Chapter 9 Review Exam

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?

30300, T17.1XXA 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.

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)

30906-50 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.

A patient with a diagnosis of chronic sphenoidal sinusitis undergoes a bilateral sinusotomy. While the provider examines the diseased sphenoid sinus, she takes a biopsy of the sphenoidal masses and removes the mucosa with several polyps. Transseptal sutures are placed and the intraoral incision is closed in a single layer. The nose is packed and external nasal dressings are placed. What CPT® and ICD-10-CM codes are reported?

31051-50, J32.3, J33.8 Rationale: In the CPT® Index look for Sinusotomy/Sphenoid Sinus directing you to codes 31050, 31051. 31051 is appropriate for the reporting of biopsies taken in the sphenoids as well as removal of mucosa and polyps. The procedure was an open procedure; it was not performed endoscopically. Modifier 50 is appended to indicate the procedure was performed bilaterally. Look in the ICD-10-CM Alphabetic Index for Sinusitis/sphenoidal directing you to code J32.3 (this is for chronic) and Polyp, polypus/sinus (sphenoidal) is J33.8. Verification in the Tabular List confirms code selection.

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?

31571, J38.5 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.

A patient presents to the emergency department (ED) with a sucking chest wound. The ED provider on duty performs an immediate tube thoracostomy in order to restore normal breathing to the patient before rushing him to surgery for another provider to address other injuries. What CPT® code is reported by the ED provider?

32551 Rationale: In the CPT® Index look for Thoracostomy/Tube which directs you code 32551. The ED provider would not be performing the surgery for other injuries so we would not bundle the tube insertion into any of those procedures.

The pulmonologist in a multispecialty group refers a patient to the otolaryngologist because he thinks that the shortness of breath that the patient is experiencing may be due to sinusitis and laryngopharyngeal reflux (LPR). The otolaryngologist decides to perform a rigid bilateral nasal endoscopy to get a better look at what is going on in the sinuses and a flexible laryngoscopy to determine if (LPR) is contributing to the problems because he could not get adequate visualization on manual exam. First the bilateral nasal endoscopy is performed and the otolaryngologist diagnosis chronic pansinusitis. Next a flexible fiberoptic laryngoscope is introduced nasally and the larynx and trachea are inspected. The diagnosis is chronic laryngitis/tracheitis and LPR. He prescribes Singulair and Nexium and proposes endoscopic surgery will be considered in the future if the current treatment does not fully take care of the problems experienced by the patient. What CPT® and ICD-10-CM codes are reported for the procedure?

31575, 31231-59, J32.4, J37.1 Rationale: The nasal endoscopy and laryngoscopy can both be performed via the nasal cavity. In the CPT ®Index look for Laryngoscopy/Fiberoptic/Diagnostic directing you to code 31575. Next in the CPT® Index look for Endoscopy/Nose/Diagnostic which refers you to 31231, 31233, 31235. The correct code is 31231 because there is no mention of entering the maxillary or sphenoid sinuses. Modifier 50 is not needed because 31231 describes a unilateral or bilateral procedure. Code 31231 is listed as a separate procedure; therefore, modifier 59 is appended. These procedures are indeed separate because a nasal endoscope was used and then the provider used a flexible laryngoscope. The otolaryngologist has diagnosed chronic pansinusitis. In the ICD-10-CM Alphabetic Index look for Pansinusitis (chronic) directing you to J32.4. Also diagnosed is chronic laryngotracheitis. In the Alphabetic Index look for Laryngotracheitis/chronic directing you to J37.1. Code J37.1 encompasses the LPR and the chronic laryngitis and tracheitis.

An ICU diabetic patient who has been in a coma for weeks as the result of a head injury becomes conscious and begins to improve. The provider performs a tracheostomy closure and since the scar tissue is minimal, the plastic surgeon is not needed. What CPT® and ICD-10-CM codes are reported for this procedure?

31820, Z43.0, S06.9X9D, E11.9 Rationale: In the CPT® Index look for Tracheostomy/Surgical Closure/without Plastic Repair which refers you to code 31820. In the ICD-10-CM Alphabetic Index look for Attention (to)/tracheostomy which directs you to Z43.0. It is reported as a primary code because the closure of the tracheostomy is the reason for the procedure performed. Diabetic coma (E11.641) is not reported because the coma resulted from a head injury not diabetes. Coma would not be reported because it is resolved and the patient no longer has it. In the Alphabetic Index look for Injury/head/with loss of consciousness directing you to S06.9-. Verification in the Tabular List shows the correct code to be S06.9X9D for unspecified intracranial injury with LOC of unspecified duration, subsequent encounter. Next, look for Diabetes/type 2 which refers you to E11.9. Verification in the Tabular List confirms code selection.

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

32120 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.

What CPT® code is reported for a percutaneous needle biopsy of mediastinum?

32405 Rationale: In the CPT® Index look for Biopsy/Mediastinum/Needle referring you to code 32405. Confirm code selection in the numeric section.

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?

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

What CPT® codes are reported for an extrapleural pneumonectomy as well as empyemectomy performed during the same surgical session?

32445, 32540-51 Rationale: In the CPT® Index, look for Pneumonectomy. By looking at codes 32440-32445 we see that code 32445 represents the extrapleural pneumonectomy. Next in the CPT® Index look for Empyemectomy which directs us to code 32540. There is also a parenthetical statement under code 32540 instructing us to report the correct lung removal code with 32540 if performed.

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 thintercostal 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?

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

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. The What CPT® code is reported?

32666 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.

A patient with AML (Acute Myelogenous Leukemia) has just learned his sister is an HLA (Human Leukocyte Antigen) match for him. Stem cells taken from the donor (the patient's sister) will be transplanted into the patient to help with his treatment. What CPT® code is used to report the harvesting of the stem cells from the donor (his sister)?

38205 Rationale: In the CPT® Index look for Stem Cell/Harvesting which refers you to 38205, 38206. Code selection is based on whether it is allogenic (from a donor) or autologous (from the patient). This is allogenic making 38205 the correct code choice.

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?

38510-50, 38525-51-RT 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.

A patient is seen in the OR for removal of a hepatic adenoma which has invaded the diaphragm. The resection of the diaphragm portion of the mass was repaired with primary sutures. What CPT® code is reported for the diaphragmatic mass resection?

39560 Rationale: In the CPT® Index look for Resection/Diaphragm which refers you to code range 39560, 39561. Code selection depends on the type of repair. The repair is with primary sutures which is considered a simple repair making 39560 the correct code choice.

A returning 2 year-old child is seen in the pediatrician's office with stridor and a bark like cough. The pediatrician examines the child quickly and determines the child has stridulous croup. The child is given a nebulizer breathing treatment in the office to improve PO 2 levels. Medication used is breathable Epinephrine. What CPT® and ICD-10-CM codes are reported?

94640, J38.5 Rationale: To code the nebulizer treatment look in the CPT® index for Inhalation Treatment/for Airway Obstruction Pressurized or Nonpressurized directing you to code 94640. This code accurately represents a nebulizer treatment. A definitive diagnosis of stridulous croup is given and the signs and symptoms the child presented with is not coded (ICD-10-CM guideline I.B.4 or I.C.18.b). In the ICD-10-CM Alphabetic Index look for Croup/stridulous directing you to J38.5. Verification in the Tabular List confirms code selection.

What ICD-10-CM code is reported for a patient that has RSV (respiratory syncytial virus) pneumonia?

J12.1 Rationale: RSV stands for respiratory syncytial virus. In the ICD-10-CM Alphabetic Index look for Pneumonia/respiratory syncytial virus which refers you to code J12.1. Verify code selection in the Tabular List.

Provide the correct ICD-10-CM code(s) for acute RSV bronchiolitis.

J21.0 Rationale: RSV is the acronym for respiratory syncytial virus. In the ICD-10-CM Alphabetic Index look for Bronchiolitis. Acute is a nonessential modifier. Bronchiolitis (acute) (infective) (subacute)/due to/respiratory syncytial virus refers you to J21.0. Verification in the Tabular List confirms code selection.

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

J44.0, J20.9 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.

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)?

J45.901 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.

What anatomical cavity or compartment contains all of the thoracic viscera except the lungs?

Mediastinum Rationale: The mediastinum extends from the sternum to the vertebral column and contains all the thoracic viscera, except the lungs.

What is the name of the structure made of bone and cartilage separating the nostrils?

Nasal septum Rationale: A septum is a partition. The nasal septum separates the nostrils.

Which statement is TRUE regarding coding COPD with asthma in ICD-10-CM?

The type of asthma is reported along with the COPD. Rationale: For COPD with asthma, ICD-10-CM Tabular List provides instructional notes to code also type of asthma, if applicable (J45.-) and use additional code for certain type of external causes listed in the Tabular List.

In ICD-10-CM, codes for Factors Influencing Health Status and Contact with Health Services begin with which letter?

Z Rationale: Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01-V91) will be reported in ICD-10-CM with Factors Influencing Health Status and Contact with Health Services (Z00-Z99).