OST-247 - Procedure Coding - Chapters 6 - 8

Hamstring muscle neurectomy

27325

Removal of woodlike item deep in the knee area

27372

Primary suture of infrapatellar tendon

27380

Knee arthrodesis

27580

Superficial biopsy of soft tissue of leg

27613

Arthrotomy of ankle with synovectomy

27625

Radical resection of tumor of the calcaneus

27647

I&D of bursa of left wrist

25031-LT

Arthrotomy with exploration of midcarpal joint

25040

Partial excision of ulna for osteomyelitis

25150

Radical resection for tumor of ulna

25170

Drainage of abscess of finger

26010

Radical resection of sarcoma of the soft tissue of the hand-3.5 cm

26118

Finger sesamoidectomy

26185

Correction of claw finger

26499

Open tenotomy of hip flexor of right side

27005-RT

Ischial bursa excision

27060

Injection procedure for hip arthrography

27093

Bilateral pelvis osteotomy

27158

Closed treatment of coccygeal fracture

27200

Removal of indwelling tunneled pleural catheter with cuff

32552

Incision of flexor tendon sheath of wrist

25001

Thoracostomy with rib resection for empyema

32035

Open biopsy of pleura

32098

Thoracotomy for exploration

32100

Thoracotomy for postoperative complications

32120

Pneumonostomy with open drainage of cyst

32200

Parietal pleurectomy

32310

Percutaneous needle biopsy of lung

32405

Temporomandibular joint arthrotomy

21010

Excision of mandible

21025

Incision and drainage of deep abscess of the soft tissue of the thorax

21501

Superficial biopsy of soft tissue of back

21920

Reinsertion of spinal fixation device

22849

I&D in shoulder area for deep abscess

23030

Incision of bone cortex of shoulder

23035

Partial acromionectomy with release of coracoacromial ligament

23130

Single tendon tenotomy of shoulder

23405

Open treatment of chronic sternoclavicular dislocation

23530

I&D of elbow for deep abscess

23930

Arthrotomy of elbow with removal of foreign body

24000

Arthrotomy of elbow with capsular excision for capsular release

24006

Olecranon bursa excision

24105

Removal of humeral and ulnar prosthesis components with debridement and synovectomy

24160

Manipulation of trimalleolar ankle fracture with closed treatment

27818

Fasciotomy of toe

28008

Excision of two interdigital neuromas

28080 and 28080

Metatarsectomy

28140

Phalangectomy of three toes

28150 and 28150 and 28150

Interphalangeal joint excisions of the proximal end of two toes

28160 and 28160

Radical resection of tumor of the phalanx of the toe

28175

Flexor tenolysis, foot, single tendon

28220

Closed treatment of talus fracture

28430

Triple arthrodesis

28715

Application of long arm cast

29065

Application of shoulder to hand cast

29065

Strapping of wrist

29260

Arthroscopy of shoulder with synovial biopsy

29805

Surgical arthroscopy of the shoulder with capsulorrhaphy

29806

Athroscopic partial shoulder synovectomy

29820

Shoulder arthroscopy for complete synovectomy

29821

Extensive debridement of shoulder via arthroscope

29823

Arthroscopic removal of a foreign body in the elbow

29834

Diagnostic arthroscopy of wrist with synovial biopsy

29840

Wrist arthroscopy with synovial biopsy

29840

Arthroscopy of wrist for internal fixation of fracture

29847

Endoscopic release of the transverse carpal ligament of the wrist

29848

Surgical arthroscopy of knee with medial meniscal transplantation

29868

Arthroscopy of knee with synovial biopsy

29870

Lateral release via arthroscopy of knee

29873

Endoscopic plantar fasciotomy

29893

Subtalar joint arthroscopy with removal of foreign body

29904

Subtalar joint arthroscopy with subtalar arthrodesis

29907

Primary rhinoplasty with elevation of nasal tip

30400

Septoplasty with cartilage scoring

30520

Intranasal repair of choanal atresia

30540

Lysis intranasal synechia

30560

Septal dermatoplasty

30620

Repair of nasal septal perforation

30630

Superficial bilateral cautery of mucosa of inferior turbinates

30801

Anterior, simple control of nasal hemorrhage

30901

Ethmoidal artery ligation

30915

Therapeutic fracture of nasal inferior turbinate

30930

Partial horizontal laryngectomy

31370

Epiglottidectomy

31420

Indirect laryngoscopy for diagnosis

31505

Indirect laryngoscopy with foreign body removal

31511

Direct operative laryngoscopy with biopsy

31535

Direct laryngoscopy with stripping of vocal cords

31540

Flexible fiberoptic laryngoscopy with removal of foreign body

31577

Flexible fiber-optic laryngoscopy with removal of lesion

31578

Laryngoplasty for laryngeal web with indwelling keel

31580

Laryngeal reinnervation by neuromuscular pedicle

31590

Thoracoscopy with removal of a clot from the pericardial sac

32658

Repair of a lung hernia via the chest wall

32800

Preoperative and postperative diagnosis: Excessive fluid in pericardial sac Procedure: Initial removal of fluid from pericardial sac After the patient was prepped and draped in the usual fashion, general anesthesia was administered. Using the sternum as an anatomical landmark, a long needle was placed below the sternum. The needle was advanced into the pericardial sac, and 5 cc of fluid were removed and sent to pathology for review. The patient was stable, and the wound was dressed. The patient was sent to the recovery area in satisfactory condition.

33010 (In the Index, reference the main term Pericardiocentesis. Code range 33010-33011 is listed. Reference the code range in the main section of the CPT manual.)

Tube pericardiostomy

33015

Complete pericardiectomy

33030

Resection of pericardial tumor

33050

Resection of external cardiac tumor

33130

Preoperative and postoperative diagnosis: Cardiac ischemia Procedure: Thoracotomy for transmyocardial laser revascularization Anesthesia: General The patient was prepped and draped in the usual sterile fashion and placed under general anesthesia. A 12-cm incision was made on the left side of the chest. The incision was made between the ribs and was carried down to expose the heart's surface. An ischemia was visualized on the right side of the heart. The laser was inserted into the cardiac area, and between heartbeats, 15 channels were made and pressure was applied to close the opened areas. Prior to closure of the incision, there was no significant bleeding from the cardiac tissue. The laser was removed, the incision was closed, and dressings were placed on the wound. The patient tolerated the procedure with no complications and was sent to the recovery area in stable condition.

33140 (In the Index, reference the main term Revascularization, then transmyocardial. Review the code range listed in the main section of the CPT manual.)

Direct repair of aneurysm with patch graft by arm incision for ruptured aneurysm of the axillary-brachial artery

35013

Repair of congenital arteriovenous fistula of head and neck

35180

Repair, acquired arteriovenous fistula, thorax and abdomen

35189

Preoperative and postperative diagnosis: Bleeding from pacemaker site Procedure: Relocation of skin pocket for pacemaker With the patient under general anesthesia, the previous skin pocket was opened, and the generator was removed. The skin pocket was explored and bleeding stopped in the area. The generator was then relocated, and the pocket was closed with sutures. A sterile dressing was applied. The patient was in stable condition.

33222 (In the Index, reference the main term Pacemaker, Heart, Revision, then relocate pocket, then chest.)

Procedure: Replacement of pacemaker generator The patient was brought to the operating room and was prepped and draped in the usual fashion. The patient was consciously sedated. The previous subcutaneous right infraclavicular skin pocket was identified, and an incision was made in this area to remove the previously inserted generator. The atrial and ventricular leads were checked. Since the pocket was clean, it was determined that the same pocket could be used for the reinsertion of a new generator. A pulse generator was placed and tested. Noting no complications, the physician sutured the site. The patient was found to be in stable condition and was returned to the recovery room in satisfactory condition.

33228 (Replacement of the pulse generator. The atrial and ventricular leads identify this as a dual chamber.)

Direct repair of blood vessel of the neck

35201

Repair of blood vessel with vein graft, intraabdominal

35251

Modified maze procedure for operative tissue ablation and reconstruction of atria

33254

Preoperative diagnosis: Chest wound Postoperative diagnosis: Foreign body on the surface of the heart Anesthesia: General Procedure: Exploratory cardiotomy This 59-year-old patient sustained an injury to his chest while loading logs onto a truck at work. He was brought to the ER, and imaging showed a chest wound with a possible foreign body on the surface of the heart. He was then taken to the operating room for exploration of the area. An incision was made in the sternum, and the heart was exposed. A foreign body was visualized on the heart and was removed. There were no penetrating cardiac wounds to be sutured. The operative wound was closed, and the patient was sent to the recovery area in stable condition.

33310 (In the Index, reference the main term Cardiotomy. Review the code range listed in the main section of the CPT manual.)

Valvuloplasty, aortic valve; open, with cardiopulmonary bypass

33390

Incision of subvalvular tissue for discrete subvalvular aortic stenosis

33415

Aortoplasty completed for supravalvular stenosis

33417

Replacement, mitral valve, with cardiopulmonary bypass

33430

Tricuspid valve valvectomy with cardiopulmonary bypass

33460

Valvotomy, pulmonary valve, closed heart; via pulmonary artery

33471

Replacement, pulmonary valve

33475

Infundibular stenosis corrected by right ventricular resection (commissurotomy)

33476

Repair of anomalous coronary artery from pulmonary artery origin; by graft, without cardiopulmonary bypass

33503

Preoperative and postoperative diagnosis: Thrombus and atherosclerosis of iliac artery Procedure: Iliac thromboendarterectomy The patient was prepped and draped in the usual sterile fashion and placed under general anesthesia. An abdominal incision was made, and dissection past the large and small bowel occurred to expose the iliac artery. Clamps were placed to isolate the iliac area. A longitudinal incision was made in the artery, and the thrombus and plaque were removed. Then the area was sutured. The diameter of the artery was significantly improved after the procedure. Blood loss was minimal, and the wounds were closed and dressed. No complications were noted. The patient was sent to recovery.

35351 (In the Index, reference the main term Thromboendarterectomy, then iliac artery. Review the code range listed in the main section of the CPT manual.)

Preoperative diagnosis: Possible hemorrhage Postoperative diagnosis: Abdominal hemorrhage of previous operative area This patient underwent abdominal surgery 36 hours ago. An exploration of the abdominal incision site is planned. After being placed under general anesthesia, the original abdominal incision site was reopened. A small bleeding site was noted, and electrocautery was used. The wound was closed. The patient tolerated the procedure and was sent to the recovery area.

35840 (In the Index, reference the main term Exploration, then blood vessel, then abdomen.)

Neonatal Intensive Care Unit Note This 4-day-old neonate is suspected to be anemic. A blood sample was ordered by the attending, who completed the collection due to the size of the neonate. Procedure: Venipuncture for collection of venous blood, nonroutine, upper-extremity vein

36406 (In the Index, reference the main term Venipuncture, then infant, then percutaneous. Review the code range listed in the main section of the CPT manual. Because the case does not specify the vein used, select Other.)

Preoperative diagnosis: Malignant carcinoma of breast Postoperative diagnosis: Same This 39-year-old female presents today for insertion of catheter for central venous access for chemotherapy. The patient was placed in the supine position and sterile prep occurred. Lidocaine was injected into the right clavicular area. A needle was inserted into the right subclavain vein, and a J-wire was then passed into place. A tunnel was created from the area over the clavicle to the venotomy site, and a dilator was placed over the wire and then dilated. The catheter was then placed into the subclavian vein and secured. The area was flushed, and incisions were sutured. There was minimal blood loss, and the patient was stable and sent to the recovery area.

36558 (In the Index, reference the main term Insertion, then catheter, then venous. Review the range listed in the main section of the CPT manual.)

Preoperative diagnosis: Leukemia, in remission Postoperative diagnosis: Same Procedure: Tunneled venous access port removal Reason for procedure: This 8-year-old male completed chemotherapy. The patient was prepped and draped in the normal sterile fashion. His right side was anesthetized, and an incision was made above the port area. The port was a tunneled device with a subcutaneous port that was peripherally inserted. The incision was taken down to the device, which was freed. The retention sutures were identified and cut. After confirmation that the device was free, it was removed. Hemostasis was obtained, and the wound was closed in layers using 3-0 nylon. A sterile dressing was applied to the area. Patient vitals were taken, and the patient was noted to be stable. He was sent to the recovery room in stable condition.

36590 (In this case, the use of the venous access device is the starting point for finding this code. In the Index, reference the main term Removal, then the subterm infusion pump, then intravenous.)

The "AV" in the term "AV node" means _____ node.

atrioventricular

When the impulse reaches the junction of the atria and the ventricles, the _____ node directs the impulse to the ventricles, causing them to contract.

atrioventricular

The heart is divided into ____ chambers.

four

Blood enters the right atrium through the superior vena cava from the upper part of the body and through the _____ _____ _____from the lower part of the body.

inferior vena cava

The middle layer of the heart is the _____.

myocardium

Fluid is drained from the pericardial space by a long needle. The needle is exchanged for an indwelling catheter. This procedure is called tube _____.

pericardiostomy

The heart is enclosed in the _____, a double-walled sac.

pericardium

The _____ node is found where the superior vena cava and the right atrium meet.

sinoatrial