Relias- Cardiovascular Part 2

Which type of muscle is considered to be a "voluntary" muscle?

Skeletal

Which modifier should be used when arthrodesis code 22551 is combined with another definitive procedure (e.g., osteotomy, laminectomy)?

-51

Which modifier should be reported if a co-surgeon acts as an assistant in the performance of an additional procedure during the same surgical session?

-80

What is the appropriate CPT code for excision of a 2-cm sebaceous cyst on the face that is subdermal or deeper?

11442

A patient presents for treatment of a contracted palmar fascial cord. After local anesthesia is applied to the hand, the physician injects the enzyme collagenase into the Dupuytren's cord in three separate, but proximate locations. What code(s) should be reported for this procedure?

20527

What coding correctly reports a bilateral arthrotomy of the temporomandibular joint?

21010-50

A physician excises a 10-cm chest wall mass that did not include removing the ribs. What is the coding for this procedure?

21558

What code(s) should be reported for open treatment of an uncomplicated unilateral right-sided rib fracture with internal fixation?

21811

Surgeon A performs the approach and serves as co-surgeon for the entire case, whereas Surgeon B performs spinal procedures. Procedures performed are anterior thoracic two-level arthrodesis, anterior thoracic single-level discectomy, anterior plate instrumentation, and structural autograft iliac crest bone graft. Which codes would Surgeon B report?

22556-62; 22585-62; 63077-62-51; 22845; 20938

Which arthrodesis code is reported per vertebral segments?

22808

Which code should be reported for L5-S1 presacral interbody arthrodesis without instrumentation?

22899

A patient undergoes right shoulder arthroplasty for a completely torn rotator cuff that cannot be repaired. The surgeon performs a reverse total shoulder arthroplasty, the rotator cuff is repaired, and the biceps tendon was tenodesed. The latissimus muscle was harvested and transferred around the humerus and secured to the greater tuberosity. What is the appropriate coding for the procedures performed?

23472

Which modifier is used when pulmonary function testing is provided in addition to a separate E/M service?

25

The orthopedic surgeon performs a wrist arthroplasty without replacement with a prosthetic device, with the use of an external fixator. What code should be reported in this case?

25332

A 25-year-old women presents with an osteosarcoma of the acetabulum with extension to the ilium, ischium, and the superior pubic ramus to the symphysis. At operation, a radical resection of the entire hemipelvis is performed with preservation of the limb. What is the appropriate coding for this case?

27077

The physician performs a total hip resurfacing arthroplasty for a young patient with advanced hip disease. The procedure involves replacing the socket and grinding the surfaces of the femoral head and acetabulum, retaining the femoral neck and majority of the femoral head. The preserved bone is then sculpted and a metal cap with a short stem is cemented to the femur. What is the appropriate code to report this procedure?

27130

A patient presents for implantation of a total hip arthroplasty. A hemiarthroplasty femoral component was removed previously because of infection with an antibiotic spacer placed to treat the infection. The antibiotic spacer is to be removed with placement of a new total joint. How is this procedure reported?

27132

A 72-year-old female initially underwent left cemented total hip arthroplasty 1 year previously. After recovery, radiographic studies disclosed loosening of the femoral component. The surgical plan included removal and replacement of the femoral component and possible replacement of the acetabular components. After induction of general anesthesia, the patient's blood pressure dropped suddenly and she went into cardiac arrest. The procedure was immediately discontinued, and measures were taken to resuscitate the patient. How should the physician's services be reported in this case?

27134-53

What is the correct coding when reporting an injection procedure for contrast-enhanced CT knee arthrography with radiological supervision?

27369, 73701

A patient presents to have a left patellofemoral replacement. The surface of the femur was prepared, and then the surface of the patella was resected. The femoral trochlear implant was cemented into place along with the patellar button component and held into place until cement hardened. What code(s) should be assigned for this surgery?

27438

A patient undergoes revision of the tibial component of the right knee total arthroplasty, but instead of revising the entire component, the orthopedic surgeon needs only to replace the polyethylene liner. The removal of the liner was more complex, because the liner was lodged under the lip of the metal component. What code(s) should be assigned for this surgery?

27486-52

What is the appropriate code for the excision of a deep subcutaneous 2.5cm mass in the posterior aspect of the left ankle?

27618

What is the code assignment for an excision of a deep subcutaneous tissue mass in the posterior aspect of the left ankle requiring a 2.5-cm diameter resection?

27618

A patient undergoes total ankle arthroplasty to replace a painful arthritic ankle joint due to posttraumatic osteoarthritis. What is the appropriate coding for this procedure?

27702

A patient underwent arthroscopy of the knee with a lateral compartment meniscectomy and shaving of the articular cartilage in the lateral compartment. What code(s) should be reported for this procedure?

29881

What is the appropriate CPT code to report when a physician removes a bead, which can be visualized with a nasal speculum, from a child's nose using forceps without local or general anesthesia?

30300

Bilateral therapeutic fractures of the inferior nasal turbinates are performed for airway improvement. How is this procedure reported?

30930

A patient with chronic hyperplastic rhinosinusitis undergoes a diagnostic nasal and sinus endoscopy, including the interior of the nasal cavity, middle and superior meatus, turbinates, and spheno-ethmoid recess; a left sinusotomy, and endoscopic intranasal polypectomy. How is this procedure reported?

31237

Using a balloon under endoscopic control, a dilation of the frontal sinus ostium is performed. Curettes are then used for removal of tissue from the frontal sinus ostium to create a sinusotomy. How is this case reported?

31276

What code(s) should be assigned to report a bronchoscopy with computer-assisted image guidance to map the pathway to a lesion to place markers to facilitate tissue sampling?

31626, 31627

The physician performs a bilateral diagnostic bronchoscopy with multiple transbronchial lung biopsies of a single lobe. How is this reported?

31628

What is the correct coding for transbronchial needle aspiration for multiple biopsies within the same lobe?

31629

The physician performs a diagnostic bronchoscopy on patient with a 1.0-cm nodule adjacent to the left upper lobe bronchus. No abnormality is identified, and the physician performs an endobronchial ultrasound to determine if the nodule invades the bronchial wall. How is this reported?

31652

The physician performs a sleeve pneumonectomy, including resection of the tracheal carina with end-to-end anastomosis of the trachea and contralateral main stem bronchus. How is this procedure reported?

32442

What code should be reported for open placement of a tube thoracoscopy with connection to a drainage system to treat a hemothorax?

32551

A 70-year-old male with atrial fibrillation undergoes insertion of a permanent single chamber ventricular pacemaker system with fluoroscopic guidance to provide ventricular pacing. The left subclavian vein is accessed, a J-wire is advanced into the vein. A pocket for the generator is created. The pacemaker wire is placed in the right ventricle. The wire is tested, and the generator pocket closed. What is the correct coding for this case?

33207

Which code(s) should be reported for removal and replacement of pacemaker generator?

33227-33229

A 74-year-old female has a leadless pacemaker system that indicates a low battery level. The device is removed with a pacemaker retrieval catheter using fluoroscopic guidance. What is the appropriate coding for this scenario?

33275

A patient had a CABG performed 6 months ago. The patient undergoes a "redo" CABG using three autogenous vein grafts. What is the correct coding for this procedure?

33512, 33530

Coronary artery bypass is performed for occlusion of the circumflex artery, the right coronary artery, and the left anterior descending artery. The procedure includes grafting of the left internal mammary to the left anterior descending artery; a greater saphenous vein graft to the diagonal branch; and a saphenous vein graft to the posterior descending artery. The vein graft was harvested from the right and left greater saphenous vein via open approach. A surgical assistant performed procurement of the grafts. What is the correct coding for this procedure?

33533-80, 33518-80

What is the correct coding for an extracranial carotid angiography with selective catheterization performed on each common carotid artery?

36222-50

What code describes placement of a peripherally inserted nontunneled central venous catheter, without subcutaneous port, with imaging guidance for patients age 5 years or older?

36573

The physician performs an endovascular revascularization of a tibial artery using atherectomy guided by intravascular optical coherence tomography (OCT). The atherectomy catheter is advanced through the lesion using OCT guidance in conjunction with fluoroscopic imaging. What code(s) should be reported?

37229

What codes are reported when an endovascular stent is deployed as a cage to trap embolization coils?

37241-37244

What code is used to report a lumbar laminotomy for discectomy endoscopic assistance?

63030

What radiology codes for imaging guidance may be reported in conjunction with trigger point injections?

76942, 77002, 77021

A 3-year-old patient with spinal muscular atrophy was discharged home on a ventilator. The physician develops a care plan and manages the patient's mechanical ventilation for a 30-day period. What is the correct coding for this case?

94005

A routine 12-lead ECG is performed. What is the correct coding for the professional interpretation, report, and the technical component?

93000

How is the technical component of a 1-to-3-lead rhythm ECG reported?

93041

How is the subsequent electronic analysis or reprogramming of a subcutaneous cardiac rhythm monitor reported?

93285, 93291, 93298, 93299

A pulmonologist performs an initial observation care evaluation and management service and initial ventilation assist and management. What is the correct coding for this case?

94002

What codes should be reported when pulse oximetry is performed in addition to spirometry testing at the same session?

94010, 94760-59

A 66-year-old patient with asthma is seen in the office with diffuse wheezing and bronchospasm. A nebulized bronchodilator is administered using a metered-dose inhaler and chamber. The treatment is repeated after 30 minutes with good clinical response. What code(s) should be reported?

94640, 94640-76

A patient receives an albuterol inhalation treatment of less than 1 hour for asthma. She returns later the same day for a repeat treatment of less than 1 hour. What is the correct code for the second encounter?

94640-76

An asthmatic patient is given 2 hours of continuous inhalation treatment with aerosol medication for acute airway obstruction. How is this reported?

94644, 94645

What is the correct coding for measurement of lung volume using helium dilution or nitrogen washout?

94727

A 45-year-old patient underwent a sleep study after the technologist instructed the patient on how to hook up the equipment at home. The sleep study lasted 5 hours and including an ECG and recordings of ventilation, respiratory effort, breathing, and O2 saturation. What are the correct code(s) to report?

95806-52

The physician performs a medically appropriate exam with straightforward medical decision making of a new patient with Dupuytren's contracture and an enzyme injection into the Dupuytren's cord. How is this encounter reported?

99205-25, 20527

A 35-year-old female presents to her physician's office with a 1.5-cm tumor on her scalp. The physician performs and documents 25 minutes total time with an established patient Evaluation and Management service and decides to remove the lipoma from the scalp. The patient is taken to the treatment room and local anesthesia is injected. An incision is made through the skin and subcutaneous tissue of the scalp. The tumor is identified and dissected free of surrounding structures and fascial attachments. The wound is inspected and irrigated and closed in layers with interrupted sutures. Steri-Strips and a gauze dressing are applied, held in place with a head wrap bandage. The specimen is packaged to send to pathology. Aftercare is discussed with the patient and a follow-up office visit is scheduled in 1 week to assess wound healing and remove sutures. What is the correct coding in this case?

99213-57, 21011

A patient presents to the emergency department with a humeral shaft fracture. An expanded problem-focused history and examination and moderate-complexity medical decision-making are documented. The emergency department physician applies a short arm cast to stabilize the fracture and refers the patient to the orthopedist for fracture care. What code(s) should be reported for this procedure?

99283-25, 29075

When assigning an arthrocentesis code, what is the correct classification for an acromioclavicular joint?

An intermediate joint

Which appendix in the CPT codebook helps to identify the specific code that should be used in reporting access to arterial vessels within a vascular tree?

Appendix L

Which term describes aspiration of fluid from a joint performed by needle puncture?

Arthrocentesis

Which procedure is performed to immobilize or permanently hold a joint in a fixed position?

Arthrodesis

An orthopedic surgeon performed a total knee replacement of a patient's right knee. What is this name of this procedure?

Arthroplasty

What are the three different types of biopsies performed via bronchoscopy?

Bronchial mucosal, transbronchial lung, transbronchial needle aspiration

What is a fluid-filled sac that functions to reduce friction between two structures in a synovial joint?

Bursa

How is code selection for radical resection of a bone tumor determined?

By the location of the tumor

What treatment is used for atrial fibrillation and atrial flutter if antiarrhythmic drugs fail to convert the heart back to normal sinus rhythm?

Cardioversion

What type of devices are known as Hickman, Port-A-Cath, or PICC line?

Central venous catheters

What type of laryngoscopy procedures are performed with a lighted scope used to visualize the larynx?

Direct

What type of aneurysm separates the layers of the arterial wall instead of bulging out?

Dissecting aneurysm

Which procedure is used to enhance visualization and provide guidance for transbronchial needle biopsy?

Endobronchial ultrasound (EBUS)

Which type of approach or technique is used when spinal procedures are performed with continuous direct visualization of the spine through an endoscope?

Endoscopic

The physician performs a full-thickness dermal excision to remove a 2.5-cm benign lesion with margins and the wound is closed with simple, nonlayered closure. Which codes are used to report this procedure?

Excision of benign lesions

Which CPT codes are used when the procedure documentation specifies "Full-thickness excision of a 2.5-cm lipoma with margins from the left arm with simple closure"?

Excision of benign/malignant lesion codes

Which type of excision is confined to the tissue within or below the deep fascia and includes digital subfascial tumors that involve the tendons, tendon sheaths, or joints of the digit?

Excision of fascial or subfascial soft-tissue tumors

Which modifier is used to identify the thumb of the right hand as the site on which a procedure or service was performed?

F5

After performing an arthroscopic meniscectomy, the surgeon injects a mixture of lidocaine, bupivacaine, and steroid for postoperative pain management. It is appropriate to report code 20610 in this instance because he included a steroid in the injection.

False

An implant removal with a total shoulder or total elbow arthroplasty when a revision procedure is performed at the same operative episode should be reported separately.

False

If both an operating microscope and a telescope are used during a laryngoscopy procedure, the applicable flexible laryngoscopy code is reported for each procedure.

False

If lung resection is performed with chest wall tumor resection, only the lung resection is reported.

False

Moderate sedation is considered a bundled service into CPT codes.

False

Musculoskeletal lesion excision codes are used to report excision involving subcutaneous or deep soft-tissue tumors, whereas the integumentary lesion excision codes are used to report excision involving superficial soft tissues.

False

Paired structures such as the vocal cords, contained within one side of the larynx, are considered bilateral.

False

Which is an accurate statement concerning injection of a contrast agent into a joint for the purpose of arthrography?

Injection of a contrast agent for arthrography is reported with code 27369

What procedure joins two bones into a single unit, obliterating motion between the two?

Fusion

Which is a true statement concerning percutaneous needle biopsies?

Imaging guidance is reported separately

How is the appropriate code selection determined for radical resection of a bone tumor?

Location of the tumor

When code 20680 is reported for removal of a deep implant, such as a buried wire, but there was an extraordinary amount of work or unusual effort involved in the removal, what modifier should be used?

Modifier -22

What modifier should be appended to code 20612 if multiple ganglion cysts are aspirated?

Modifier -59

What modifier is used to report the components of TAVR/TAVI procedures?

Modifier 62

What type of pacemaker or implantable cardiac device (ICD) with pacing and sensing function is in three or more chambers of the heart?

Multiple lead

What term describes the insertion of a catheter or needle directly into a vessel (major artery or aorta) that is not manipulated farther into a branch?

Nonselective catheterization

When multiple injections are administered to the same tendon, how many times should code 20550 be reported?

Once

A left knee meniscectomy is started arthroscopically and is completed as open procedure. How is this reported?

Only the open procedure is reported

Which treatment is described as neither open nor closed with fracture fragments not visualized, but pins are placed across the fracture site under x-ray imaging?

Percutaneous skeletal fixation

What term identifies a bony projection or prominence?

Process

Which portion of a CABG procedure is not reported separately?

Procurement of a saphenous vein graft

In an anterior approach for lumbar fusion, surgical dissection exposes which of the following anatomical sites?

Psoas major muscle, body of vertebra, and sympathetic trunk

Which type of soft-tissue excision procedure in which wide margins of normal tissue are excised is most commonly used for malignant tumors and extremely aggressive benign tumors?

Radical resection of soft-tissue tumors

When arthroscopic procedures are performed in two knee compartments, how should the procedures performed be reported?

Report a code for each compartment as a separate service, with modifier 59 appended to the code for the secondary procedure.

What is the correct coding when a diagnostic bronchoscopy is performed followed by a surgical bronchoscopy?

Report only the surgical bronchoscopy

What is the correct reporting for a patient who is seen for monthly trimming of corns, callouses, and toenails?

Routine foot care procedure code

What term describes the removal of one division of a single lobe of the lung?

Segmentectomy

Which procedures should not be reported separately when performed in conjunction with mechanical thrombectomy?

Subsequent or prior continuous infusion of a thrombolytic

How is bilobectomy defined?

Surgical removal of two lobes from the right lung.

What procedure involves percutaneous insertion of a bioprosthetic tissue valve and must be performed by a co-surgeon team?

TAVR/TAVI procedure

Where are the arthroscopic procedures usually located within the Musculoskeletal System subsections in the CPT codebook?

The end of each subsection

What is the treatment zone for endograft procedures reported with CPT codes 34707 and 34708?

The portion of the iliac arteries that contains an endograft

What criteria is NOT used when selecting codes for arthrocentesis procedures?

The type of substance injected

Which anatomical structures are examined during a laryngoscopy?

Tongue base, larynx, and hypopharynx

Transbronchial lung biopsies are taken peripherally using fluoroscopy to guide the biopsy forceps of the lobe of a lung. When additional lobes are investigated during the same procedure, an add-on code is reported for each additional lobe.

True

How are paired structures, such as the vocal cords, in one side of the larynx considered for the purposes of reporting therapeutic interventions?

Unilateral

Modifiers -RT and -LT are appended to what kind of procedures?

Unilateral

What is the name of the nonbony compartment located between two adjacent vertebral bodies?

Vertebral interspace

What term is used to describe the non-bony compartment between two adjacent vertebral bodies that contains the intervertebral disc and includes the nucleus pulposus, annulus fibrosus, and two cartilaginous endplates?

Vertebral interspace

How would code 32608 be reported when masses of both lungs are biopsied?

With modifier 50

What procedure is not included as part of the TAVR/TAVI codes?

cardiopulmonary bypass

Which type of laryngoscopy uses a fiber optic cable to visualize the larynx?

direct

Which is considered a part of the surgical package definition?

evaluating the patient in the postanesthesia recovery area

A 55-year-old woman presents to the general surgeon during her postoperative follow-up visit for a total right knee replacement, which has a 90-day global period. She had been experiencing lumbar back pain the previous week and asked the surgeon to examine her. The physician performed the examination and sent the patient for an MRI, which verified bulging discs at L4-S1. Which modifier may be reported for the patient encounter?

modifier -24

An orthopedic surgeon performs a closed treatment of a tibial fracture. The patient's primary care physician performs all follow-up care for this procedure. What modifier would apply to reporting the postoperative care by the primary care physician?

modifier -55

What modifier should be appended when a unilateral diagnostic nasal endoscopy (CPT code 31231) is performed?

no modifier

When a bilateral diagnostic nasal endoscopy (CPT code 31231) is performed, which modifier should be appended?

no modifier

Is it appropriate to report code 31572, Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral, with code 31578, Laryngoscopy, flexible; with removal of lesion(s), nonlaser?

no, this is not allowed

How many times is it appropriate to report code 20550 when multiple injections are administered to the same tendon?

one time

What type of treatment is it when the fractured bone is opened remote from the fracture site in order to insert an intramedullary nail and the fracture site is not opened and visualized?

open treatment

Which term describes a fixation at each end of the construct and at least one additional interposed bony attachment?

segmental instrumentation

What anatomical structures are examined in a laryngoscopy?

tongue base, larynx, and hypopharynx

When coding a polysomnography, multiple physiologic tests are performed to isolate various signs and symptoms of sleep disorders. For these studies, one comprehensive code is reported.

true

How is a bilobectomy defined?

two lobes from the right lung

Which type of procedure is appropriate for use with modifiers RT and LT?

unilateral

A single endovascular revascularization code is used for the initial iliac artery treated in each leg (37220 or 37221). What number of add-on codes can be reported if other iliac vessels are also treated in that leg?

up to 2

Which bone biopsy site is appropriate to report with code 20225, Biopsy, bone, trocar, or needle; deep?

vertebral body