OST-249 - Chapter 8 - Respiratory, Cardiovascular, Hemic and Lymphatic System, and Mediastinum and Diaphragm Coding (30000 Series)

Diagnostic bronchoscopy performed with specimens taken from the mass identified. Pathology report was positive for malignancy. Procedure proceeded and lobectomy was performed.

32480, 31625-59 (Lobectomy was performed, which codes to 32480. Prior to the lobectomy, a bronchoscopy was performed with biopsy, code 31625. Modifier -59 would be appended to indicate that it was performed for a specific purpose and to determine the need for additional surgical intervention, which is allowed as per NCCI guidelines.) WRONG

A patient is brought from an MVA to the ER with multiple fractured ribs, labored breathing, and complaints of chest pain and palpitations. In the ER, the thoracic surgeon performs a tube thoracostomy with some relief of the patient's most severe symptoms.

32551 (When tube thoracostomy is performed, locate code 32551 in the Introduction/Removal of Procedures on Lungs/Pleura.)

Preoperative diagnosis: Left breast carcinoma. Postoperative diagnosis: Left breast carcinoma. Name of procedure: Left lumpectomy and sentinel node biopsy. Description of procedure: The patient is a 55-year-old female admitted with a diagnosis of left breast carcinoma. Incision was made with a 15 blade through skin and subcutaneous. Homeostasis achieved with bovie electrocautery. Flaps were formed in the usual manner. A wire was brought out through the incision. Then all the tissue around the wire down to the tip was circumferentially removed. A hot node in the axilla and at least two lymph nodes, which were blue-dyed within the sentinel nodes, were identified. Lymphoscintigraphy was performed, 2 cc of methylene blue dye was injected in the periareolar area preoperatively, and the breast was massaged for 5 minutes. A sentinel node biopsy was performed on one axillary nodes.

19301-LT, 38525-51-LT, 38792-51 (Lumpectomy considered partial mastectomy. Assigned to code 19301-LT. In addition, sentinel lymph node was excised, which codes to 38525-51-LT, as well as code for the injection for the lymphoscintigraphy, 38792-51. Lumpectomy code with axillary lymphadenectomy not assigned unless all or majority of lymph nodes excised.) WRONG

Tracheostomy

31600 (Tracheostomy, not stated otherwise, should be assigned the least significant code, 31600.)

Rhinoplasty to correct damage caused by a broken nose. One year later patient had a secondary rhinoplasty with major revisions. At the end of the second surgery, the incisions were closed with a single layer technique. How would you report the second surgery?

30450 (Secondary rhinoplasty code would be assigned 30450 when major revisions are performed.)

Traumatic external nasal and internal nasal septal defect. There were several fractures of the septum. Portions of the cartilaginous septum were missing, and there were several tears in the mucoperichondrium. Remnants were removed as well as spurs off the maxillary crest. Tip support was reconstructed with cartilaginous graft obtained from removed cartilaginous septum remnants.

30520 (Repair of the nasal septum (septoplasty) was performed, coded to 30520.)

Open reduction of nasal fracture, septoplasty, and bilateral inferior turbinate reduction. First, the septoplasty was performed. The mucoperichondrial flap was elevated off the cartilage and bone of the septum. The deviated portions of the septum were removed or replaced. Lateral and medial osteotomies were performed due to the significant deviation of the nose. Reduction of the inferior turbinates was performed by outfracturing and reducing them with bipolar electrocautery. The bony nasal work was done via intercartilaginous incisions between the upper lateral and lower lateral cartilage of the nose. Splints were placed in the nose, and a splint was placed on the dorsum of the nose.

30520, 30130-51 (In addition to the septoplasty (repair of the nose) code 30520, code 30130-51 is assigned for reduction of the inferior turbinates.)

ED visit for epistaxis. Both nares were treated with cauterization, and the bleeding appeared to be well controlled.

30901-50 (When epistaxis is controlled solely by cauterization, code 30901 is assigned. In this instance, the procedure was performed bilaterally; therefore, code assigned would be 30901-50.)

The patient had trouble breathing for 3 days. Her urgent care physician referred her to an ENT physician. The ENT performed a diagnostic maxillary sinusoscopy.

31233 (Endoscopic nasal sinusoscopy without any surgical intervention is assigned 31233, diagnostic sinusoscopy.)

Endoscopic ethmoidectomy, bilateral, right maxillary antrostomy, concha bullosa resection

31254-50, 31256-51-RT, 31240-51 (When multiple endoscopic procedures are performed, bilateral procedures are reported first. In this case, 31254-50, followed by the right maxillary antrostomy, 31256-51-RT, and the concha bullosa resection, 31240-51, would be assigned.)

Bilateral endoscopic anterior and posterior ethmoidectomies. Polyps were identified and we followed them into the anterior and posterior ethmoid air cells, and a large amount of mucus and tissue was removed. The left maxillary sinus opening was enlarged endoscopically.

31255-50, 31256-51-LT (Total (anterior and posterior) ethmoidectomies were performed bilaterally and, therefore, are assigned as the primary code as bilateral would be more significant than unilateral (31255-50). Only left maxillary antrostomy was performed; therefore, 31256-51-LT would be assigned.)

Hypertrophic mucosa of the left lateral nasal wall and anterior wall of the ethmoid sinuses were removed with microdebrider. Maxillary sinus was addressed and thickened mucosal tissue was removed, widening the maxillary tract.

31267-LT, 31254-51-LT (Maxillary antrostomy with tissue removal was performed endoscopically (code 31267), as well as anterior ethmoidectomy (code 31254). Code 31267-LT should be listed first, with 31254-51-LT listed second.) WRONG

Endoscopic right anterior ethmoidectomy, bilateral maxillary antrostomy, bilateral frontal sinus exploration

31276-50, 31256-50-51, 31254-51-RT (Bilateral frontal sinus exploration was performed (31276-50), as well as bilateral maxillary antrostomy (31256-50-51) and right ethmoidectomy (31254-51-RT). All subsequent procedures should have modifier -51 appended.) WRONG

Endoscopic sphenoidotomy with tissue removal

31288 (Endoscopic nasal sphenoidotomy was performed, which is assigned 31288.)

A sinus endoscopy with tissue removal from the sphenoid sinus was performed.

31288 (When sinus endoscopic sphenoidotomy is performed that includes removal of tissue, code 31288 is assigned.)

Emergency endotracheal intubation

31500 (Code assigned is 31500.)

Patient positioned properly and given 2 mg of Versed and 40 mg Amidate. After one attempt, she was intubated with a French 7.5 ET tube without difficulty.

31500 (Endotracheal intubation is assigned 31500.)

Procedure performed: Laryngoscopy with excision of laryngeal lesion. Laryngoscope was advanced into the larynx. There was a yellow cystic lesion along the left false vocal cord. The scope was advanced just superior to the lesion. Lesion was grasped, and by using straight and upbiting scissors, the entire capsule was excised.

31540 (Laryngoscopic excision of lesion is assigned 31540.)

Microdirect laryngoscopy with CO2 laser excision of polyps. Anterior commissure laryngoscope was passed where the polyp on the left vocal cord was immediately visible. There also appeared to be a small polyp on the left false vocal cord. Biopsies were taken. CO2 laser was used to carefully excise the polyps without injuring the vocal cords themselves.

31540 (Laryngoscopy was performed, biopsies were taken, and the polyps were excised. When biopsies are performed and the polyps/lesions removed, only the most definitive procedure is assigned. In this instance, 31540 only would be assigned.) WRONG

The patient had been hoarse for a month. His surgeon scheduled a direct laryngoscopy with injection of his vocal cords. During the surgery, it became necessary to use an operating microscope.

31571 (When direct laryngoscopy is performed with injection of vocal cords with the use of an operating microscope, the code assigned would be 31571. Code would be located in the Larynx, Endoscopy section.)

A 10-month-old child suffering from chronic inflammation of the trachea, which is causing difficulty in breathing, was presented to the emergency room. Physician inserted a planned incisional tracheal tube. This procedure was completed under general endotracheal anesthesia.

31601 (The procedure was planned (not stated as emergency) on a child < 2 years old; therefore, code 31601 is assigned.)

Emergency tracheostomy, transtracheal

31603 (An emergency tracheostomy was performed transtracheal, which is assigned 31603.)

The patient is 2 years old who attempted to swallow a quarter. The patient was in acute respiratory distress when arrived in the ED. A temporary tracheostomy was accomplished, allowing oxygen exchange. X-ray revealed the coin to be deeply wedged in the trachea. Several attempts were made to remove the coin in the ED with the use of forceps, without success. The patient was given a mild sedative and taken to the OR where a scope was used to successfully remove the coin.

31603, 31530-59 (An emergency tracheostomy was performed transtracheal, which is assigned 31603. Following this procedure, a direct laryngoscopy was performed with removal of a foreign body, coded to 31530-59. Modifier -59 is assigned to indicate that the laryngoscopy was distinct and separate from the emergency tracheostomy that was required to stabilize the patient until the foreign body could be removed.)

Bronchoscope was inserted, and the tracheobronchial tree showed extensive bronchitis and mucous plugging. Trachea; right mainstem; and upper, middle, and lower lobe segments were visualized and appeared normal. Left mainstem also found to be free of any endoluminal gross foreign bodies.

31622 (Only diagnostic bronchoscopy was performed; therefore, code 31622 would be appropriate.)

Diagnostic bronchoscopy with endoscopic BAL

31624 (Bronchoscopic bronchoalveolar lavage was performed, code 31624.)

Upon introduction of the bronchoscope, a large amount of mucus was removed from the tracheal lumen. Findings were consistent with emphysema. As soon as the large amount of mucus was suctioned, a large endobronchial lesion was visualized. Numerous bronchoalveolar lavage specimens were obtained for cytological purposes. Brushings were also obtained from these areas.

31624, 31623-51 (Bronchoscopy was performed with bronchoalveolar lavage (31624) as well as brushings (31623-51).) WRONG

The bronchoscope was passed in the tracheobronchial tree. Right upper lobe, middle lobe, and lower lobe were all patent. Bronchoscope was taken through the right upper lobe, and biopsies were obtained of the density in the right upper lobe.

31625 (Bronchoscopic biopsies were obtained; therefore, 31625 would be appropriate.) WRONG

The bronchoscope was passed via the left nares without difficulty. The scope was passed into the tracheobronchial tree. Scope was then taken into the right lower lobe, and multiple tracheobronchial brushings and biopsies were obtained.

31625-RT, 31623-51-RT (Bronchoscopy was performed, where biopsies (31625-RT) and tracheobronchial brushings (31623-51-RT) were obtained.)

Bronchoscope was passed into the tracheobronchial tree. All lobes were patent. The scope was taken into the right upper lobe where two transbronchial biopsies were obtained of a density in the right upper lobe.

31628 (Bronchoscopy was performed with transbronchial biopsies, all in the same lobe; therefore, 31628 would be appropriate.)

Bronchoscope was passed into the transbronchial tree. The right upper, right middle, and right lower lobes were all patent with no endobronchial lesions seen. Bronchoscope was then taken in the left tracheobronchial tree. A total of four transbronchial biopsies were obtained from the left lower lobe.

31628 (Transbronchial biopsies are assigned codes based on each lobe; therefore, 31628 should be assigned for the left lower lobe only.) WRONG

Endoscopic transbronchial biopsies six times, RUL

31628 (Transbronchial biopsies were obtained endoscopically, all to the same lobe, that is, right upper lobe (RUL); therefore, code 31628 only would be appropriate, as these are coded by lobe.)

Bronchoscopic transbronchial lung biopsy, left lower lobe and right upper lobe

31632, 31628 (Transbronchial biopsies are assigned based on the number of lobes; therefore, 31632 and 31628 would be assigned for two lobes.) WRONG

Scope was introduced through right nare and past into trachea, which appeared normal. There was a thick mucous plug in the right main stem of the tracheobronchial tree and the right lower lobe that was thinned with saline and aspirated and sent for culture and sensitivity.

31645 (Aspiration of the tracheobronchial tree was performed, which codes to 31645.)

Bronchoscope passed through right nare and advanced to the trachea and carina. Right main stem and lower, middle, and upper lobes appeared normal. Left main stem bronchus was almost completely occluded. Lavage with therapeutic aspiration was performed with the two large mucous plugs removed. Biopsy was obtained of the left main bronchus as well as two endobronchial biopsies were performed.

31645, 31625-51 (Bronchoscopic biopsy, 31625, was performed as well as aspiration of the tracheobronchial aspiration, code 31645. Codes should be listed in order of significance, listing 31645 first and then 31625 with modifier -51 for multiple procedures listed last.) WRONG

Thoracentesis

32554 (Thoracentesis performed, not stated whether with guidance or indwelling, therefore, assumed without guidance or indwelling catheter, which codes to 32554.)

Thoracentesis. A Pharmaseal thoracentesis kit was used with aspirating catheter. Patient was prepped in the posterior position and catheter advanced into the intercostal space, two interspaces below the scapula. About 1 liter of cloudy amber fluid was removed.

32554 (When thoracentesis is performed without imaging, and no catheter is placed indwelling, code 32554 is assigned.)

Left side of the chest was probed, and area appropriate for thoracentesis was marked. Probe needle used to locate the effusion before inserting needle. Needle inserted and straw-colored fluid was withdrawn. At that point, patient complained of chest pain; therefore, the thoracentesis catheter was withdrawn and patient discharged to PACU.

32554-LT (CPT code 32554 was completed prior to the patient's chest pain.) WRONG

Thoracentesis. Right posterior chest was prepped, and Pharmaseal catheter was instilled into the right posterior clavicular line. About 1.2 liters of serosanguineous fluid was removed.

32554-RT (Thoracentesis was performed with no imaging, and no indwelling catheter was placed; therefore, 32554-RT is assigned.)

The right posterior chest was prepped with Betadine and Pharmaseal catheter instilled in the right posterior clavicular line. About 1.2 liters of serosanguineous fluid was removed without difficulty. Once thoracentesis was completed, the patient reported no shortness of breath.

32554-RT (Thoracentesis was performed, and catheter was not indicated as left in place or imaging performed; therefore, 32554-RT would be appropriate.)

Physician performed a subsequent thoracentesis of the pleural cavity for aspiration with needle fluoroscopic guidance.

32555 (When thoracentesis is performed with imaging guidance, code 32555 is assigned when no indwelling catheter is left in place.)

A thoracentesis kit including water seal was advanced into the intercostal space and half liter of cloudy fluid removed. Due to the recurring nature of this condition in this patient, it was decided to leave the catheter sutured into place. Patient will be monitored for additional aspiration as necessary.

32556 (Thoracentesis was performed, and catheter was left indwelling; therefore, 32556 would be assigned.)

An area in the right posterior chest was punctured using an 18-gauge needle, and an 8.5 French drainage catheter was inserted. Pus was withdrawn with approximately 100 cc of yellowish pus without odor. The catheter was secured and left in position.

32556-RT (Thoracentesis was performed with a catheter left indwelling, which codes to 32556-RT.)

A 60-year-old male with symptomatic bradycardia and syncope is taken to the operating suite where an insertion of a DDD pacemaker will be performed. A left subclavian venipuncture was carried out. A guide wire was passed through the needle, and the needle was withdrawn. A second subclavian venipuncture was performed, a second guide wire was passed, and the second needle was withdrawn. An oblique incision was made in the deltopectoral area incorporating the wire exit sites. A subcutaneous pocket was created with the cautery on the pectoralis fascia. An introducer dilator was passed over the first wire, and the wire and dilator were withdrawn. A ventricular lead was passed through the introducer, and the introducer was broken away in the routine fashion. A second introducer dilator was passed over the second guide wire, and the wire and dilator were withdrawn. An atrial lead was passed through the introducer, and the introducer was broken away in the routine fashion. Each of the leads were sutured down to the chest wall with two 2-0 silk sutures each, were connected to the generator, and were curled, and the generator was placed in the pocket.

33208 (Pacemaker was inserted with two leads; therefore, code 33208 would be assigned.)

Dual-chamber pacemaker placement with dual leads

33208 (Pacemaker with dual leads was inserted; therefore, 33208 would be assigned.)

A patient has a temporary pacemaker system placed due to significant trauma.

33210 (Only a temporary pacemaker was placed; therefore, code 33210 would be appropriate.)

Revision of pacemaker skin pocket

33222 (Revision of skin pocket is assigned 33222 only.)

Procedure Performed: Pacemaker replacement due to generator end of life. Incision made over prior incision, capsule opened, and pacemaker delivered out of pocket. Lead checked and found to be adequate. New pacemaker readied and old pacemaker disconnected and replaced with new SESR01 pulse generator, serial number YS1234.

33227 (Old pacemaker (pulse generator) removed and replaced, and assigned 33227 as single lead only.)

Incision made over the previous pacemaker scar and pulse generator extruded and leads disconnected. Atrial lead is number 6586, serial number 9937589, and ventricular lead is number 6878, serial number 97759587. The new pacemaker is model 3535, serial number 3938465. The leads were reconnected and the pocket irrigated, and all was inserted back into the pocket and the pocket closed.

33228 (Pacemaker pulse generator was inserted; however, leads were left intact. Therefore, code 33228 would be appropriate.)

Removal of old pacemaker pulse generator, insertion of new pacemaker pulse generator for a two-lead system

33228 (Pacemaker pulse generator was inserted; however, leads were left intact. Therefore, code 33228 would be appropriate.)

End of life pacemaker replacement. Small incision was made over the previous scar, and the old pulse generator was extruded and the leads were disimplanted. Leads were tested and found to be in satisfactory condition. The new pulse generator was implanted into the existing pocket, and the atrial and ventricular leads were reimplanted and hooked to the new pulse generator. The pocket was closed.

33228 (Pulse generator for pacemaker only was inserted; therefore, 33228 would be assigned. The dual leads were not replaced.)

Patient presents for replacement of pulse generator, which has reached end of life. Pacemaker pocket is incised and the pulse generator and leads are removed from the pocket. The battery is replaced and the two leads tested, reinserted, and reconnected.

33228 (Pulse generator only replaced for a dual-lead pacemaker; therefore, 33228 would be appropriate.)

Patient has a dual-chamber pacemaker. The leads in this system were recalled. The leads were extracted via transvenous technique, the generator was left in place, and new leads were inserted via transvenous technique.

33235, 33217-51 (In this instance, only the dual leads are being replaced and then reconnected to the existing pacemaker. Therefore, code 33235 is assigned as well as 33217-51, one for the removal of the old leads and one for the insertion of the new leads.)

Procedure: Dual-chamber permanent defibrillator implantation. Indications: A 67-year-old who has significant underlying ischemic cardiomyopathy with EF of 25%, prior infarcts. Description of procedure: A 5 cm incision was made at the left deltopectoral groove. With blunt dissection and cautery, this was carried down through the prepectoralis fascia. The cephalic vein was identified and ligated distally. Through the venotomy, a subclavian venogram was performed to provide a roadmap. The atrial and ventricular leads were then advanced into the vessel to the level of the right atrium under fluoroscopic guidance. The ventricular lead was maneuvered to the right ventricular outflow tract and then through the RV apex where it was actively fixed. Good sensing and pacing thresholds were demonstrated. The lead was anchored to the prepectoralis fascia with interrupted 2-0 Tycron sutures. A 10-volt pacing did not result in diaphragmatic capture. The atrial lead was maneuvered to the anterolateral right atrial wall where it was actively fixed. Good sensing and pacing thresholds were demonstrated. A subcutaneous pocket was created with good hemostasis achieved. The generator was connected to the lead and then placed in the pocket with no tension on the lead.

33249 (Insertion of permanent defibrillator with single or dual leads is assigned 33249.)

A 62-year-old female with three-vessel disease and supraventricular tachycardia, which has been refractory to other management. She previously had pacemaker placement and stenting of the coronary artery stenosis, which has failed to solve the problem. She will undergo CABG with autologous saphenous vein and a modified maze procedure to treat the tachycardia. A median sternotomy incision is made, and cardiopulmonary bypass is initiated. The endoscope is used to harvest an adequate length of saphenous vein from her left leg. This is uneventful and bleeding is easily controlled. The vein graft is prepared and cut to the appropriate lengths for anastomosis. Three bypasses are performed, one to the LAD, one to the circumflex, and another distally on the circumflex. A modified maze procedure was then performed and the patient was weaned from bypass. Once the heart was again beating on its own, an attempt was made to induce an arrhythmia, but this could not be done. At this point, the sternum was closed with wires and the skin reapproximated with staples.

33254, 33512-51 (A modified maze procedure was performed during the session (code 33254), as well as a coronary artery bypass graft, three venous grafts (33512-51).) WRONG

Patient with history of mitral stenosis is now symptomatic, requiring mitral valve replacement. Physician performs mitral valve replacement necessitating cardiac bypass.

33430 (Mitral valve replacement was performed with cardiac bypass, which codes to 33430.)

Thromboendarterectomy, subclavian thoracic incision

35301 (When thromboendarterectomy is performed through a subclavian incision, assign code 35301.) WRONG

The patient is a 69-year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. He is taken to the operating room to redo left carotid endarterectomy. The left neck was prepped and the previous incision was carefully reopened. Using sharp dissection, the common carotid artery and its branches were dissected free. The patient was systematically heparinized, and after a few minutes, clamps applied to the common carotid artery and its branches. A longitudinal arteriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastic balloon-tip shunt was inserted first proximally and then distally, with restoration of flow. Plaque blocking the vessel and vessel lining were separated from the artery and removed, following which a patch graft was applied and sutured to the vessel.

35301, 35390 (Excision of plaque was performed; therefore, the thromboendarterectomy would be assigned code 35301. Per CPT guidelines, when the procedure is a "reoperation" and is performed more than one month after the original surgery, code 35390 should also be assigned in addition to the thromboendarterectomy.)

Venipuncture, age 7

36415 (When venipuncture is performed for a patient aged 7, code 36415 is assigned.)

Patient was admitted for observation, was transfused two units of packed red blood cells, hemoglobin was 13, and was clinically feeling better and discharged.

36430 (Only one transfusion code is assigned, 36430, found in Arteries/Veins, Venous Procedures. The number of units of blood product is assigned HCPCS "P" codes, which would be assigned by the facility that provides the units of blood.)

Crohn's disease in a 47-year-old male requiring central venous access for hyperalimentation. Left side of chest was prepped and draped and subclavian vein was percutaneously entered, and guide wire was advanced into the superior vena cava. Double-lumen central venous catheter was placed. Catheter was sutured to skin using 2-0 silk sutures.

36556 (Central venous catheter was placed, however, nontunneled with no port/pump; therefore, 36556 would be appropriate.)

The placement of an infuse-a-port on the right anterior chest wall. A 51-year-old patient with history of colon cancer with poor peripheral access presents for placement of an infuse-a-port. Using Seldinger technique, a guide wire was placed into the right internal jugular vein to the superior vena cava. Pocket was then made in the right anterior chest wall. The guide wire and dilator were removed and the catheter itself threaded into the superior vena cava. The tunneling device was used and the catheter tunneled into the anterior chest wall, hooked to the infuse-a-port, and the port placed into the pocket.

36561 (A central venous catheter was placed, which involved tunneling and the placement of a port. Therefore, code 36561 is assigned.)

Insertion of tunneled central venous catheter, subclavian vein, with subcutaneous port, age 61

36561 (Central venous catheter was inserted with a port for a patient aged 61; therefore, code 36561 would be appropriate.)

A 65-year-old patient undergoing chemotherapy with poor peripheral IV access presents for insertion of port. Guide wire placed into the right internal jugular vein to the superior vena cava. Pocket was made and catheter was threaded into the superior vena cava. Tunnel device was utilized to tunnel the catheter, hooked to the port, and pocket closed.

36561 (Central venous catheter was placed, utilizing tunneling device and port; therefore, code 36561 would be appropriate.)

The patient is a 77-year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an infuse-a-port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically.

36561 (Central venous tunneled catheter was inserted with a port for a patient aged 77; therefore, code 36561 would be appropriate.)

A 60-year-old patient was admitted for the removal of an old port-a-cath. The capsule was opened, and the port was delivered out of the chest. Sutures were cut, and the tunnel that housed the catheter was closed. Access was via the left internal jugular vein and into the right atrium. Pocket was developed and catheter tunneled from that site to the exit site of the previously placed guide wire. Catheter inserted into the sheath and placed at the right atrial superior vena cava junction. Port was also placed.

36561, 36590-59 (Old catheter was removed from one site and assigned 36590-59 to indicate distinct, separate from newly placed catheter. New catheter was tunneled; therefore, code 36561, central venous catheter with port, is assigned.) WRONG

Removal of tunneled central venous catheter

36589 (When a tunneled central venous catheter is removed, code 36589 is appropriate.)

An area of the infuse-a-port was prepped and incision made over the port. Capsule opened and port delivered out of the chest. Suture was cut, and tunnel was closed.

36590 (Removal of tunneled central venous catheter is assigned 36590.)

Balloon angioplasty, percutaneous, iliac vessel

37220 (When angioplasty is performed of the iliac vessel percutaneously, code 37220 is assigned.)

Peroneal artery revascularization with stent and atherectomy, open

37231 (Revascularization of the peroneal artery was performed, which includes stent and atherectomy. Open revascularization is assigned 37231.)

Patient scheduled for a temporal artery biopsy to rule out temporal arteritis. A Doppler probe was used to isolate the temporal artery, and using a marking pen, the path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade scalpel, the skin was opened in the preauricular area and dissected down to the subcutaneous tissue where the temporal artery was identified in its bed. It was a medium-sized artery, and it was dissected out for a length of approximately 4 cm with some branches. The ends were ligated with 4-0 Vicryl, and the artery was removed from its bed and sent to pathology as specimen.

37609 (Code 37609 is assigned when ligation or biopsy is performed of the temporal artery.)

Left axilla prepped and incision was made. Axillary contents and several enlarged lymph nodes were removed for pathology.

38500 (When lymph nodes are biopsied/excised, code 38500 should be assigned unless specified as deep.) WRONG

What code would you report for a cervical approach of a mediastinotomy with exploration, drainage, removal of foreign body, or biopsy?

39000 (Code would be located in the Mediastinum, Incision section. Code 39000 would be assigned when exploration, drainage, removal of foreign body, or biopsy are performed.)

In what surgical section of the CPT book would one find a copy for the repair of vestibular stenosis?

Respiratory System (Repair of vestibular stenosis refers to the nose and, therefore, would be included in the Respiratory System section.)

A surgical bronchoscopy includes a diagnostic bronchoscopy.

True (All surgical procedures include any diagnostic test performed on the same anatomical location. This is indicated by the designation of "separate procedure" assigned to these diagnostic codes.)