CPT Coding Practice Quiz 4

Radial keratotomy

65771 NOTE: A code of 65771 should be used for the radial keratotomy procedure.

Code anesthesia for decortication of left lung.

00542 NOTE: A code of 00542 is used for anesthesia provided to the patient for a decortication of left lung procedure (thoracotomy).

Patient presents to the operating room for excision of three lesions. The 1.5 cm and 2 cm lesions of the back were excised with one excision. The 0.5 cm lesion of the hand was excised. The pathology report identified both back lesions as squamous cell carcinoma. The hand lesion was identified as seborrheic keratosis.

11604, 11420 NOTE: If two lesions are removed with one excision, only one excision code would be reported. 1.5 cm back + 2 cm back = 3.5 cm back malignant lesion A code of 11604 is used for the excision of the 3.5 cm total malignant back lesions. A code of 11420 is used for the excision of the 0.5 cm benign hand lesion.

Patient presents to the emergency room with lacerations sustained in an automobile accident. Repairs of the 3.3 cm skin laceration of the left leg that involved the fascia, 2.5 cm and 3 cm lacerations of the left arm involving the fascia, and 2.7 cm of the left foot, which required simple sutures, were performed. Sterile dressings were applied.

12034, 12002-59 NOTE: An intermediate repair requires one or more of the deeper layers of subcutaneous tissue and superficial fascia, as well as the skin be closed in layers. Wounds that require closure of subcutaneous tissue or more than one layer of tissue beneath the dermis should be coded as intermediate. 3.3 cm leg + 2.5 cm arm + 3 cm arm = 8.5 cm total for intermediate repair 2.7 cm foot for simple repair A code of 12034 is used for the intermediate repair of lacerations to the leg and arm totaling 8.5 cm. An additional code of 12002 is needed for the simple repair of the 2.7 cm laceration to the foot. Modifier -59 is added to the 12002 code because it is a distinct procedural service.

Patient presents to the emergency room following an assault. Examination of the patient reveals blunt trauma to the face. Radiology reports that the patient suffers from a fracture to the frontal skull and a blow-out fracture of the orbital floor. Patient is admitted and taken to the operating room where a periorbital approach to the orbital fracture is employed and an implant is inserted.

21390 NOTE: A code of 21390 is used for the procedure to fix the orbital fracture with an implant (open treatment of orbital fracture, periorbital approach, with implant).

Chronic nontraumatic rotator cuff tear. Arthroscopic procedure of the shoulder with removal of foreign body and open rotator cuff repair

23412, 29819-59 NOTE: Code both the arthroscopic procedure and the open procedure. Both need to be reported because there were two separate procedures. Modifier -59 must be added to code 29819 because it is a component of the comprehensive procedure 23412. That is allowed if an appropriate modifier is used per NCCI edits.

Patient with laryngeal cancer has a tracheoesophageal fistula created and has a voicebox inserted.

31611 NOTE: A code of 31611 is needed to code the tracheoesophageal fistula that was created and the insertion of the voicebox (construction of tracheoesophageal fistula and insertion of a laryngeal speech prosthesis). No additional codes are needed as the one combination code listed above includes both procedures.

Patient was admitted with hemoptysis and underwent a bronchoscopy with transbronchial lung biopsy. Following the bronchoscopy, the patient was taken to the operating room where a left lower lobe lobectomy was performed without complications. Pathology reported large cell carcinoma of the left lower lobe.

31628, 32480 NOTE: Code 31628 is for the bronchoscopy with biopsy and an additional code 32480 for the lobectomy.

Patient is admitted with alcohol cirrhosis and has a TIPS procedure performed.

37182 NOTE: A code of 37182 is needed for the placement of a tunneled implanted venous access port [insertion of transvenous intrahepatic portosystemic shunts (TIPS)]. No additional codes are needed.

Laparoscopic retroperitoneal lymph node biopsy

38570 NOTE: A code of 38570 is needed for the laparoscopy with retroperitoneal lymph node biopsy. No additional codes are needed.

Hydrocelectomy of spermatic cord

55500 NOTE: In order to code the hydrocelectomy of the spermatic cord procedure, a code of 55500 should be used (puncture aspiration of hydrocele).

Patient underwent anoscopy followed by colonoscopy. The physician examined the colon to 60 cm.

45378 NOTE: A code of 45378 should be used for the colonoscopy (colonoscopy, flexible; diagnostic, including collection of specimens). A separate code is not needed for the anoscopy as the code for the colonoscopy includes an anoscopy.

Patient was admitted for right upper quadrant pain. Workup included various X-rays that showed cholelithiasis. Patient was taken to the operating room where a laparoscopic cholecystectomy was performed. During the procedure, the physician was unable to visualize through the ports, and an open cholecystectomy was elected to be performed. An intraoperative cholangiogram was performed. Pathology report states acute and chronic cholecystitis with cholelithiasis.

47605 NOTE: Only one code (47605) is needed to code the cholecystectomy and the cholangiography.

Nephrectomy with resection of half of the ureter

50220 NOTE: A code of 50220 should be used for the nephrectomy with resection of half of the patient's ureter (neophrectomy, including partial ureterectomy, any open approach including rib resection). This code includes both the nephrectomy and resection. No additional codes are needed.

Male with urinary incontinence. Sling procedure was performed 6 months ago, and now the patient has returned for a revision of the sling procedure.

53442 NOTE: A code of 53442 should be used for the revision of the sling procedure that was previously done (removal or revision of sling for male urinary incontinence).

Patient has been diagnosed with carcinoma of the vagina, and she has a radical vaginectomy with complete removal of the vaginal wall.

57111 NOTE: In order to code a radical vaginectomy with a complete removal of the vaginal wall, a code of 57111 is needed (vaginectomy, complete removal of vaginal wall). No additional codes are needed.

Patient is 24 weeks pregnant and arrives in the emergency room following an automobile accident. No fetal movement or heartbeat noted. Patient is taken to the OB ward where prostaglandin is given to induce abortion.

59855 NOTE: A code of 59855 should be used for an induced abortion (induced abortion, by 1 or more vaginal suppositories with or without cervical dilation, including hospital admission and visits, delivery of fetus). No additional codes are needed.

Unilateral partial thyroidectomy

60210 NOTE: A code of 60210 should be used for a unilateral partial thyroidectomy (partial thyroid lobectomy, unilateral).

Patient with Parkinson's disease is admitted for insertion of a brain neurostimulator pulse generator with one electrode array.

61885 NOTE: In order to code insertion of a brain neurostimulator pulse generator with one electrode array, a code of 61885 should be used (insertion or replacement of cranial neurostimulator pulse generator or receiver; with connection to a single electrode array). This code encompasses the insertion with the electrode. No additional codes are needed.

Myringoplasty

69620 NOTE: A code of 69620 should be used for a myringoplasty.

Insertion of cochlear device inner ear

69930 NOTE: In order to code the insertion of a cochlear device in the inner ear, a code of 69930 (cochlear device implantation) should be used. No additional codes are needed.

Patient undergoes X-ray of the foot with three views.

73630 NOTE: A code of 73630 should be used for the X-ray of the foot with three different views (radiologic examination; complete, minimum of 3 views). No additional codes are needed as this code is good for up to three views.

A physician orders a lipid panel on a 54-year-old male with hypercholesterolemia, hypertension, and a family history of heart disease. The lab employee in his office performs and reports the total cholesterol and HDL cholesterol only.

82465, 83718 NOTE: In order to use the code for the panel, every test must have been performed.

Patient presents to the emergency room complaining of right forearm/elbow pain after racquetball last night. Patient states that he did not fall but overworked his arm. Past medical history is negative and the physical examination reveals the patient is unable to supinate. A four-view X-ray of the right elbow is performed and is negative. The physician signs the patient out with right elbow sprain. Prescription of Motrin is given to the patient.

99281-25, 73080 NOTE: One code is needed for the emergency room visit (99281-25), and one code is needed for the X-ray of the elbow minimum of three views (73080).

The physician provided services to a new patient who was in a rest home for an ulcerative sore on the hip. A problem-focused history and physical examination were performed, and a straightforward medical decision was made.

99324 NOTE: This scenario is an example of a domiciliary visit to a new patient in a rest home. Since a problem-focused history and exam as well as straightforward decision making was completed, code 99324 should be used.