscopic ethmoidectomy, is not coded and reported separately? a. Frontal sinus b. Middle turbinate c. Nasal vestibule d. Maxillary sinus

b. middle turbinate

The Musculoskeletal subsection is arranged from head to toe according to ___ ___.

body area

CPT notes associated with osteotomy codes (22210-22226) provide direction to use which code group when reporting arthrodesis separately?? a. 22840-22855, 22859 b. 22100-22116 c. 22590-22632 d. 20930-20938

c. 22590-22632

When a physician performs surgical nasal/sinus endoscopy with partial ethmoidectomy (anterior) and septoplasty or submucous resection, report the: a. endoscopy code (31254) or the septoplasty code (30520). b. endoscopy code (31254). c. endoscopy code (31254) and the septoplasty code (30520). d. septoplasty code (30520).

c. endoscopy code (31254) and the septoplasty code (30520)

Open carpal tunnel decompression surgery (for carpal tunnel syndrome) is classified in which CPT Surgery subsection? a. Operating Microscope b. Integumentary System c. Nervous System d. Musculoskeletal System

c. nervous system

Unlisted maxillofacial prosthetic procedure. Which CPT code is assigned? a. 22899 b. 21299 c. 23929 d. 21089

d. 21089

Surgical nasal endoscopy with repair of cerebrospinal fluid leak, sphenoid region, right side. Which CPT code is assigned? a. 31287-RT b. 31290-RT c. 31292-RT d. 31291-RT

d. 31291-RT

Which procedure is performed to comb the mucous lining of the trachea or bronchus and uses a bronchial brush to collect cells? a. Cell washing b. Tracheotomy c. Bronchoscopy d. Brushing

d. brushing

Which component(s) of a lung transplant are reported as distinct code(s) by the physician who performs the component procedure(s)? a. Cadaver donor pneumonectomy b. Backbench work for lung transplantation c. Recipient lung allotransplantation d. Each of the above

d. each of the above

The application of casts and strapping are reported when the cast (or splint) or strapping is an initial service performed ________________ to stabilize or protect a fracture, a dislocation, or another injury and/or to provide comfort to a patient. a. instead of placing a cast (or splint) or strap b. during restorative treatment/procedure c. when a reduction or manipulation is completed d. without restorative treatment/procedure

d. without restorative treatment/procedure

Fracture management codes include pinning, open or closed treatment of the fracture, application and removal of the initial cast or splint, and normal uncomplicated ___ ___.

follow-up care

Open and closed fractures may not receive the same type of ___.

treatment