Test Your Knowledge - 50 Question Exam (should be completed in 115 minutes)

17273, 17272-51, 17272-51

Two malignant lesions on the scalp measuring 1.1 cm and 2.0 cm, and one malignant lesion on the neck measuring 2.2 cm were destroyed. Electrocautery was used for the first two lesions and laser was used for the third lesion. What procedure code(s) is/are reported?

64493-50, 64494-50

Using fluoroscopic guidance, the anesthesiologist injects an analgesic and steroid mixture into the paravertebral facet joint on both the right and left side at L2-L3 and L3.-L4 for persistent pain secondary to spondylosis with myelopathy. What procedure codes are reported?

00912

What CPT code(s) is/are reported for anesthesia for a patient having a cystoscopy for biopsy and fulguration of a 1.5 cm bladder tumor with the cystoscope being inserted through the urethra into the bladder?

A radiographic study of the renal pelvis and ureter

What is an ureteropyelogram?

A4312

What is the code for supplies for a two-way silicone Foley catheter?

J0882

What is the code to report 1 mcg of Aranesp for a patient on dialysis with ESRD?

Select the code that includes "without contrast" in the description.

What is the correct code to select when a patient is given oral contrast to complete a CT scan?

An ABN includes the items that may be denied and is signed prior to performing the service.

When should a provider have a patient sign an ABN?

The hip joint

Which of the following best describes an acetabulum?

They can never be the first listed code.

Which of the following is TRUE regarding ICD-10-CM codes with the statement "in diseases classified elsewhere" in their descriptions?

Coding for an intermediate closure whenever a simple closure is performed

Which of the following is an example of fraud?

Gastroepiploic

Which of the following vessels is in the third-order branch of the celiac trunk?

21931, D17.1

.Operative Report Preoperative Diagnosis: Lipoma of right back. Postoperative Diagnosis: Lipoma of right back. Procedure Performed: Excision of lipoma, right back (6 cm diameter). Description of Procedure: The patient was placed on the operating table in the lateral positicin with the right side elevated. The location of the lipoma had been marked in the preoperative area. It was at the superior edge of the right iliac crest. The area was prepped with Betadine and sterile drapes were applied. A transverse incision was made directly over the lipoma. Subcutaneous tissues were incised. The lipoma was identified and found to be smooth, multilobulated, yellow, and discrete. It was completely excised down to the muscle overlying the iliac crest. Bleeding was controlled with electrocautery. The subcutaneous tissues were approximated with a continuous subcuticular 3-0 plain catgut suture. Benzoin, Steri-Strips, and dry gauze dressings were applied. Blood loss was negligible and the final sponge count was reported as correct. The patient was sent to the recovery room in stable condition. What CPT° and ICD-10-CM codes are reported?

77065

A patient presents for a mammogram to evaluate a suspicious lump that was found in her left breast during her recent annual exam. Computer algorithm analysis of the digital image was employed to detect the extent of the lesion. What CPT code is/are reported?

95004 x 2

A 10 year-old is brought in to see an allergist for generalized urticaria. The family just recently visited a family member that had a cat and dog. The mother wants to know if her daughter is allergic to cats an dogs. The child's skin was scratched with two different allergens. The physician waited 15 minutes to check the results. There was a flare-up reaction to the cat allergen, but there was no flare-up to the dog allergen. The physician included the test interpretation and report in the record. What CPT code(s) is/are reported?

95120

A 22 year-old male is coming in for his immunotherapy to desensitize him to ragweed. The physician provided the serum with the allergenic extract and performed the injection. After the injection was given, the patient was observed to make sure he did not experience an allergic reaction. He was told to return in three days for his next injection. What CPT code is reported?

99291-25, 36555, 92950, 31500

A 28 day-old male child is brought into the emergency room in respiratory arrest with suspected SIDS. The emergency room physician performs critical care for 45 minutes. In addition to the critical care time, CPR, placement of a central venous line, and emergency endotracheal intubation are performed. What procedure codes are reported for this encounter?

T21.31XA, T22.20XA, T24.201A, T24.202A, T20.10XA, T31.31

A 30 year-old is brought into the burn unit with burns covering 30% of his total body. He has third-degree burns to his chest wall (10%), second-degree burns on his arm and both legs (15%), and first-degree burns on his face (5%). What ICD-10-CM codes are reported for the burns?

59510, 59409-51

A 36 year-old who is 37 weeks pregnant with twins goes into labor. Twin A is delivered vaginally with no complications. Twin B is delivered via cesarean section because the cord is wrapped around the infant's neck. The obstetrician performing the deliveries provided the prenatal care and will follow the patient throughout the postpartum period. This is the patient's first pregnancy. What procedure code(s) is/are reported?

27250-RT, 99156, 99157

A 55 year-old patient complains of an injury to his right hip leading to a probable dislocation that occurred one hour prior to arrival. The patient states he was sleeping in bed, fell off, and landed on his right side. Patient denies numbness or tingling. Patient denies any further injury. No additional complaints or treatments prior to arrival. Intervention: IV: normal saline; Pulse Ox: 98 percent on room air; X-ray right hip: Positive hip dislocation. Dr. Thompson was notified of the patient's physical exam findings and test results. The patient was prepared and agreed to conscious sedation to include placement on continuous EKG monitoring, 02, suction and bag-valve-mask ready, pulse oximetry in place. Fentanyl 50 mg IV and Versed 2 mg IV were given by Dr. Miller who supervised the MCS for 30 minutes. The patient's right hip was easily reduced using gentle traction by Dr. Thompson. Post reduction X-ray showed right hip in good location with no obvious fracture. The patient tolerated the procedure very well. What procedure code(s) is/are reported by both physicians?

82550, 82550-91 x 2 units, 82552, 82552-91 x 2 units

A patient presents to the ER with crushing chest pain radiating down the left arm and up under the chin. There are elevated S-T segments on EKG. The cardiologist orders three serial CPK enzyme levels with instructions that the tests are also to be performed with isoenzymes if the initial tests are elevated on that date of service. The CPK enzyme levels were elevated; therefore, the lab codes would be:

99283

A patient presents to the Emergency Department suffering from an acute exacerbation of his asthma. The ED physician performs an expanded problem focused history. The physician documents a detailed six organ exam. Medical decision making of moderate complexity is performed and includes ordering a chest X-ray and providing a prescription for an inhaler to be used every two hours. What Emergency Department E/M level is reported?

51600, 74455

A patient with recurrent bladder infections presents today for a voiding urethrocystogram. The urologist performs the injection procedure and four views under radiological supervision and interpretation in his office. What codes are reported by the urologist?

99308

A primary care provider admitted a 96 year-old patient to the nursing facility last week. He returns to the nursing home for follow-up. The physician performs an expanded problem focused interval history, a detailed examination, and documents the findings of the patient's lungs, heart, skin, cranial nerves/ sensations, ears, nose, throat, and eyes, and bowel sounds throughout the abdomen. Medical decision making is of low complexity. What E/M level is reported?

88304

A surgeon performs a cholecystectomy for a patient with cholecystitis. The removed organ is sent to the pathologist for gross and microscopic examination. What CPT code is reported for the surgical pathologist's service of examining and reporting on the specimen?

55700, 76942-26

After the patient was placed in the left lateral decubitus position, five needle biopsies were obtained from each prostate lobe under ultrasound guidance. No suspicious areas were noted on the ultrasound evaluation of the prostate, which demonstrated a prostate the size of approximately 68 grams. Procedure was performed in the outpatient facility. What procedure code(s) is/are reported?

00142,99100

An 83 year-old patient is admitted to the ASC for the following procedures: 1. Intraocular lens removal and new intraocular lens insertion, right eye 2. Suture-in intraocular lens, right eye 3. Partial vitrectomy, right eye Anesthesia: Local with MAC Operative Procedure: The operative eye was prepped and draped in a sterile ophthalmic fashion. A drop of betadine solution was placed on the eye. An eyelid speculum was placed. Conjunctival peritomies were made between 11, 2, and 8 o'clock. Two cornea paracentesis were made at 10 and 4 o'clock. A scleral tunnel was made superiorly into clear cornea with a crescent blade. A 3 mm keratome entered the scleral tunnel into the anterior chamber and enlarged it to 6 mm. The conjunctival flaps were repositioned with 10-0 nylon sutures, Xylocaine 1%, preservative free, and instilled subtenons superiorly. Any bleeding was controlled with diathermy. Viscoelastic was instilled into the anterior chamber. A Kuglen instrument was then used to dial out the lens implant from the capsular bag. It was removed from the eye with lens forceps. Viscoelastic deepened the capsular bag and anterior chamber. A posterior chamber lens made by Bausch & Lomb, model P366UV, with a power of +20.5 was inserted through the pupil and sutured into position using the lens eyelets with double armed 10-0 Prolene passing the needle from the posterior segment through the sclera at the 8 and 2 o'clock positions. The knots were rotated into the scleral grooves. The viscoelastic was removed with the irrigation-aspiration tip. The wound was noted to seal watertight. The conjunctival flap was laid back into position. The patient was taken back to the recovery room awake and alert. What anesthesia code(s) is/are reported?

Cataract surgery

An IOL would be inserted in which of the following surgeries?

70543-26, H05.022, B95.7

An MRI is taken to confirm the diagnosis of a subperiosteal abscess (SPA) between the orbital bones and left periorbital caused by a Staphylococcus infection. The MRI is performed first without contrast material and then followed by contrast materials and further sections. An independent radiologist reads the MRI confirming the diagnosis. What are the CPT. and ICD-10-CM codes reported for the radiologist's services?

36569, 76937-26

At the patient's bedside using Xylocaine local anesthesia, aseptic technique, and ultrasound guidance, a 21-gauge needle was used to aspirate the right cephalic vein of a 72 year-old patient. Ultrasound demonstrated vascular needle entry and vessel patency of the cephalic and subclavian veins. 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 SVA RA junction. 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. Permanent ultrasound recordings were placed in the record. A sterile dressing was applied and the patient was discharged in improved condition. What CPT codes are reported for the physician?

11056, L85.9

Chief Complaint: Patient presents today for paring of calluses that have formed on the fifth toes of each foot. Patient is an avid runner who averages 10-15 miles daily. Calluses continue to form as observed over previous visits. Patient is unable to effectively train for upcoming marathon due to increasing discomfort. Dermatologic Review of Systems: Positive for painful skin abnormality of the fifth toe of both the right and left foot. Physical Exam Vital Signs: BP 110/80 Integumentary: Visual examination revealed thick calluses on both the right and left foot. Raised, thickened, and extremely tender to touch. Area is pale yellow in color. Each callus measures 2 cm in size. Shape is round. Arrangement is isolated and has a well-demarcated distribution. Status is worsening due to continued vigorous physical activity. Procedures Lesion Excision/Shaving: Explanation of procedure given and consent obtained. Lesion prepped and draped using sterile technique. Anesthetized using Lido 2% w/sodium bicarb 10:1 solution, less than 1 cc was administered to both left and right fifth toes. A 2.0 cm hyperkeratotic lesion including margins on the both the right and left fifth toe were removed via paring method. Assessment/Plan: Removal of hyperkeratotic lesion from the left and right fifth toes. Await pathology. Specimens sent to lab. Antibiotic ointment was applied and toes wrapped with sterile dressing. Patient advised to abstain from running for 2-3 days and to wear an additional pair of socks when running to prevent or slow callus formation in the future. Specimen for pathology. What CPT* and ICD-10-CM codes are reported?

99214-25, 36415, 80051, E86.0, R11.2, R19.7

Emily, 23 months-old, has severe diarrhea and vomiting. She is extremely dehydrated. She is brought to the outpatient clinic to see her pediatrician. The patient's pediatrician performs an expanded problem focused history that includes four elements for an extended HPI, five elements for an extended ROS, and no PFSH. He performs a general multisystem comprehensive exam of eight organ systems. The physician orders labs to be performed in the office including carbon dioxide, chloride, potassium, and sodium. The nurse performs venipuncture to obtain the blood sample. The physician diagnoses the patient with dehydration and instructs the mother to increase fluid intake to hydrate the baby. The medical decision making is moderate. What procedure and diagnosis codes are reported for this encounter?

42415-RT

Mildred was seen by the surgeon for a right parotid mass measuring 1.7 x 1.1 cm. She complained of pain and did not get relief from antibiotics. A right lateral lobe parotidectomy, with dissection and preservation of the facial nerve, was completed. What procedure code is reported?

92960, 148.91

Operative Report Preoperative Diagnosis: Atrial fibrillation Operation: Direct current cardioversion Procedure: After obtaining informed consent, a direct current cardioversion was per Formed. The patient was given sedation by a member of the anesthesia department. A 120 J of synchronized shock was delivered but atrial fibrillation appeared to persist after a few sinus beats. A 200 J of synchronized biphasic shock was delivered. Once again, sinus rhythm was restored but only for 50 seconds. Then, a second 200 J of synchronized biphasic shock was delivered, and this time sinus rhythm was restored and persisted. Conclusions: Successful direct current cardioversion after a few attempts with restoration of normal sinus rhythm. What are the diagnosis and procedure codes?

G0105, Z85.038, Z86.010

Operative Report Preoperative Diagnosis: Carcinoma of the colon, colonic polyps Postoperative Diagnosis: Carcinoma of the colon, colonic polyps Operative Procedure: Colonoscopy Indications: The patient is a 75 year-old white male patient of Dr. Smith whom I have followed for a number of years for colon polyps. About three years ago, he underwent a radical right hemicolectomy for carcinoma of the hepatic flexure of the colon. His postoperative course has been uneventful to date. He returns now for his routine recommended screening colonoscopy. He appears to understand the risks, rationale, expected outcome, and typical postoperative course and is willing to proceed. Procedure: The patient was placed on the table in the left lateral decubitus position, given intravenous Demerol and propofol for sedation. Following this, a digital rectal exam was performed, which was essentially unremarkable. This was followed by introduction of the Olympus video colonoscope, which was advanced through a relatively normal appearing rectum, sigmoid colon, descending colon, and transverse to the level of the ileocolic anastomosis. This was unremarkable in its appearance and widely patent. The scope was then withdrawn. There were no polyps, telangiectasias, angiodysplasias, or other endoluminal abnormalities encountered. The scope was removed. The patient tolerated the procedure well and was transferred to the recovery area in stable 41-1 condition. What are the diagnosis and procedure codes for this Medicare patient?

33208

Operative Report Preoperative Diagnosis: Symptomatic bradycardia Postoperative Diagnosis: Symptomatic bradycardia Operative Procedure: Implantation of cardiac pacemaker Indications: The patient is an 83 year-old white male who presented with spells of being lightheaded and near syncopal. Evaluation showed him to be in first-degree AV block with symptomatic bradycardia and rates in the 40s. For this reason, consideration was given regarding implantation of a dual-chamber pacemaker. I reviewed the risks, rationale, expected outcome and typical postoperative course of implantation of a cardiac pacemaker. He appears to understand and is willing to proceed. Procedure: The patient was placed on the operating room table in the supine position under satisfactory intra-venous sedation. The skin of the anterior chest wall and base of the neck was prepped and draped in the usual sterile fashion. Following this, the infraclavicular space was thoroughly anesthetized with a 50:50 mixture of 1 percent Lidocaine with epinephrine and 0.5 percent Marcaine. Following this, two separate needle sticks in the subclavian vein were made and two guide wires inserted. Over the first or more proximal guide wire, an introducer sheath was passed and the ventricular lead was introduced. The ventricular lead was taken down into what appeared to be the ventricle. Placement was very difficult as there were many surfaces in the right ventricle that were nonconductive. Eventually we were able to find an area near the tip of the ventricle with R waves in the 7-10 range and capture at 0.5 volt. This being an acceptable parameter, we passed a split sheath introducer over the other wire and an atrial lead slipped into place. It was positioned relatively easily into the atrial appendage. The lead was screwed into position and it returned P waves in the 1.5 range and capture down to 1.1 volt. Overall this was, considering the circumstances and his advanced age, felt to be a reasonable implant site. The leads were secured at the pectoralis major muscle with suture of 2-0 silk and the pacemaker attached without incident. The pacemaker was placed in its pocket. The wound was closed in layers of 2-0 Vicryl subcutaneous and 3-0 Monocryl for a subcuticular skin closure. Tegaderm dressing was applied. The patient tolerated the procedure well and was transported to the recovery area in stable condition. What procedure code is reported?

63045, 63048

Operative Report Preoperative diagnoses: Cervical stenosis C3-C4, cervical spondylosis with myelopathy, and C3-C4 cervical instability. Procedures: Laminectomies at C3 and C4 with bilateral foraminotomies. Description of Procedure: The patient was taken to the operating room. In the supine position, general anesthesia was induced, intra-venous antibiotics administered, a Foley catheter placed, and neurophysiological monitoring leads applied. Mayfield head tongs were applied in the standard surgical fashion. The patient was then transferred into the prone position with all pressure points padded and the Mayfield head tongs attached to the bed firmly. The shoulders were very gently taped down to allow better visualization with fluoroscopy, and then the posterior cervical region was prepped and draped in the usual sterile fashion. The head of the bed was elevated about 30 degrees. An incision was made from approximately the level of C2 to C6 to allow dissection down to the C3 to C4 region. We took care to preserve the ligamentum nuchae and interspinous ligaments outside the level of decompression. Dissection was carried down with Bovie electrocautery through subcutaneous tissues in the midline directly onto the spinous processes. Subperiosteal dissection was then carried out over the C3 and C4 lamina out to the lateral border of the lateral masses. We then closed over a deep drain with #1 Vicryl sutures in the deep fascia, followed by 2-0 Vicryl sutures in the subcutaneous tissues, followed by 3-0 nylon interrupted horizontal mattress sutures. A sterile dressing was applied, the patient was transferred into the supine position, and a cervical collar applied. The drain was hooked up to bulb suction. The Mayfield head tongs were removed. The patient was awakened and extubated. He was able to flex and extend across the ankles and toes, flex and extend across the elbows and wrists bilaterally, and was following commands. The patient was taken to the post-anesthesia care unit in good condition. He tolerated the procedure well and there were no complications. What CPT code(s) is/are reported?

52601, N40.1, N13.8

Operative Report Preoperative diagnosis: Benign prostatic hyperplasia Postoperative diagnosis: Benign prostatic hyperplasia Operation: Transurethral resection of the prostate History: This is a pleasant 72 year-old man who has a urinary obstruction. He opted for a transurethral resection of the prostate, having understood the risks and benefits of surgery. Description of Procedure: Patient was brought to the operating room and given spinal anesthesia. He was then dressed and draped in the usual sterile fashion in the lithotomy position. Pancystoscopy revealed the presence of orthotopic ureteral orifices, a very large median lobe and large kissing lateral lobes. The prostate itself was a short length. The veru was easily identified. The resectoscope sheath was then prepared and inserted with a visual obturator. Using our resectoscope and an electrocautery knife, we resected the lateral lobes and the floor of the prostate. We did this systemati¬cally, maintaining good hemostasis throughout. There was a small amount of tissue anteriorly which was also resected. Tissue was resected proximal to the veru until a nice clear channel was present. Meticulous hemostasis was maintained using coagulation. When meticulous hemostasis was confirmed, we rechecked the bladder again. The ureteral orifices were seen. There was no evidence of any bleeding and the channel was clear. Next, a 22 French three-way Foley catheter was placed and a 30-cubic cm balloon was filled. The patient was then connected to continuous bladder irrigation. Patient was taken to the recovery room in a good condition. What CPT and ICD-10-CM codes are reported?

11606, 15220, 15221, C44.719

Operative Report Preoperative Diagnosis: Possible basal cell carcinoma Postoperative Diagnosis: Basal cell carcinoma Procedure Performed: Excision lesion 4.3 cm x 2 cm left thigh; FTSG from calf to thigh Anesthesia: General by LMA Description of Procedure: After undergoing adequate general anesthesia and DuraPrep prepping, the left thigh and draping with cloth towels and drapes, 0.25 percent Marcaine with epinephrine, total of 30 cc, was used to anesthetize the skin., A lesion slightly over 4 cm was observed on the patient's left thigh. A small portion was removed and sent' for frozen section analysis. This returned basal cell carcinoma. Per prior consent, we removed the remaining lesion with a 0.75 surrounding margin. Due to size and location of this lesion, the decision was made to harvest a full thickness skin graft from his left lower leg. Lower leg was prepped and draped and 0,25 percent Marcaine was injected. Excision of 5 cm x 5 cm full thickness graft was obtained and placed on back table for prep. We returned to the thigh area. All edges were trimmed and the graft was placed into the defect and sewn with a running #3-0 Vicryl. The skin edges were approximated with a running subcuticular #4-0 Vicryl, and further sealed with Dermabond. Hemostasis was well controlled. The wound was irrigated with normal saline. What procedure and diagnosis codes are reported?

20610, M10.062

Operative Report: Diagnosis: Idiopathic gout, left knee. Procedure: Aspiration, left knee Procedure: The knee was prepped and draped in the usual sterile fashion. After the skin was infiltrated with lidocaine, a needle was inserted through the skin into the joint and 10 mL of slightly cloudy yellow fluid was aspirated from the knee. A sterile dressing was applied. There was good apposition and hemostasis, no complications, and the patient tolerated the procedure well. The patient was advised to keep the dressing clean and dry. Instructions were given for signs and symptoms of infection (such as increased pain, swelling, redness, puss, heat or fever). Patient was told to return immediately if any of these developed. Ace bandage was placed. Fluid showed glucose 156, WBC 100. These findings did not seem to indicate septic joint. The patient will be treated with Keflex and Vicodin. She is to ice, rest, and elevate the left knee. She is to contact her doctor on Monday and follow up. She is to return for any fever, redness of the left knee. She understands these instructions and agrees to follow up. What CPT® and ICD-10-CM codes are reported?

88304

Pathology Report Preoperative Diagnosis: Abdominal pain Tissues Submitted: Gallbladder, NOS Gross Description: The specimen is received in formalin in a container labeled "gallbladder." The specimen consists of an unopened gallbladder measuring 6.0 cm in length by up to 2.5 cm in diameter at the tip. The light purple-tan serosal surface is glistening and the duct at the margin measures 0.2 cm. The gallbladder contains a small amount of thick, dark green-brown fluid. The dark pink-tan mucosa is velvety and free of ulceration, erosion, and cholesterolosis. The wall appears slightly thickened. No stones are noted within the gallbladder or loose within the container. Representative sections from the tip, mid portion, and neck region are submitted along with a section demonstrating the duct adjacent to the margin. Microscopic Description: A microscopic examination has been performed. Clinical Diagnosis: Gallbladder: mild chronic cholecystitis What code does the pathologist report?

46606, K64.8

Patient presents with complaints of blood per rectum for the past three months. He has not been experiencing significant abdominal pain, but his bowels have been alternating between constipation and diarrhea. The blood is ribbon-like in appearance. Abdominal exam reveals mild tenderness throughout all quadrants. Proctoscopy is performed with 8 cm of interference. Multiple biopsies are taken, unable to pass regular scope; stricture size scope was advanced past the lesion and visualized the distal rectal mucosa. Digital exam reveals internal hemorrhoids prolapsing. Biopsies sent to lab. Patient scheduled for follow-up visit pending pathology report. What CPT and ICD-10-CM codes are reported?

33533, 33518

Preoperative Diagnoses: 1. Severe multivessel coronary artery occlusive disease with increasing angina 2. Non-Q wave myocardial infarction 3. Hypertension 4. Hypercholesterolemia 5. Non-insulin dependent diabetes mellitus Postoperative Diagnoses: Same Name of Procedure: Coronary artery bypass graft times three (left internal mammary artery to mid LAD, saphenous vein graft to intermediate and saphenous vein graft to distal right coronary artery). Anesthesia: General endotracheal History: This patient is a 72 year-old female with known coronary artery occlusive disease treated medically. She has had increasing angina. She has multiple risk factors. Repeat catheterization showed rather significant progression of disease and recommendation was made for bypass grafting. Ventricular function was well-preserved and was normal. Description of Operative Procedure: The patient was brought to the operating room. After having induced adequate general endotracheal anesthesia, she was prepared and draped in sterile fashion. The segment of saphenous vein was taken from the left thigh through multiple skin incisions. Adequate length of good quality vein was obtained. The thigh was closed in layers with 2-0 and 3-0 Dexon over a tubular Jackson-Pratt drain. The chest was entered through a standard median sternotomy and systemic heparin administered. She was cannulated for bypass with a catheter placed in the distal ascending aorta for perfusion and a venous return catheter in the right atrial appendage. Cardiopulmonary bypass was instituted. After achieving a systemic temperature of 30 degrees, the aorta was cross clamped. Cold potassium cardioplegia was instilled in the aortic root and topical ice saline placed on the heart. We bypassed the intermediate branch first. This was an intramyocardial 2.5 to 3 mm vessel. A segment of reverse vein was sewn end-to-side with 7-0 Prolene and then more cardioplegia instilled down the graft. Next, we bypassed the distal right coronary artery. This was a diffusely diseased vessel with a distal plaque. The distal plaque was bridged. A segment of vein was sewn end-to-side with 7-0 Prolene and again more cardioplegia instilled down the graft. We then sewed a nice size left internal mammary artery to the mid LAD with 7-0 Prolene. The cross clamp was removed and a partial occlusion clamp was placed on the base of the aorta. Two aortotomies were made. The veins were cut to the appropriate length and sewn to the aorta end-to-side with 5-0 Prolene. Vein graft to the right was placed superiorly and the vein graft to the intermediate inferiorly on the aorta. Cardiac action returned promptly in sinus rhythm. She was fully rewarmed, weaned from bypass and decannulated. Cannulation sites were reinforced with 3-0 Prolene. Protamine was administered. Hemostasis was assured. A temporary pacing wire was placed on the right ventricular surface. Two chest tubes were placed in the midline and secured to the skin with -0- Tevdek. The sternum was closed with multiple interrupted wires, linea alba with #1 Tevdek, presternal fascia with -0- Dexon, the skin with 4-0 subcuticular Dexon and Dermabond. She tolerated this procedure well and was returned to the CVR in stable condition. What CPT codes are reported?

69436-50

Preoperative Diagnosis: Bilateral serous otitis media Postoperative Diagnosis: Bilateral serous otitis media Operative Technique: The patient has a history of persistent serous otitis media, unimproved with aggressive antibiotic therapy over the past six months, with recurrent acute otitis and failure on maintenance antibiotics. The patient was brought to the operating room and given a general anesthetic by mask. The ear canals were inspected. A tympanostomy incision was made in the anterior inferior quadrant in a radial incision. A small amount of serous fluid was found in the middle ear space on both sides. An Armstrong grommet ventilation tube was placed in both ears with alligator forceps and suctioned clear. TobraDex drops were placed through the PE tube in each ear. The patient was sent to the recovery room in good condition, discharged with TobraDex drop prescription for two days, and will follow up in the office in two weeks. What procedure code is reported?

36471, 183.811, Z86.718

Preoperative Diagnosis: Painful varicose veins, right lower extremity. Postoperative Diagnosis: Painful varicose veins, right lower extremity with history of DVT. Procedure: Sclerotherapy Anesthesia: Moderate conscious sedation provided. Operative Procedure: This 38 year-old patient was brought to the ASC operating room and placed under moderate conscious sedation. The right lower extremity was prepped and draped in a sterile manner. Varicose veins were identified. Utilizing a 21-gage butterfly needle, multiple varicose veins along the posterior and anterior right lower extremity were injected with polidocanol foam. Symmetrical Class III reticular vessels of 2-3 mm diameter were injected with equal amounts (0.5 cc) of sclerosing solutions: 0.5% POL in the right leg. Distance of vessel sclerosing effect was calibrated from the inferior patellar tendon employing a calibrated measuring window. Patient tolerated the procedure well. A compression stocking was applied, which will need to remain in place for the next 72 hours. Patient was monitored until complete consciousness returned. Total intra-services sedation time: 28 min. Patient was then taken to the recovery room in stable condition. No specimens to lab. What CPT and ICD-10-CM codes are reported?

S46.011A, W00.0XXA

The MRI shows a full-thickness tear of the right rotator cuff consistent with Mr. John's acute symptoms. The symptoms began when he slipped and fell on the ice Thursday. What codes are reported for the diagnoses?

96360, 96361, J7030

The patient was brought to the physician's office in a severely dehydrated condition. She received one hour and 32 minutes of hydration therapy with 1,000 cc of normal saline. What codes are reported?

Z12.39, R92.2, Z80.3

The patient's dense breast tissue made the mammogram unreadable and she is here today for a breast ultrasound. Her mother and sister both have a history of breast cancer. What codes are reported for the diagnosis?

00220; 50 minutes

The physician inserted a ventriculoperitoneal shunt for the purpose of draining a cerebrospinal fluid shunt in a 10 year-old male patient with secondary hydrocephalus resulting from bacterial meningitis. Anesthesia was started at 11 AM and ended at 11:50 AM. The procedure was performed from 11:05 AM to 11:45 AM. What CPT code is reported for the anesthesia and what anesthesia time is reported?

L03.319, B95.62

The site of the patient's cellulitis is within the fold of redundant skin in his apron of fat. It covers approximately 20 cm of skin. A swab from the site was cultured and found to be methicillin resistant Staphylococcus aureus. What code(s) is/are reported for the diagnosis?