CPT Information

Name some chronic wounds requiring comprehensive care.

1. Arterial/venous ulcers 2. Diabetic foot ulcers 3. Pressure ulcers 4. Autoimmune related wounds 5. Cancer-related wounds 6. Peripheral vascular disease 7. Venous stasis ulcers

Name some diagnostic ancillary services?

1. Audiology 2. Radiology 3. Pulmonary testing 4. Clinical lab

Name some patient conditions where you might want to consult wound care ancillary services.

1. Diabetes 2. Vascular problems 3. Medication 4. Infections 5. Poor nutrition 6. Ostomy

What are the 3 broad categories of ancillary services?

1. Diagnostic 2. Therapeutic 3. Custodial

Name some custodial ancillary services.

1. Hospice 2. Home health 3. Nursing home care

Name some ancillary services you may need to consult postoperatively.

1. Nutrition 2. Respiratory therapy 3. Physical therapy 4. Occupational therapy 5. Wound care 6. Social services 7. Discharge planning 8. Home health

Name some therapeutic ancillary services.

1. PT 2. OT 3. Speech therapy 4.Radiation 5. Nutrition 6. Weight management 7. Pharmacy 8. DME

There are three locations for ultrasound service codes:

76506-76886: Radiology codes for diagnostic ultrasound services. Ultrasonic guidance codes are in the range 76930-76999. •93880-93990: Medicine codes for vascular studies. •93303-93352: Medicine codes for echocardiography.

pathology and laboratory

80000-89398

organ and disease-oriented panels

80100-80076

drug testing

80100-80103

therapeutic drug assays

80150-80440

evocative/suppression testing

80400-80440

urinalysis

81000-81099

chemistry

82000-84999

hematology and coagulation

85002-85999

immunology

86000-86849

transfusion medicine

86850-86999

microbiology

87001-87999

anatomic pathology (postmortem)

88000-88099

cytopathology

88104-88199

cytogenic studies

88230-88299

surgical pathology

88300-88399

in vivo (transcutaneous) lab procedures

88720-88741

other procedures

89250-89398

B

A 14 year-old boy was thrown against the window of the car on impact. The resulting injury was a star-shaped pattern cut to the top of his head. In the ED, the MD on call for plastic surgery was asked to evaluate the injury and repair it. The total length of the intermediate repair was 5+4+4+5 cm (18 cm total). The star-like shape allowed the surgeon to pull the wound edges together nicely in a natural Y-plasty in two spots. What CPT® code is reported for the repair? A) 13121 B) 12035 C) 14041 D) 14040

A

A 32-year-old female is having excision of a mass in her left breast. The physician makes a curved incision along the inferior and medial aspect of the left areola. A breast nodule, measuring approximately 1 cm in diameter, was identified. It appeared to be benign. It was firm, gray, and discrete. It was completely excised. There was no gross evidence of malignancy. The bleeding was controlled with electrocautery. The skin edges were approximated with a continuous subcuticular 4-0 Vicryl suture. Indermil tissue adhesive was applied to the skin as well as a dry gauze dressing. What is the correct CPT® code to report for this example? A) 19120-LT B) 19125-LT C) 19301-LT D) 19370-LT

C

A 45 year-old male with a previous biopsy positive for malignant melanoma presents for definitive excision of the lesion. After induction of general anesthesia, the patient is placed supine on the OR table, the left knee prepped and draped in the usual sterile fashion. IV antibiotics are given as the patient had previous MRSA infection. The previous excisional biopsy site on the left knee measured approximately 4 cm and was widely ellipsed with a 1.5 cm margin. The excision was taken down to the underlying patellar fascia. Hemostasis was achieved via electrocautery. The resulting defect was 11cm x 5cm. Wide advancement flaps were created inferiorly and superiorly using electrocautery. This allowed skin edges to come together without tension. The wound was closed using interrupted 2-0 Monocryl and 2 retention sutures were placed using #1 Prolene. Skin was closed with a stapler. What CPT® code(s) is/are reported? A) 15758 B) 14301, 11606-51 C) 14301 D) 15738, 11606-51

B

A 63 year-old patient arrives for skin tag removal. As previously noted at her last visit, she has 3 located on her face, 4 on her shoulder and 15 on her back. The physician removes all the skin tags with no complications. What CPT® code(s) is/are reported for this encounter? A) 11200, 11201-52 B) 11200, 11201 C) 11201, 11201-51 D) 11201

Radiology

A branch of medicine that uses radiant energy to diagnose and treat patients. The term originally referred to the use of x-rays to produce radiographs but now commonly applied to all types of medical imaging.

D

A localization wire placement in the lower outer aspect of the right breast was performed by a radiologist the day prior to this procedure. During this operative session, the surgeon created an incision through the wire track and the wire track was followed down to its entrance into breast tissue. A nodule of breast tissue was noted immediately adjacent to the wire. This entire area was excised by sharp dissection, sent to pathology and returned as a benign lesion. Bleeders were cauterized, and subcutaneous tissue was closed with 3-0 Vicryl. Skin edges were approximated with 4-0 subcuticular sutures and adhesive strips were applied. The patient left the operating room in satisfactory condition. What is/are the correct code(s) for the surgeon's service? A) 19120-RT B) 11400-RT C) 19125-RT, 19285 D) 19125-RT

B

A patient arrives at the hospital from a nursing home with a stage 3 bed sore on his left hip. List the ICD-10-CM code for the bedsore. A) L89.209 B) L89.223 C) L97.823 D) L89.323

A

A patient has a squamous cell carcinoma on the tip of the nose. After prepping the patient and site, the physician removes the tumor (first stage) and divides it into seven blocks for examination. Seeing positive margins, he removes a second stage, which he divides into five blocks. The physician again identifies positive margins. He performs a third stage and divides the specimen into three blocks proving to be clear of the skin cancer. What are the correct CPT® codes to report for this example? A) 17311, 17312, 17312, 17315, 17315 B) 17311, 17312, 17312 C) 11640 x 3 D) 11440 x 3

A

A patient is diagnosed with actinic keratosis of the chest and arms. She presents to her physician's office for destruction of these lesions. Using cryosurgery, the physician destroys 4 lesions on the right arm, 4 lesions on the left forearm and 4 lesions on the chest. What CPT® and ICD-10-CM codes are reported? A) 17000, 17003 x 11, L57.0 B) 17000, 17003, D49.2 C) 17000, 17003, 17004, L57.0 D) 17003 x 19, D48.5

B

A patient presents for reduction of her left breast due to atrophy of the breast. After being prepped and draped, the surgeon makes a circular incision above the nipple to indicate where the nipple is to be relocated. Another incision is made around the nipple, and then two more incisions are made from the circular cut above the nipple to fold beneath the breast, which creates a keyhole shaped skin and breast incision. Skin wedges and tissue are removed until the surgeon is satisfied with the size. Electrocautery was performed on bleeding vessels and the nipple was elevated to its new position and the nipple pedicle was sutured with layered closure. The last incision was repaired with a layered closure as well. What is the correct CPT code to report for this example? A) 19324-LT B) 19318-LT C) 19350-LT D) 19316-LT

A

A patient presents for tattooing of the nipple and areola of both breasts after undergoing breast reconstruction. The total area for the right breast is 11.5 cm2 and for the left breast of 10.5 cm2. Select the CPT® code(s) for this procedure. A) 11921, 11922 B) 11921-50 C) 19350 D) 19120-50

B

A patient presents to her doctor with three medium sized suspicious lesions on her leg. The physician uses a saw type instrument and slices horizontally to remove the lesions. The lesions are sent for pathology. What CPT® code(s) should be reported for this example? A) 11000, 11101 x 2 B) 11300, 11300-51 x 2 C) 11302 x 3 D)11303

B

A patient presents to the Dermatologist with a suspicious lesion on her left arm and another one on her right arm. After examination the physician feels these lesions present as highly suspicious and obtains consent to perform punch biopsies on both sites. After prepping the area, the physician injects the sites with Lidocaine 1% and .05% Epi. A 3 mm punch biopsy of the lesion of the left arm and a 4mm punch biopsy of the lesion of the right arm is taken. The sites are closed with a simple one-layer closure and the patient is to return in 10 days for suture removal and to discuss the pathology results. The patient tolerated the procedure well. Select the CPT® code(s) for this procedure. A) 10060 B) 11100, 11101 C) 11400, 11400-59 D) 11600, 11600-59

D

A patient presents to the emergency department with multiple lacerations. After inspection and cleaning of the multiple wounds the physician proceeds to close the wounds. The documentation indicates the following: 2.7 cm complex closure to the right upper abdominal area, a 1.4 cm complex repair to the right buttock, a 7.4 cm intermediate repair to the right arm, a 3.8 cm intermediate repair to the left cheek, an 8.1 cm intermediate repair to the scalp and a 2.3 cm simple repair the right lower lip. What are the correct CPT® codes to report for this example? A) 13101, 13100-59, 12051-59, 12011-59 B) 13100, 12035-59, 12052-59, 12013-59 C) 13101, 12034-59, 13100-59, 12052-59 D) 13101, 12035-59, 12052-59, 12011-59

D

A patient presents to the primary care physician with multiple skin tags. After a complete examination of the skin, the provider discusses with the patient the removal of 18 skin tags located on the patient's neck and shoulder area. Patient consent is obtained and the provider removes all 18 skin tags by scissoring technique. Select the CPT® code(s) for this procedure. A) 11201 B) 11200, 11201-51 C) 17000 D) 11200, 11201

D

A provider performs a punch biopsy of two pre-cancerous lesions on the patient's back, which he has determined to be actinic keratosis (AK). List the ICD-10-CM code for the AK. A) D49.2 B) C44.519 C) D23.5 D) L57.0

Biometry

Application of a statistical method to a biologic fact

Inferior

Away from the head or the lower part of the body; also known as caudad or caudal

Cholangiography

Bile ducts

Biometry

Biometry is the application of statistics to biologic data. The use of biometry aids the radiologist in the diagnosis of patient conditions, for example, the use of ultrasound echography in the diagnosis of conditions of the eye, as described in code 76516. It is the application of a statistical method to a biologic fact. For example, the application of this science is radiology has resulted in analysis of data, for example, of the effectiveness of radiation used in the treatment of brain tumors-science applied to biology.

83003

Blood analysis for HGH

85032

Blood count (leukocyte only): one manual cell count

85060

Blood smear interpretation

86910

Blood typing for paternity test, ABO, Rh, and MN

ICD-10-CM code: L85.8 CPT® codes: 12051, 11442-51

CASE 1 PREOPERATIVE DIAGNOSIS: Rapidly enlarging suspicious lesion on patient's right side of forehead. (Indications for surgery.) POSTOPERATIVE DIAGNOSIS: Rapidly enlarging suspicious lesion on patient's right side of forehead. OPERATION PERFORMED: Wide local excision with intermediate closure of the right side of forehead. (An excision with intermediate closure was performed.) INDICATIONS: The patient is a 78-year-old white male who noticed within the last month or so, a rapidly enlarging suspicious lesion on the right side of his forehead. DESCRIPTION OF PROCEDURE: The patient was placed in the supine position on the table, and was given no sedation. The area of his right forehead (Location is the right forehead.) was draped and prepped with Betadine paint in normal sterile fashion. The area to be excised was on the right side of the patient's mid forehead. This lesion had a maximum diameter of 1.1 cm (Greatest clinical diameter is 1.1 cm.) with a 0.3 cm margin (0.3 cm margin on both sides - total 0.6cm) designed for total resection of 1.7 cm (total size of the lesion is 1.7 cm). The area for excision was infiltrated with 1% lidocaine with epinephrine. Careful dissection of the lesion was carried down through the dermis into the subcutaneous tissues. After waiting for hemostasis, it was excised, tagged, and sent for permanent pathology. The wound was irrigated; several bleeders were cauterized. The defect was closed in multiple layers (closure in multiple layers indicates an intermediate repair, which is reported separately) with 3-0 Vicryl, a running subcuticular stitch of 4-0 Vicryl and a few 5-0 chromics. The total length of this closure was 3 cm (repair length is 3 cm). This was covered with Steri-Strips, adaptic gauze, and tape. Patient tolerated this procedure with no complication and was sent home in stable condition. FINAL DIAGNOSIS: Skin, right forehead (Location is right forehead.), wide local excision, keratoacanthoma (diagnosis to be coded), possible squamous cell carcinoma (Squamous cell carcinoma is possible, possible diagnoses are not coded), margins are free of tumor. What are the CPT® and ICD-10-CM codes reported? ICD-10-CM code: CPT® code #1, #2 (the second code has one modifier):

CPT® codes: 15002-58, 15271-58-51 ICD-10-CM code: M72.6

CASE 10 PREOPERATIVE DIAGNOSIS: Necrotizing fasciitis. POSTOPERATIVE DIAGNOSIS: Necrotizing fasciitis. PROCEDURE: Planned return to the OR to assess wound closure options. Wound excision and homograft placement with surgical preparation, exploration of distal extremity. FINDINGS AND INDICATIONS: This very unfortunate gentleman with liver failure, renal failure, pulmonary failure, and overwhelming sepsis was found to have necrotizing fasciitis last week. At that time we excised the necrotizing wound. The wound appears to have stabilized; however, the patient continues to be very sick. On return to the operating room, he appears to have no evidence of significant healing of any areas with extensively exposed tibia, fibula, Achilles tendon, and other tendons in the foot as well as the tibial plateau and fibular head without any hope of reconstruction of the lower extremity or coverage thereof. There is an area on the lateral thigh that we may be able to be closed with a skin graft for a viable above-the-knee amputation. PROCEDURE IN DETAIL: After informed consent, the patient was brought to the operating room and placed in supine position on the operating table. The above findings were noted. Sharp debridement with the curved Mayo scissors and the scalpel were helpful in demonstrating the findings noted above. Because of the unviability of this area, it was felt that we would not perform a homografting to this area; however, the lateral thigh appeared to be viable and this was excised further with curved Mayo scissors. Hemostasis was achieved without significant difficulty. The homograft was meshed 1.5:1 and then placed over the hemostatic wound on the lateral thigh. This was secured in place with skin staples. Upon completion of the homografting, photos were taken to demonstrate the rather desperate nature of this wound and the fact that it would require above the knee amputation for closure. The wound was dressed with a moist dressing with incorporated catheters. The patient was taken back to the ICU in satisfactory condition What are the CPT® and ICD-10-CM codes reported? CPT® codes #1 (has modifier), #2 (has 2 modifiers): ICD-10-CM code:

CPT® codes: 17311 ICD-10-CM code: C44.311

CASE 2 PREOPERATIVE DIAGNOSIS: Basal cell carcinoma (postoperative and preoperative diagnosis) POSTOPERATIVE DIAGNOSIS: Same OPERATION Mohs micrographic surgery (Mohs surgery is performed) Indications: The patient has a biopsy proven basal cell carcinoma on the nasal tip (Location) measuring 8 x 7 mm.(Size) Due to its location, Mohs surgery is indicated. Mohs surgical procedure was explained including other therapeutic options, and the inherent risks of bleeding, scar formation, reaction to local anesthesia, cosmetic deformity, recurrence, infection, and nerve damage. Informed consent was obtained and the patient underwent fresh tissue Mohs surgery as follows. STAGE I: (Mohs surgery is performed in stages, this report indicates only one stage) The site of the skin cancer was identified concurrently by both the patient and doctor and marked with a surgical pen; the margins of the excision were delineated with the marking pen. The patient was placed supine on the operating table. The wound was defined and infiltrated with 1% lidocaine with epinephrine 1:100,000 (Local anesthesia was used). The area of the tumor and margins were marked for excision. Additional soft tissue markings were created to keep the specimen oriented with the excision site.(Noting the tumor has been removed, which supports stage 1.) Hemostasis was obtained by electrocautery. A pressure dressing was placed. The tissue was divided into two tissue blocks (The tissue is divided into two tissue blocks.) which were mapped, color coded at their margins, and sent to the technician for frozen sectioning. The surgeon examined the tissue and no microscopic tumor was found persisting in the tumor margins on the tissue blocks. Following surgery, the defect measured 10 x 13 mm to the subcutaneous tissue.(Size and depth of the defect.) Closure will be done by the Dr. Hill from Plastics with a Burow's graft.(A Burow's graft is not reported because it was performed by a different provider.) CONDITION AT TERMINATION OF THERAPY: Carcinoma removed. Pathology report on file. What CPT® and ICD-10-CM codes are reported? CPT® code: ICD-10-CM code:

CPT® code: 11450-RT ICD-10-CM code: L73.2

CASE 3 CHIEF COMPLAINT: The patient is a 42-year-old female with infected right axillary hidradenitis. (The diagnosis to report, and location of the hidradenitis.) PROCEDURE NOTE: With the patient in supine position and under general anesthesia, the right axilla was prepped and draped in the usual sterile fashion. A skin incision was made in the axilla to excise most of the hidradenitis tracts. The incision was carried down through the subcutaneous tissue. The underlying subcutaneous tissue was excised. (The excision went to the subcutaneous tissue.) Bleeding points were controlled by means of electrocautery. The subcutaneous tissues were closed in intermediate layers (The repair was intermediate.) with a suture of 2-0 Vicryl. The skin edges were stapled together and a dry sterile dressing was applied. The patient tolerated the procedure well. What are the CPT® and ICD-10-CM codes reported? CPT® code (has modifier): ICD-10-CM code:

CPT® code: 15879-50 ICD-10-CM code: E66.8

CASE 4 PREOPERATIVE DIAGNOSIS: Segmental obesity of posterior thighs. POSTOPERATIVE DIAGNOSIS: Segmental obesity of posterior thighs. (Postoperative diagnosis to be used for coding) OPERATIVE PROCEDURE: Posterior thigh suction-assisted lipectomy of posterior medial thigh, bilateral (procedure performed). CLINICAL NOTE: This obese patient presents for the above procedure. She understood the potential risks and complications including the risk of anesthesia, bleeding, infection, wound healing problems, unfavorable scarring, and potential need for secondary surgery. She understood and desired to proceed. PROCEDURE: The patient was placed on the operating table in supine position. General anesthesia was induced.(General anesthesia.) Once she was asleep, she was turned and positioned prone. The buttocks and thigh regions were prepped and draped in the usual sterile fashion. She had been marked in the awake, standing position, outlining the incision area, along the gluteal crease that was in continuity with her medial thigh lift scar and extended to the posterior axillary line. The right posterior medial thigh(Location) region was infiltrated with tumescent solution utilizing 750 ml. The liposuction (Liposuction performed.) was then accomplished, removing a total of 200 ml. Then an incision was made along the gluteal crease at the desired site for the final incision. A posterior skin flap was elevated approximately 3 to 4 cm. Hemostasis was assured by electrocautery. There was no residual flap or dead space and the fascia was closed at the deep level with 0 PDS, and then in anatomical layers the closure was completed with 2-0, 3-0, and 4-0 PDS. Dermabond and Steri-Strips were then applied. The medial third was also closed with a running 4-0 plain gut. The same was then accomplished on the left side in similar fashion and steps, achieving a symmetric result, and closure was accomplished similarly (same procedure performed on both left and right sides requiring the use of modifier). A compression garment was applied. The patient was awakened, extubated, and transferred to the recovery room in satisfactory condition. There were no operative or anesthetic complications. What are the CPT® and ICD-10-CM codes reported? CPT® code (has modifier): ICD-10-CM code:

CPT® code: 15830, 15847 ICD-10-CM code: E65, M62.08

CASE 5 PREOPERATIVE DIAGNOSIS: Panniculus, Diastasis recti POSTOPERATIVE DIAGNOSIS: Panniculus, diastasis recti (this is the diagnosis used for coding) PROCEDURE PERFORMED: Abdominoplasty (procedure performed) ANESTHESIA: General CLINICAL NOTE: The patient has had multiple pregnancies, with diastasis recti occurring with the last pregnancy. She has had long term problems with low back pain and constipation as a result of the diastasis recti to the point where child care and every day activities are limited. Since having her last child she has also developed a pannus causing significant chaffing and irritation, which at times results in bleeding and infection. She is here today for the above procedure. She understood the potential risks and complications including the risks of anesthesia, bleeding, infection, wound healing problems, unfavorable scaring, and potential need for secondary surgery. She wanted to proceed. She also understood the possibility of impaired circulation to the flaps and hematoma/seroma formation. PROCEDURE IN DETAIL: The patient was placed on the operating table in supine position. General anesthesia was induced (general anesthesia was used). The abdomen was prepped and draped in the usual sterile fashion and marked for abdominoplasty along the suprapubic natural skin crease. This coursed 36 cm in total. The umbilicus was also marked, and the area was infiltrated with 100 cc of 0.5% Xylocaine with 1:200,000 epinephrine. After adrenaline effect, the incision was made. The flap was elevated to the umbilicus. The umbilicus was circumscribed and dissected free, with care taken to maintain a generous vascular stalk. Dissection was then taken to the subcostal margin as it tapered superiorly and narrowed the exposure. Hemostasis was obtained by electrocautery. There was still a lot of skin laxity, and it appeared that an ellipse of skin could be removed (excessive skin) through the superior margin of the umbilicus. The flap was incised at the midline for greater exposure. She had significant diastasis recti (separation between the right and left sides of the rectus abdominis muscle), which was closed with interrupted mattress sutures of 0 Ethibond, followed by a running suture of 0 Ethibond (closure of the rectus abdominis muscle). She was placed in semi-flexed position and the ellipse of skin was excised to the superior margin of the umbilicus in the midline (excision of the excessive skin). This gave an easy fit for the flap without undue tension. The #No. 15 drains were placed through the mons area and secured with 3-0 Prolene. The skin was then closed at Scarpa fascia with sutures of 2-0 PDS. The umbilicus site was marked and a disc of skin was removed. The umbilicus was delivered and sutured with dermal sutures of 4-0 PDS, and the skin with 5-0 fast absorbing plain gut. Deep dermal repair was completed with reabsorbable staples, and the skin was closed with a subcuticular suture of 4-0 PDS. Steri-Strips were applied over Mastisol. An abdominal binder was placed. The patient was awakened, extubated, and transferred to the recovery room in satisfactory condition. There were no operative or anesthetic complications. Estimated blood loss was less than 30 cc. What are the CPT® and ICD-10-CM codes reported? CPT® codes #1, #2: ICD-10-CM codes #1, #2:

CPT® code: 19325-50 ICD-10-CM: N64.82

CASE 6 PREOPERATIVE DIAGNOSIS: Hypoplasia of the breast. POSTOPERATIVE DIAGNOSIS: Hypoplasia of the breast. OPERATIVE PROCEDURE: Bilateral augmentation mammoplasty. ANESTHESIA: General. OPERATIVE SUMMARY: The patient was brought to the operating room awake and placed in a supine position, where general anesthesia was induced without any complications. The patient's chest was prepped and draped in the usual sterile fashion. The patient had previous inframammary crease incisions on both the left and right sides. The extent of the dissection would be to the sternal border within two fingerbreadths of the clavicle and slightly beyond the anterior axillary line. The left breast was operated upon first. An incision was made in the inframammary crease going through skin, subcutaneous tissue, down to the muscle fascia. Dissection at the subglandular level was then performed until an adequate pocket was made according to the previous limits. After irrigation with normal saline and careful hemostasis, a Mentor and Allergan silicone filled, high profile, textured implant was used and placed into the pocket. It was 300 cc. The skin was closed using 4-0 vicryl in an interrupted fashion for the deep subcutaneous tissue 4-0 Monocryl in an interrupted fashion was used for the superficial subcutancous tissue and the skin was closed using 4-0 Monocryl in a subcuticular fashion. Antibiotic ointment and Tegaderm were applied. The right breast was operated on in a very similar fashion. The implant was a 340 cc silicone gel, high profile, textured implant from Allergan. Skin closure was the same. Both left and right breasts were very similar in size and shape. The patient had a bra applied. The patient tolerated this procedure well and left the operating room in stable condition. What are the CPT® and ICD-10-CM codes reported? CPT® code (has modifier): ICD-10-CM:

CPT® codes: 13101, 11403-51 ICD-10-CM code: D23.5

CASE 7 PREOPERATIVE DIAGNOSES: Large Dysplastic nevus, right chest. POSTOPERATIVE DIAGNOSES: Large Dysplastic nevus, right chest. PROCEDURES PERFORMED: Excision, dysplastic nevus, right chest with diameter of 1.2 cm and 0.5 cm margins on each side, and complex repair of 4.0 cm wound. ANESTHESIA: Local using 20 cc of 1% lidocaine with epinephrine. COMPLICATIONS: None. ESTIMATED BLOOD LOSS: Less than 2 cc. SPECIMENS: Dysplastic nevus, right chest with suture at superior tip, 12 o'clock for permanent pathology. INDICATIONS FOR SURGERY: The patient is a 49-year-old white woman with a dysplastic nevus of her right chest, which I marked for elliptical excision in the relaxed skin tension lines of her chest with gross normal margins of around 0.5 cm. I drew my best guess at the resultant scar, and she observed these markings well and we proceeded. DESCRIPTION OF PROCEDURE: We started with the patient prone. The area has been infiltrated with local anesthetic. The chest prepped and draped in sterile fashion. I excised the dysplastic nevus as drawn into the subcutaneous fat. Hemostasis was achieved using the Bovie cautery. To optimize the primary repair extensive undermining was done to pull wound edges together and retention sutures were used to keep it closed. This constituted a very a complex repair technique due to skin tension. The wound was closed in layers using 4-0 Monocryl and 5-0 Prolene. A loupe magnification was used. The patient tolerated the procedure well. ADDENDUM: Pathology report confirms it is benign. What are the CPT® and ICD-10-CM codes reported? CPT® codes #1, #2 (second code has modifier): ICD-10-CM code:

CPT® codes: 15240, 14040-51, 11643-59 ICD-10-CM codes: C44.319, C44.629

CASE 8 PREOPERATIVE DIAGNOSES: 1. Basal cell carcinoma, right temple. 2. Squamous cell carcinoma, left hand. POSTOPERATIVE DIAGNOSES: Same PROCEDURES PERFORMED: 1. Excision of basal cell carcinoma right temple, with excised diameter of 2.2 cm and full thickness skin graft 4 cm2. 2. Excision squamous cell carcinoma, left hand, with rhomboid flap repair 2.5 cm2. ANESTHESIA: Local using 8 cc of 1% lidocaine with epinephrine to the right temple and 3 cc of 1% plain lidocaine to the left hand. INDICATIONS FOR SURGERY: The patient is a 77-year-old white woman with a biopsy-proven basal cell carcinoma of right temple that appeared to be recurrent and a biopsy-proven squamous cell carcinoma of her left hand. I marked the lesion of her temple for elliptical excision in the relaxed skin tension lines of her face with gross normal margins of around 2-3 mm. I also marked my planned rhomboidal excision of the squamous cell carcinoma of her left hand with gross normal margins of around 3 mm, and I drew my planned rhomboid flap. She observed all these markings with a mirror so she could understand the surgery and agree on the locations, and we proceeded. DESCRIPTION OF PROCEDURE: All areas were infiltrated with local anesthetic (the anesthetic with epinephrine). The face and left upper extremity were prepped and draped in normal sterile fashion. I excised the lesion of her right temple and left hand as drawn to the subcutaneous fat. Hemostasis was achieved with Bovie cautery. It took a few more passes to get the margins clear from the basal cell carcinoma on the right temple. The wound had become very large by that time, around quarter sized, and I attempted to close the wound. I began with a 3-0 Monocryl. It was simply too tight and was deforming her eyelid. I felt that we would have to close with a skin graft. I marked the area of her right clavicle for the donor site, and I prepped and draped this area in a sterile fashion. I infiltrated with a plain lidocaine. I harvested and defatted the full-thickness skin graft using scissors. I achieved meticulous hemostasis in the donor site using the Bovie cautery. The skin graft was inset into the temple wound using 5-0 plain gut suture. The skin graft was vented, and a xeroform bolster was placed using xeroform and nylon. The donor site was closed in layers using 4-0 Monocryl and 5-0 Prolene. I then turned my attention to the hand. The margins had been cleared from that region, even though it did take two passes. I incised the rhomboid flap and elevated it with a full-thickness subcutaneous fat. Hemostasis was achieved in the wound and donor site using Bovie cautery. The flap rotated into the defect. The donor site was closed with flap inset in layers using 4-0 Monocryl and 5-0 Prolene. Loupe magnification was used. The patient tolerated the procedure well. What are the CPT® and ICD-10-CM codes reported? CPT® codes #1, #2 (has modifier), #3 (has modifier): ICD-10-CM codes #1, #2:

CPT® code: 19301-RT ICD-10-CM code: N63

CASE 9 PREOPERATIVE DIAGNOSIS: Right breast mass, lower outer quadrant. POSTOPERATIVE DIAGNOSIS: Right breast mass. PROCEDURE: Right breast lumpectomy. ANESTHESIA: A 1% lidocaine with epinephrine mixed 1:1 with 0.5% Marcaine along with IV sedation. INDICATIONS: The patient is a 23 year-old female who recently noted a right breast mass (lower outer quadrant). This has grown somewhat in size and we decided it should be excised. FINDINGS AT THE TIME OF OPERATION: This appeared to be a fibroadenoma. OPERATIVE PROCEDURE: The patient was first identified in the holding area and the surgical site was reconfirmed and marked. Informed consent was obtained. She was then brought back to the operating room where she was placed on the operating room table in supine position. Both arms were placed comfortably out at approximately 85 degrees. All pressure points were well padded. A time-out was performed. The right breast was prepped and draped in the usual fashion. I anesthetized the area in question with the mixture noted above. This mass was at the areolar border at approximately the outer central to lower outer quadrant. I made a circumareolar incision on the outer aspect of the areola. This was carried down through skin, subcutaneous tissue, and a small amount of breast tissue. I was able to easily dissect down to the mass itself. Once I was there, I placed a figure-of-eight 2-0 silk suture for traction. I carefully dissected this mass out from the surrounding tissue along with a margin of healthy breast tissue. Once it was removed from the field, the traction suture was removed and the mass was sent in formalin to pathology. The wound was then inspected for hemostasis, which was achieved with electrocautery. I then re-approximated the deep breast tissue with interrupted 3-0 vicryl suture and another 3-0 vicryl suture in the superficial breast tissue. The skin was then closed in a layered fashion using interrupted 4-0 Monocryl deep dermal sutures followed by a running 4-0 Monocryl subcuticular suture. Benzoin, Steri-Strips and dry sterile pressure were applied. The patient tolerated the procedure well and was taken back to the short stay area in good condition. What are the CPT® and ICD-10-CM codes reported? CPT® code (has modifier): ICD-10-CM code:

Location: Outpatient Hospital RADIOLOGY REPORT EXAMINATION OF: X-ray of left ankle CLINICAL SYMPTOMS: Charcot joint LEFT ANKLE RADIOGRAPHS, 2:05 PM: Three views submitted of the left ankle. No prior studies. There is some soft tissue swelling adjacent to the distal fibula. Plantar caliectasis spurring is seen. There are radiopaque densities seen along the plantar aspect of the foot, including hindfoot and midfoot. Question if there is overlying bandage with radiopaque densities or that could relate to soft tissue calcifications. Suggest clinical correlation. No obvious acute fracture or dislocation is seen. Suggest clinical correlation regarding further assessment of the foot with left foot radiographs.

CPT code: 73610-LT-26,73610-26-LT,73610 - LT - 26,73610 - 26 - LT ICD-9-CM code: 094.0, 713.5 ICD-10-CM code: M14.672 Hint: In the CPT index, locate x-ray, ankle, 73610. The radiology code indicates a three-view x-ray examination of the ankle. Modifier -LT is appended to identify that the examination was of the left ankle. Modifier -26 is appended to indicate the professional component of the procedure. In the ICD-9-CM index, locate the main term Charcot's and subterm joint, 094.0. The code description for 094.0 instructs you to use additional code to identify the manifestation, neurogenic arthropathy [Charcot's joint disease], 713.5. In the ICD-10-CM index, locate the main term Arthropathy and subterms neuropathic (Charcot), ankle, M14.672. The sixth character "2" indicates left ankle.

EXAMINATION OF: Biophysical profile. CLINICAL SYMPTOMS: High blood pressure, gestational age 28 weeks 5 days. BIOPHYSICAL PROFILE: The placenta is located along the anterior wall. It is heterogeneous in echotexture, grade II. The AFI is 5.4 cm, which is low. Fetal motion noted by the technologist. Heart rate is 147 beats per minute. Intrauterine hypoechoic area seen anteriorly within the uterus measures about 2 cm in size and a second similar sized hypoechoic area is located within the uterus. Both findings are presumed fibroids. They are nonspecific findings, however. Biophysical profile was scored a perfect 8 out of 8.

CPT code: 76819-26, ">76819 - 26 ICD-9-CM code: 642.93 ICD-10-CM code: O16.3 Hint: In the CPT index, locate fetal testing, ultrasound, biophysical profile, 76819. Modifier -26 is appended to report the professional component. In the ICD-9-CM index, see the Hypertension table and locate the subterms complicating pregnancy, unspecified, 642.93. The fifth digit "3" indicates antepartum condition or complication. In the ICD-10-CM index, locate the main term Hypertension and subterms complicating, pregnancy, O16.3. The fourth character "3" indicates third trimester. Note: 1st trimester is from the last menstrual period (LMP) to week 12; 2nd trimester is from weeks 13 to 27; 3rd trimester is from weeks 28 to the estimated delivery date (EDD).

85280

Clotting factor XII (Hageman factor) for excessive bleeding menopausal onset

Component coding examples & Third-party payers usually reimbursements

Component Coding Example •Professional component: 71030-26 (Supervision and final report) •Technical component: 71030-TC (Technician, supplies and equipment) •Global procedure: 71030 (Supervision with final report, technical, supplies and equipment) Third-party payers usually reimburse radiology services as follows: •40% for professional component •60% for technical component •100% for global procedure

87086

Culture of urine for bacteria with colony count for pain on urination

Diagnostic Ultrasound Subsection

Diagnostic Glossaryultrasound uses high-frequency sound waves to image anatomic structures. As illustrated here (shown in your text as Fig. 28-14), ultrasound of the gallbladder shows shadowing of a gallstone. There are nine subheadings in Diagnostic Ultrasound that are based primarily on anatomy

The subsections of the Radiology section are as follows:

Diagnostic Radiology •Diagnostic Ultrasound •Radiologic Guidance •Breast Mammography •Bone/Joint Studies •Radiation Oncology •Nuclear Medicine

Changing Radiology Section

Each year there are numerous changes within the Radiology section to reflect the many advances in the use of radiation in the diagnosis and treatment services. Keep this in mind so that your knowledge of coding within this section is current.

Epididymography

Epididymis

Fluoroscopy

Fluoroscopy views the inside of the body and projects it onto a television screen. It provides a live image whereby the physician can view the function and structure of an organ, for example, 71034 (Chest x-ray with Glossary fluoroscopy). is an x-ray procedure that allows the visualization of internal organs in motion. It uses real-time video images. After x-rays pass through the patient, instead of using film, the images are captured by a device called an image intensifier and converted into light. The light is then captured by camera and displayed on a video monitor. Fluoroscopy allows the study of the function of the organ, physiology, as well as the structure of the organ, anatomy.

C

INDICATIONS FOR SURGERY: The patient is an 82 year-old male with biopsy-proven basal cell carcinoma of his right lower eyelid extending to the upper part of the cheek. I marked the area for rhomboidal excision and I drew my planned rhomboid flap. The patient observed these markings in a mirror, he understood the surgery and agreed on the location and we proceeded. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion as drawn into the subcutaneous fat. Hemostasis was achieved using Bovie cautery. Modified Mohs analysis showed the margin to be clear. I incised the rhomboid flap as drawn and elevated the flap with a full-thickness of subcutaneous fat. Hemostasis was achieved in the donor site, the Bovie cautery was not used, hand held cautery was used. The flap was rotated into the defect. The donor site was closed and flap inset in layers using 5-0 Monocryl and 6-0 Prolene. The patient tolerated the procedure well. The total site measured 1.3 cm x 2.7 cm. What CPT® code(s) should be reported? A) 14060, 11643 B) 11643 C) 14060 D) 14040, 14060

Posterior, dorsal

In back of

Anterior, Ventral

In front of

Diskography

Intervertebral joint

Arthography

Joint

Urography

Kidneys, renal pelvis, ureters, and bladder

83721

LDL cholesterol using direct measurements

85345

Lee and White coagulation time

Lymphangiography

Lymphatic vessels and nodes

Magnetic resonance imaging MRI

MRI uses magnetic energy to view the soft tissue structures of the body. Codes such as 72148 (MRI, spinal canal) describe procedures that use magnetic resonance imaging. Procedure that uses nonionizing radiation to view the body in a cross-sectional view is a radiology technique that uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet.

A

Melanin is found in what layer of the epidermis? A) Basal B) Epithelium C) Dermal D) Squamous

C

Most categories in ICD-10-CM chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes have three main 7th character extenders (with the exception of fractures). What does 7th character D indicate? A) Sequela B) Initial encounter C) Subsequent encounter D) 7th character extenders are not applicable for injury and poisoning.

Diagnostic Radiology Subsection

Most standard radiographic procedures are within this subsection. Codes are often divided based on whether or not contrast material was used. Codes are further based on the number of views (pictures) taken. Diagnostic radiology is used to diagnose a disease, to monitor a disease process (progression or remission), and for therapeutic procedures. Diagnostic procedures include the following: •X-ray •Computerized axial tomography (CAT or CT scan) •Magnetic Resonance Imaging (MRI) •Angiography If fewer than the total number of views specified in the code were provided, use modifier -52, Reduced Service

Location of Diagnostic Ultrasound Codes

Now, let's consider the location of the Diagnostic Ultrasound codes. The ultrasound codes are often divided based on extent. For example, was the scan a complete scan (entire body), limited scan (part of the body, e.g., one organ), or a follow-up or repeat (limited study of part of the body, previously scanned)? There are three locations for ultrasound service codes: •76506-76886: Radiology codes for diagnostic ultrasound services. Ultrasonic guidance codes are in the range 76930-76999. •93880-93990: Medicine codes for vascular studies. •93303-93352: Medicine codes for echocardiography.

Nuclear Medicine Subsection

Nuclear Medicine is the last subsection within the Radiology section. Nuclear Medicine involves the placement of radioactive material into the body and the subsequent measurement of the emissions from that material. This technique is used both for diagnosis and treatment. The codes are divided primarily based on organ system, such as endocrine system, gastrointestinal system, and cardiovascular system. The last subheading, Therapeutic, contains the radiopharmaceutical therapies and is divided based on the type of treatment (such as intracavitary or interstitial) and the reason for treatment (such as leukemia, hyperthyroidism). The codes do not include the material injected (radionuclides). Report the radionuclides with therapeutic codes such as 79101 (intravenous), 79200 (intracavity), or 79300 (interstitial), etc. or Level II HCPCS code.

B

Operative Report Diagnosis: Basal Cell Carcinoma Procedure: Mohs micrographic excision of skin cancer. Site: Face left lateral canthus eyelid Pre-operative size: 0.8 cm Indications for surgery: Area of high recurrence, area of functional and/or cosmetic importance. Discussed procedure including alternative therapy, expectations, complications, and the possibility of a larger or deeper defect than expected requiring significant reconstruction. Patient's questions were answered. Local anesthesia 1:1 Marcaine and 1% Lidocaine with Epinephrine. Sterile prep and drape. Stage 1: The clinically apparent lesion was marked out with a small rim of normal appearing tissue and excised down to subcutaneous fat level with a defect size of 1.2 cm. Hemostasis was obtained and a pressure bandage placed. The tissue was sent for slide preparation. Review of the slides show clear margins for the site. Repair: Complex repair. Repair of Mohs micrographic surgical defect. Wound margins were extensively undermined in order to mobilize tissue for closure. Hemostasis was achieved. Repair length 3.4 cm. A layered closure was performed. Multiple buried absorbable sutures were placed to re-oppose deep fat. The epidermis and dermis were re-opposed using monofilament sutures. There were no complications; the patient tolerated the procedure well. Post-procedure expectations (including discomfort management), wound care and activity restrictions were reviewed. Written Instructions with urgent contact numbers given, follow-up visit and suture removal in 3-5 days What CPT® and ICD-10-CM codes are reported? A) 13152, 11442-51, C44.311 B) 17311, 13152-51, C44.119 C) 17313, 13152-51, C44.119 D) 13152, 11642-51, C44.311

A

Operative Report PREOPERATIVE DIAGNOSIS: Diabetic foot ulceration. POSTOPERATIVE DIAGNOSIS: Diabetic foot ulceration. OPERATION PERFORMED: Debridement and split thickness autografting of left midfoot. ANESTHESIA: General endotracheal. INDICATIONS FOR PROCEDURE: This patient with multiple complications from type 2 diabetes developed skin ulcerations which were debrided with homograft last week. The homograft is taking quite nicely; the wounds appear to be fairly clean. He is ready for autografting. DESCRIPTION OF PROCEDURE: After informed consent the patient is brought to the operating room and placed in the supine position on the operating table. Anesthetic monitoring was instituted; general anesthesia was induced. The left lower extremity is prepped and draped in a sterile fashion. Staples were removed and the homograft was debrided from the surface of the wounds. One wound appeared to have healed; the remaining two appeared to be relatively clean. We debrided this sharply with good bleeding in all areas. Hemostasis was achieved with pressure, Bovie cautery, and warm saline soaked sponges. With good hemostasis a donor site was then obtained on the left anterior thigh, measuring less than 100 cm2. The wounds were then grafted with a split-thickness autograft that was harvested with a patch of Brown dermatome set at 12,000 of an inch thick. This was meshed 1.5:1. The donor site was infiltrated with bupivacaine and dressed. The skin graft was then applied over the wound, measured approximately 60 cm2 in dimension on the left midfoot. This was secured into place with skin staples and was then dressed with Acticoat 18's, Kerlix incorporating a catheter, and gel pad. The patient tolerated the procedure well. The right foot was redressed with skin lubricant sterile gauze and Ace wrap. Anesthesia was reversed. The patient was brought back to the ICU in satisfactory condition. What CPT® and ICD-10-CM codes are reported? A) 15120-58, 15004-58-51, E11.621, L97.421 B) 15950-78, 15004-78-51, E11.9, I70.244 C) 11044-78, 15120-78, 15004-78-51, E11.621, L97.421 D) 15220-58, 15004-58-51, L97.421, E11.621

D

Operative Report PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp. POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp. PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin-Yang flap repair ANESTHESIA: Local, using 4 cc of 1% lidocaine with epinephrine. COMPLICATIONS: None. ESTIMATED BLOOD LOSS: Less than 5 cc. SPECIMENS: Squamous cell carcinoma, scalp sutured at 12 o'clock, anterior tip INDICATIONS FOR SURGERY: The patient is a 43 year-old male patient with a biopsy-proven squamous cell carcinoma of his scalp measuring 2.1 cm. I marked the area for excision with gross normal margins of 4 mm and I drew my planned Yin-Yang flap closure. The patient observed these markings in two mirrors to understand the surgery and he agreed on the location. We proceeded with the procedure. DESCRIPTION OF PROCEDURE: The area was infiltrated with local anesthetic. The patient was placed prone, his scalp and face were prepped and draped in sterile fashion. I excised the lesion as drawn to include the galea. Hemostasis was achieved with the Bovie cautery. Pathologic analysis showed the margins to be clear. I incised the Yin-Yang flaps and elevated them with the underlying galea. Hemostasis was achieved in the donor site using Bovie cautery. The flap rotated into the defect with total measurements of 2.9 cm x 3.2 cm. The donor sites were closed and the flaps inset in layers using 4-0 Monocryl and the skin stapler. Loupe magnification was used. The patient tolerated the procedure well. What CPT® and ICD-10-CM codes are reported? A) 14041, C44.49 B) 14060, C43.39 C) 14040, C44.42 D) 14020, C44.42

D

Operative Report: Pre-Operative Diagnoses: Basal Cell Carcinoma, forehead Basal Cell Carcinoma, right cheek Suspicious lesion, left nose Suspicious lesion, left forehead Post-Operative Diagnoses: Basal Cell Carcinoma, forehead with clear margins Basal Cell Carcinoma, right cheek with clear margins Compound nevus, left nose with clear margins Epidermal nevus, left forehead with clear margins INDICATIONS FOR SURGERY: The patient is a 47 year-old white man with a biopsy-proven basal cell carcinoma of his forehead and a biopsy-proven basal cell carcinoma of his right cheek. We were not quite sure of the patient's location of the basal cell carcinoma of the forehead whether it was a midline lesion or lesion to the left. We felt stronger about the midline lesion, so we marked the area for elliptical excision in relaxed skin tension lines of his forehead with gross normal margins of 1-2 mm and I marked the lesion of the left forehead for biopsy. He also had a lesion of his left alar crease we marked for biopsy and a large basal cell carcinoma of his right cheek, which was more obvious. This was marked for elliptical excision with gross normal margins of 2-3 mm in the relaxed skin tension lines of his face. I also drew a possible rhomboid flap that we would use if the wound became larger. He observed all these margins in the mirror, so he could understand the surgery and agree on the locations, and we proceeded. DESCRIPTION OF PROCEDURE: All four areas were infiltrated with local anesthetic. The face was prepped and draped in sterile fashion. I excised the lesion of the forehead measuring 6 mm and right cheek measuring 1.3 cm as I had drawn them and sent in for frozen section. The biopsies were taken of the left forehead and left nose using a 2-mm punch, and these wounds were closed with 6-0 Prolene. Meticulous hemostasis was achieved of those wounds using Bovie cautery. I closed the cheek wound first. Defects were created at each end of the wound to facilitate primary closure and because of this I considered a complex repair and the wound was closed in layers using 4-0 Monocryl, 5-0 Monocryl and 6-0 Prolene, with total measurement of 2.1 cm. The forehead wound was closed in layers using 5-0 Monocryl and 6-0 Prolene, with total measurement of 1.0 cm. Loupe magnification was used and the patient tolerated the procedure well. What ICD-10-CM codes are reported? A) C44.202, C44.309, D48.5, D49.2 B) C44.202, C44.40, D22.23, D22.39 C) C44.319, D04.39, D48.5, D22.39 D) C44.319, D22.39

C

Operative Report: INDICATIONS FOR SURGERY: The patient is a 72-year-old male with a biopsy-proven squamous cell carcinoma of his left forearm. With his permission, I marked my planned excision and my best guess at the resultant scar, which included a rhomboid flap repair. The patient observed these markings in a mirror, so he could understand the surgery, agree on the location and I proceeded. DESCRIPTION OF PROCEDURE: The patient was given 1 g of IV Ancef. The area was infiltrated with local anesthetic. The forearm was prepped and draped in a sterile fashion. I excised this lesion measuring 1.2 cm diameter as drawn into the subcutaneous fat. A suture was used to mark this specimen at its proximal tip and this was labeled at 12 o'clock. Negative margins were then given. Meticulous hemostasis was achieved using a Bovie cautery. I incised my planned rhomboid flap measuring 2cm x 2cm. I elevated the flap with a full-thickness of skin and subcutaneous fat. The total defect size was 5.44 sq cm. The flap was rotated into the defect and the donor site was closed and the flap was inset in layers using 4-0 Monocryl and 5-0 Prolene. Loupe magnification was used throughout the procedure and the patient tolerated the procedure well. What CPT® code(s) should be reported for this example? A) 14040 B) 14020, 11602-51 C) 14020 D) 14021

What two ancillary services often overlap?

PT, OT

85730

PTT of whole blood

88329

Pathology consultation during surgery

A

Patient has returned to the operating room for aspiration of a seroma that developed from a genitourinary surgical procedure performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported? A) 10160-78, N99.842 B) 10140-78, S20.20XS C) 10180-58, N99.820 D) 10140-58, N99.89

C

Patient is an 81 year-old male with a biopsy-proven basal cell carcinoma of the posterior neck just near his hairline; additionally, the patient had two other areas of concern on his cheek. Informed consent was obtained and the areas were prepped and draped in the usual sterile fashion. Attention was first directed to the basal cell carcinoma of the neck. I excised the lesion measuring 2.6 cm as drawn down to the subcutaneous fat. With extensive undermining of the wound I closed it in layers using 4.0 Monocryl, 5.0 Prolene and 6.0 Prolene; the wound measured 4.5cm. Attention was then directed to the other two suspicious lesions on his cheek. After administering local anesthesia, I proceeded to take a 3mm punch biopsy of each lesion and was able to close with 5.0 Prolene. The patient tolerated the procedures well. Pathology later showed the basal cell carcinoma was completely removed and the biopsies indicated actinic keratosis. What CPT® codes should be reported? A) 12042, 11623-51, 11100-59, 11101 B) 13132, 11623-51, 11440-51, 11440-51 C) 13132, 11623-51, 11100-59, 11101 D) 13131, 11622-51, 11100-59, 11100-59

B

Patient presents to the dermatologist for the removal of warts on his hands. Upon evaluation it is noted the patient has nine warts on his right hand and 10 on his left hand, all of which he has indicated he would like removed today. After discussion with the patient regarding the destruction method and aftercare the patient agreed to proceed. Using cryosurgery the physician applied two squirts of liquid nitrogen on each of the warts on his right and left hand. Aftercare instructions were given to the patient's wife. The patient tolerated the procedure well. What CPT® code(s) should be reported for this example? A) 17110, 17111 B) 17111 C) 17004 D) 17111 x 19

C

Patient presents to the physician for removal of a squamous cell carcinoma of the right cheek. After the area is prepped and draped in a sterile fashion the surgeon measured the lesion, and documented the size of the lesion as 2.3 cm at its largest diameter. Additionally, the physician took margins of 2 mm on each side of the lesion. Single layer closure was performed. The patient tolerated the procedure well. What CPT® code(s) is/are reported? A) 11643, 12013 B) 11642, 12013 C) 11643 D) 11442

A

Patient presents with a cyst on the arm. Upon examination the physician decides to incise and drain the cyst. The site is prepped and the physician takes a scalpel and cuts into the cyst. Purulent fluid is extracted from the cyst and a sample of the fluid is sent to the laboratory for evaluation. The wound is irrigated with normal saline and is covered with a bandage. The patient is to return in a week to ten days to re-examine the wound. Select the CPT® code for this procedure. A) 10060 B) 11400 C) 11100 D) 10061

Xeroradiography

Photoelectric process of radiographs

88007

Postmortem examination, gross only, with brain and spinal cord

80323

Quantitative analysis of urine for alkaloids

Reporting Radiation Treatment Management

Radiation Treatment Management codes reflect the reporting of the professional component. The professional (physician) portion of the service includes the following: •Review of the port films •Review of dosimetry, dose delivery, treatment parameters •Treatment setup •Patient examination for medical evaluation and management

Radiation Oncology Subsection

Radiation oncology is the therapeutic use of radiation that involves both professional and technical services. The subsection is divided into subheadings based on the treatment. The initial consultation, prior to the decision to treat, is reported with an E/M consultation code. For the initial inpatient, report codes 99251-99255 and or the outpatient, report codes 99241-99245. Clinical Treatment Planning is the professional component and includes the following: •Interpretation of special testing •Tumor localization •Determination of treatment volume of radiation •Choice of treatment method •Determination of number of treatment ports (locations in which the radiation is placed) •Selection of treatment devices •Other necessary procedures used for the treatment Clinical Treatment Planning consists of planning a simulation.

Barium enema

Radiographic contrast medium

Three Interesting Subsections

Radiologic Guidance Subsection (77001-77032). Guidance. •Fluoroscopic •Computed tomography •Magnetic resonance •Other Breast, Mammography Subsection (77051-77059). Example: Computer-aided detection and screening Bone/Joint Studies Subsection (77071-77084). Example: Bone density, bone mineral density, and joint survey

87197

Schlichter test for complaints of leg pain and fever

85652

Sedimentation rate, automated for fever and swelling in hand

Myelography

Subarachnoid space of the spine

85004

The Hematology and Coagulation subsections contain codes based on the various testing methods and tests. The method used to do the test is often the code determiner. Blood cell counts can be manual or automated, with many variations of the tests. What would the code be for an automated blood count (hemogram) with automated differential WBC count?

Medical Radiation, Physics, Dosimetry, Treatment Devices, and Special Service Subheading

The Medical Radiation, Physics, Dosimetry, Treatment Devices, and Special Service subheading is an important subheading within the Radiation Oncology subsection. The codes in this subheading represent the decision-making services of the physician regarding the type of treatment, dose calculation and placement (dosimetry), and development of the treatment device(s). Radiation Treatment Delivery category codes are used to report the actual delivery of the radiation. The information you need to correctly code the delivery of the radiation treatment is: •Amount of radiation delivered •Number of areas treated (single, two, three, or more) •Number of ports involved (single, three or more, or tangential) •Number of blocks used (none, multiple, custom)

The injection procedure

The injection procedure is bundled into the x-ray procedures that state with contrast unless the guidelines state that a surgical code should also be listed to report the injection procedure.

A

The patient is here to follow-up for a keloid excised from his neck in November of last year. He believes it is coming back. He does have a recurrence of the keloid on the superior portion of the scar. Because the keloid is still small, options of an injection or radiation to the area were discussed. It was agreed our next course should be a Kenalog injection. Risks associated with the procedure were discussed with the patient. Informed consent was obtained. The area was infiltrated with 1.5 cc of medication. This was a mixture of 1 cc of Kenalog-10 and 0.5 cc of 1% lidocaine with epinephrine. He tolerated the procedure well. What codes are reported? A) 11900, J3301, L91.0 B) 11950, J3301, L90.5 C) 11951, J3300, L91.0 D) 11900, J3300, L90.5

D

The patient is here to see us about some skin tags on her neck and both underarms. She has had these lesions for some time; they are irritated by her clothing, itch, and at times have a burning sensation. We discussed treatment options along with risks. Informed consent was obtained and we proceeded. We removed 16 skin tags from the right axilla, 16 skin tags from the left axilla, 10 from the right side of the neck and 17 from the left side of the neck. What CPT® and ICD-10-CM codes are reported? A) 11057, D23.5, D23.4 B) 11200, 11201-51 x 5, D23.5, D23.4 C) 11200, 11201 x 4, 11201-52, L91.8 D) 11200, 11201 x 5, L91.8

D

The patient is seen for removal of fatty tissue of the posterior iliac crest, abdomen, and the medial and lateral thighs. Suction-assisted lipectomy was undertaken in the left posterior iliac crest area and was continued on the right and the lateral trochanteric and posterior aspect of the medial thighs. The medial right and left thighs were suctioned followed by the abdomen. The total amount infused was 2300 cc and the total amount removed was 2400 cc. The incisions were closed and a compression garment was applied. What CPT® codes are reported? A) 15830, 15832-50-51 B) 15877, 15878-50-51 C) 15830, 15839-50-51, 15847 D) 15877, 15879-50-51

D

The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a fragment of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, and we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it; the mass was removed. There was a capsule around this, containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal. He wanted me to, and so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene. What CPT® and ICD-10-CM codes are reported? A) 10121, L92.3, Z18.10, Z85.828 B) 11010, S01.84XA, Z18.10, Z85.828 C) 11010, M79.5, Z85.828 D) 10121, M79.5, Z85.828

88300

The specimen is a tooth. The procedure is an odontectomy, gross examination only.

88302

The specimen is an appendix. The procedure is an incidental appendectomy.

88304

The specimen is tonsils and adenoids. The procedure is a tonsillectomy with adenoidectomy.

80162

Therapeutic drug assay for total digoxin and vancomycin, patient has chronic sinus bradycardia

Professional component

This component is sometimes called the physician portion of the service. The professional portion includes the supervision of the technician and the interpretation of the results, including the preparation of a written report. describes the services of the physician, including the supervision of the taking of the x-ray film and the interpretation with report of the x-ray films. When only the professional component of the service is provided, modifier -26 is placed after the CPT code. Modifier -26 alerts the third-party payer to the fact that oly the professional component was provided. If, for example, an independent radiology facility takes a complete chest x-ray, 71030, and sends the x-rays to an independent radiologist who reads the x-rays and writes a report of the findings in the x-rays, the coding for the independent radiologist would be the professional component o;y: 71030-26 for complete chest x-ray, four views. The professional (physician) portion of the service includes the following: •Review of the port films •Review of dosimetry, dose delivery, treatment parameters •Treatment setup •Patient examination for medical evaluation and management

Technical component

This component is the technologist's service and the equipment, film, and supplies necessary to perform the service. describes the services of the technologist, as well as the use of the equipment, film, and other supplies. There is no CPT modifier to indicate the technical component of radiologic services. The modifier most commonly used is the HCPCS Level II Modifier -TC, which reports the technical component. When submitting claims for radiologic services in which only the technical component was provided, use a code followed by -TC. For example, if you were the coder for independent radiology facility that took the chest x-ray, 7100, but sent it elsewhere to be interpreted, you would report the technical component only: 71030-TC complete chest x-ray, four views.

Global component

This describes a procedure in which both the professional and technical portions of the radiology service are provided.

82930 x 3

Three specimens of gastric secretions for total gastric acid

Tomography

Tomography, or computed tomography (CT), is used to view a single plane of the body. For example, code 70450 documents the use of tomography to view the head or brain on a single plane. The use of tomography for a patient who has right lung carcinoma is illustrated here. There is much greater detail obtained with tomography than with conventional radiography. Procedure that allows viewing of a single plane of the body by blurring out all but that particular level is the process of producing a tomogram, a two-dimensional image of a slice or section, through a three-dimensional object. Tomography achieves this result by simply moving an x-ray source in one direction as the s-ray film is moved in the opposite direction. The tomogram is the picture, tomograph is the apparatus, and tomography is the process.

83525

Total insulin

Superior

Toward the head or the upper part of the body; also known as cephalad or cephalic

Medial

Toward the midline of the body

Cystography

Urinary bladder

Hysterosalpingography

Uterine cavity and fallopian tubes

Venography

Veins and tributaries

84597

Vitamin K analysis of blood

84181

Western Blot of blood, with interpretation and report

C

What CPT® code(s) would best describe treatment of 9 plantar warts removed and 6 flat warts all destroyed with cryosurgery during the same office visit? A) 17110, 17003 B) 17110, 17111-52 C) 17111 D) 17110

A

What CPT® codes are reported for the destruction of 16 premalignant lesions and 10 benign lesions using cryosurgery? A) 17004, 17110 B) 17000, 17003, 17004, 17110 C) 17000, 17003 x 2, 17110 D) 17110, 17003

D

What is the correct diagnosis code to report treatment of a melanoma in-situ of the left upper arm? A) C44.609 B) C43.62 C) D04.62 D) D03.62

C

What term relates to connection of skin to underlying muscles? A) Dermis B) Sebaceous C) Hypodermis D) Epidermis

C

When coding multiple burns, which is correct? A) Sequence first the code reflecting the largest area in rule of nines with this degree of burn B) Sequence first the circumstance of the burn occurrence C) Sequence first the code reflecting the highest degree of burn D) Sequence first the code identifying burns to the head and neck

D

Which statement is TRUE regarding the Table of Neoplasms in ICD-10-CM? A) The Table of Neoplasms is found in the Tabular List. B) There is not a Table of Neoplasms in ICD-10-CM. C) The Table of Neoplasms is found by looking for Neoplasm in the ICD-10-CM Alphabetic Index. D) There are six columns in the Table of Neoplasms; Malignant Primary, Malignant Secondary, Ca in situ, Benign, Uncertain Behavior and Unspecified Behavior.

_______ involves health care services designed to meet a specific need for a particular population.

ancillary services

axial projection

any projection that allows the beam to pass through the body part lengthwise.

Proximal and distal

are directional body references that mean closest to, proximal or farthest from, distal, the trunk of the body. The term "proximal" describes a part as being closer to the body trunk than another part, and the term "distal" describes a part as being farther away from the body than another part. The knee would be described as being proximal to the ankle and it would also be described as being distal to the thigh or hip.

Decubitus position

are recumbent, lying, positions; the x-ray beam is places horizontally.

Lateral position

are side positions. When the patient's right side is closest to the film, it is call right lateral. When the patient's left side is closest to the film, it is called left lateral.

Which requires a bachelor's degree and certification, dietitian or nutritionist?

dietitian

______ assess how well nutritional needs are being met.

dietitians

Who might you consult to help a patient identify services that can be provided in the home and community and help arrange for these services?

discharge planner

_______ can be consulted to help coordinate discharges from hospitals and transfers between institutions.

discharge planners

What are some activities assessed by occupational therapy?

eating, dressing, grooming, bathing, toileting, cooking, cleaning

Name some treatments used by physical therapy.

exercise, heat, ultrasound, positioning

anteroposterior, AP

front to back position, in which the patient has his or front, anterior, closest to the x-ray machine, and the x-ray travels through the patient from the front to the back.

_______ is indicated when patients need monitoring, adjustment of drugs, dressing changes, and limited physical therapy.

home health

What is the goal for physical therapy?

improve function and independence

Contrast material

is radiopaque and is placed into the body to improve the view. Radiopaque areas appear light or white on the x-ray film because x-rays cannot pass through the contrast material. is radiopaque and is placed into the body to improve the view. Radiopaque areas appear light or white on the x-ray film because x-rays cannot pass through the contrast material. Using the Radiology Guidelines, locate the heading Administration of Contrast Material(s) to complete the following: oral and/or rectal contrast administration alone does not qualify as a study "with contrast"

Clinical Brachytherapy

is the placement of the radioactive material into or around the site of the tumor. The placement can be intracavitary (within the body) or interstitial (within the tissue). The source is a container of a radioactive element that can be inserted directly into the body where it delivers the radiation dose over time. Examples of sources are seeds, ribbons, and capsules. The ribbons are seeds embedded in tape, the tape is cut to the desired length to control the amount of radiation, and the ribbon is temporarily inserted into the tissue. The codes in the Clinical Brachytherapy subsection are divided based on the number of sources or ribbons applied: •Simple: 1 to 4 •Intermediate: 5 to 10 •Complex: 11 or more Brachytherapy for prostate cancer

Tangential

is the position that allows the beam to skim the body part, which produces a profile of the structure of the body.

Doppler ultrasound

is the use of sound that can be transmitted only through solids or liquids and is a specific version of ultrasonography or ultrasound.

Recumbent

means lying down. Thus, right lateral recumbent means the patient is lying on the right side, etc.

Lateral

means lying on the side, Away from the midline of the body (to the side)

Ventral

more commoly refers to the "anterior" but may be states as "prone", means lying on the stomach.

Dorsal

more commonly refers to the "back" but may be stated to mean "supine", means lying on the back.

__________ evaluate and treat people who have difficulty with self-care activities and fine motor coordination (mostly UE).

occupational therapists

Who might you consult to assess patients' ability to do their daily activities?

occupational therapy

M-Mode

one-dimensional display of the movement of structures. "M" stands for motion.

A-Mode

one-dimensional display reflecting the time it takes the sound wave to reach a structure and reflect back. This process maps the outline of the structure. "A" is for amplitude of sound return, echo.

Who might you contact to provide education on how to safely and effectively take meds?

pharmacist

_______ evaluate and treat people who have difficulty functioning; for example, difficulty walking, changing positions, transferring from bed to chair, lifting or bending. They assess strength, endurance, and coordination.

physical therapists

Who might you consult to work with people who have had problems such as stroke, amputation of a limb, or hip surgery?

physical therapy

________ tends to focus on evaluating and diagnosing movement dysfunctions as well as treating a person's injury itself.

physical therapy

posteroanterior, PA

position, the patient has his or her back, posterior, located closest to the machine, and the beam travels through the patient from back to front.

Who might be available to determine ventilator settings and management or take and evaluate ABGs?

respiratory therapy

________ may bring family members together for discussions about important health care issues or counsel people with anxiety, depression, or difficulty coping with a disorder or disability.

social workers

_______ specializes in evaluating and treating disorders that interfere with swallowing and/or communication. (including thought process)

speech therapy

Real-time scan:

two-dimensional display of both the structure and the motion of tissues and organs that indicates the size, shape and movement of the tissue or organ.

B-scan

two-dimensional display of the movement of tissues and organs. "B" stands for brightness. The sound waves bounce off tissue or organs and are projected onto a black and white television screen. The strong signals display as black and the weaker signals display as lighter shades of gray. B-scan is also called gray-scale ultrasound.

Oblique

views refer to those obtained while the body is rotated so it is not in a full anteroposterior or posteroanterior position but somewhat diagonal.