Medical Procedures and Coding: CPT and ICD-10-CM Codes, Exams of Nursing

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CODING CPC>AAPC CHP.12 PRACTICAL APPLICATIONS 1-

10:QUESTIONS AND ANSWERS LATEST 2023/2024 BEST

ACCURATE ANSWERS

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10outof10poin ts Preoperativediagnosis: Desireforcircumcision. Postoperativediagnosis: Desireforcircumcision. (Thisisthediagnosistoreportforthissurgeryiftherearenofurtherfi ndingsintheoperativenote.) Procedure:Circum cision.Anesthesia: General. Indications:Thepatientisa 19year- old(Theageofthepatient.) whitemale,sexuallyactivefortwoyears.Herequests circumcision.Heunderstandstherisksandbenefitsofcircumcision. ProcedureDescription:Thepatientwasbroughttotheoperatingroomandplacedon theoperatingroomtableinthesupineposition.AfteradequateLMAanesthesiawasa ccomplishedhewasgiven a dorsal penile blockandamodified ringblockwith 0.25% Marcaine plain.(This isthe typeofpenilenerveblockprovidedforthecircumcision.) Two circumferential incisions (Surgical incision is made, as using a clamp or device is usuallyreservedforinfants.) weremadearoundthepatient’spenistoallowfor themaximalaestheticresult.AdequatehemostasiswasthenachievedwiththeBo vie,andtheskinedgeswerereapproximatedusing4- 0chromicsimpleinterruptedsutureswithaU-stitchatthefrenulum. Thepatientwasextubatedandtakentotherecoveryroomingoodcondition.

Disposition:Thepatientwastakentothepostanesthesiacareunitandthendisch argedhome.WhatCPT®andICD-10-CMcodesshould bereported? CPT®code(s): [a] ICD-10-CMcode(s): [b] SpecifiedAn swerfor:a SpecifiedAn swerfor:b

Z41.

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Questio n2 5outof10poin ts CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 54161 CorrectAnswersfor:b EvaluationMethod CorrectAnswe r ExactMatch Z41.

Preoperativediagnosis:Prostatecancer. Postoperativediagnosis: Prostatecancer. (Thisisthediagnosistoreportforthesurgery.Thepreandpost- operativediagnosesmatchandaresupportedinthestatementof medicalnecessity.) Procedure:Radicalretropubicprostatectomywithbilateralpelviclymphnodedissection. StatementofMedicalNecessity:Thepatientisaverypleasant58year- oldgentlemanwithGleason7prostatecancer.Heunderstoodtherisksandbenefitso fradical retropubicprostatectomyincluding failuretocure,recurrenceofcancer,needforfutureprocedures,impotenceandinco ntinence.Heunderstoodtheserisks,andheelectedtoproceed. StatementofOperation:Thepatientwasbroughttotheoperatingroomandplacedon theoperatingtableinthesupineposition.Afteradequategeneralendotrachealanes thesiawasaccomplished,hewasputinthedorsallithotomypositionandwasprepped anddrapedintheusualsterilefashion.A20French Foley catheter was introduced in the patient’s urethra, and the balloon was inflated with 20ml ofsterilewater. Madea mid- lineinfraumbilicalincisionanddissecteddowntotherectusfascia.Then transectedthe rectusfasciabetween the belliesofthe rectusmuscle anddissected into theretropubicspace.(This indicates thesurgeryis performedbyanopenapproachinto theretropubicarea.) PlacedaBookwalterretractortoaidinvisualizationandto protectthesurrounding structures. Performeda bilateralpelviclymphnodedissection, (Bilateralpelviclymphadenectomy.) taking care to avoid the hypogastric and obturator nerves bilaterally. The nodepackets were sent off the field for permanent section and frozen section. Then dissected the prostatefreefromitslateralsidewallanddorsalattachmentssuperficiallyandplaced aright-angleclampbehind the dorsal venous complex and tied off the dorsal venous complex with two free ties of #1Vicryl.Sewedsomebackbleedingsuturesovertheprostateandweplacedarig

ht-angleagainbehindthedorsalvenouscomplexandthentransectedit withalonghandledblade.Carefullyinspectedthedorsal venous complex for any bleeding and no bleeding was noted. Then placed a right angle clampbehind the urethra and transected the anterior aspect of the urethra, exposing the Foley catheter. WegraspedthiswithatonsilandthencutofftheFoleycatheterattheurethralmeatusa ndpulledtheFoley catheter into the urethral incision that had been made. Then transected the posterior urethra,freeing the prostate from its apical attachment. This allowed us to apply upward retraction to theprostateanddissectitfreefromtherectalanteriorwall.Thenclipped andcutthelateralpediclestofreetheprostateuptothelevelofthebladd erneck.ThentransectedDenonvilliers’fasciaandidentifiedthebilater alvasdeferens,whichwereclippedandcutaccordingly.Also,dissected theseminalvesiclesleavingthetipsoftheseminalvesiclesinplaceinthe hopesofimprovinghisincontinence.(Radicallyremoving the entire prostate.)Oncethiswascomplete,dissectedtheprostatefreefromthe bladderneckusingelectrocautery. (Radicallyremovingtheentireprostate.) Openedtheanterior aspectof thebladder, able to identify the bilateral ureteral orifices effluxing indigo carmine that had beenadministeredabout10minutesearlierbytheanesthesiologist.Oncetheprosta tewassentoffthefieldfor permanent section, attention was turned to recapitulating the bladder neck. Everted the bladdermucosawith4- 0Monocrylandthenclosedthebladderneckinatennisracquetclosureusing2- 0Vicryl.ThenplacedaRothsoundinthepatient’surethraafterensuringadequatehe mostasisinthepelvisandplaced five anastomotic sutures of 2-0 Monocryl surrounding the urethra. Then placed them in thecorresponding location in the bladder neck after a Foley catheter, 20 French in size, had been placedthrough the urethra and into the bladder, and the balloon was inflated with 20ml of sterile water.

Thencincheddowntheseanastomoticsuturesandtiedthemoff.IrrigatedtheFoleyc atheterandensuredthat there was no bladder leak. Then placed a JP drain in the patient’s left lateral quadrant, taking careto avoid the epigastric vessels. Stitched the drain in place with a 2-0 silk. Closed the fascia with #1Vicryl in a running fashion and closed the subcutaneous tissues with 3-0 Vicryl. The skin was stapledclosed anda steriledressingwasapplied.Hiscatheterwasagainirrigatedwithreturnofblueurine. Noclots. Thepatientwasextubated,and taken totherecoveryroomingoodcondition.WhataretheCPT®andIC D-10-CMcodesforthisprocedure? CPT®code(s): [a] ICD-10-CMcode(s): [b] SpecifiedAn swerfor:a SpecifiedAns werfor:b

C

CorrectAnswersfor:a EvaluationMethod CorrectAnswe r ExactMatch^55845 CorrectAnswersfor:b

Respon seFeed back : CPT®code:Theoperativenotedocumentsthataradicalprostatectomywasperf ormedviaanincisionintheretropubicspace.IntheCPT®Index,lookforProstatec tomy/Retropubic/Radical, Code55845iscorrectbecausetherewasalocalbilaterallymphadenectomyperf ormedwiththeradical prostatectomy. A bilateral lymphadenectomy includes the lymph nodes of the internal,external,andcom- moniliacnodes.Theinternaliliacisalsoknownasthehypogastricarteryanditsbra nchesaretheobturators. ICD-10-CMcode:IntheICD-10-CMAlphabeticIndex,lookforCancer- seealsoNeoplasm,bysite,malignant. In the Table of Neoplasms, look for Neoplasm, neoplastic/prostate (gland)/MalignantPrimary(column)C61.VerifycodeselectionintheTabularList. CAS E Questio n3 10outof10poin ts Preoperativediagnosis:Prostatecancer. Postoperativediagnosis: Prostatecancer. (Thisisthediagnosistoreport.Thepreandpost- operativediagnosesarethe sameandare supported in theoperative note.) Procedure:Ultrasoundguidanceplacementofgoldfiducialmarkers. Description of procedure: The patient is a 62 year-old male with prostate cancer. He is to undergoexternalbeamradiationtherapy,andradiationtherapy,andradiationoncol ogyaskedmetoplacethefiducialgold markers.Informed consentwasobtained.The patientwasbroughttotheprocedureroom.He received oral sedation prior to the EvaluationMethod CorrectAnswe r ExactMatch C

procedure. Ultrasound was performed, and utilizing 20ml oflidocaine,theprostatewasnumbedwithlidocaine.Next, positionmarkersw ereplacedattherightandleftbases,aswellastheleftapexoftheprostat eglandwithoutdifficulty.(Thisistheplacement of markers for radiation therapy.) He had an excellent appearance and ultrasound. Thepatient did not suffer any pain or other problems during the procedure. The hospital ultrasounddepartmentassistedmeinimaging. (Indicationnottocodefortheradiologyservice.) WhataretheCPT®andICD-10-CMthatshouldbereportedforthisprocedure? CPT®code(s): [a] ICD-10-CMcode(s): [b] SpecifiedAn swerfor:a SpecifiedAns werfor:b

C

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Questio n4 (^) 10outof10poin ts PreoperativeDiagnosis:RTureteralstones. PostoperativeDiagnosis: RTureteralstones. CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 55876 CorrectAnswersfor:b EvaluationMethod CorrectAnswe r ExactMatch C

(Thisisthediagnosistoreportasthepreandpost- operativediagnosesmatchandthediagnosisissupportedintheo perativereport.) Operation:Openrightureterolithotomy. Intraoperative Findings: The patient had marked inflammatory reaction around the proximal ureter, justbelow therenalpelvis.Multiple stonefragments wereembeddedin theedematousureteral lining. Procedure: Thepatientwasplaced on theoperating room tablein thesupineposition.General

anesthesia was induced. He was then placed in a right flank up position. An incision was made offthe tipofthe 12thrib, anddissection wascarrieddown through skin, fatandfasciato openthelumbodorsalfasciaenteringtheretroperitonealspace. (Thisindicatesthesurgerywasperformedbyopenapproach.) Thepe ritoneumwassweptanteriorly. Carefuldissection wasthen carried down in theretroperitonealspace tofirstidentifythevena cava andthentoidentifytherenalvein.Oncethesestructureswerelocalized,theureterwa sidentified. Careful dissectionwasdoneto mobilizethe ureter andtoidentify theareaofthestoneimpactionbypalpation. The ureter was then opened longitudinally and the ureteral stent was identified. Themultipleembeddedstonefragmentswerethen removedfromthe ureterallumen.(Surgicalremoval of the stone from the ureter.) The ureteral lumen was then irrigated copiously, and nootherstonefragmentswereidentifiable. The ureterotomy was then re-approximated with interrupted sutures of 5-0 chromic.Inspectionshowedgoodhemostasis. Spongeandneedlecountswerecorrect,andclosurewasbegunafterplacementofaB lakedrainthroughseparateinferiorstabwound.Marcaine0.5%withnoepinephrine wasusedtoinfiltratetheintercostalnerves.Thewoundwasthenclosedinlayerswith muscleandfascialapproximationwith#1Vicryl.Theskinwasclosedwithstaples.St eriledressingswereapplied. The patient returned to the recovery area in satisfactory condition.WhataretheCPT®andICD-10- CMcodesreportedforthisprocedure?CPT®code: [a] ICD-10-CMcode: [b] SpecifiedAn swerfor:a SpecifiedAnswerfor:b pg. 9 CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 50610-RT ExactMatch^50610 CorrectAnswersfor:b

0

610-RT

N20.

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Questio n5 (^) 10outof10poin ts Preoperativediagnosis:Leftrenalcalculus. Postoperativediagnosis: Leftrenalcalculus. (Thisisthediagnosistoreportiftherearenofurtherpositivefindings arefoundintheoperativenote.) Procedure:ESWL2300shocksat22kV. Description of Procedure: The KUB was reviewed, revealing a lower caliceal calculi on the left. Thepatientwasanesthetized and positioned onthe lithotripsytable.Thestonewastargetedandtreatedwith 60 shocks for 2 minutes, and then a 2-minute pause was carried out. We then resumed at 60slowlyworkingupto120,foratotalof1800shocksonthelowerpole,w hichcompletelydisappeared.(Lithotripsy.) We then shocked the tip of the stent with 500 shocks as calcification wasseen there on the prior KUB, but it was unclear on today’s KUB with fluoro whether that was stillpresent. The patient appeared to tolerate the procedure well, and he was brought to

the recovery roominstablecondition.He willfollowup in1weekforpossiblestent removalasKUBprior tothe procedure.WhataretheCPT®andICD-10- CMcodesforthisprocedure? CPT®code(s): [a] ICD-10-CMcode(s): [b]

SpecifiedAn swerfor:a SpecifiedAnsw erfor:b

50590-

LT

N20.

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Questio n6 (^) 10outof10poin ts Preoperative diagnosis:Ta grade 3 transitional cell carcinoma (TCC) bladder CA in January 2010Postoperativediagnosis:Tagrade3transitionalcellcarcinoma(TCC)bladder CAinJanuary2010;now2newbladderlesions. Operation:Cystos copy.Anesthesia: Local. Findings:Therewere2tinypapillarylesionsintheposteriorwallofthebladder;othe rwise,thecystoscopywasnegative. Procedure description: A flexible cystoscope was introduced into the patient’s urethra. A thoroughcystoscopic examination was done. Bilateral ureteral orifices were visualized effluxing clear yellowurine. All sides of CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 50590-LT ExactMatch^50590 CorrectAnswersfor:b EvaluationMethod CorrectAnswer ExactMatch N20.

the bladder were inspected, and retroflexion was performed. Cytology was sent.Plan:Wewillschedulethepatientforabladderbiopsyatthenextavailabled ate. WhatCPT®andICD-10- CMcodesarereportedforthisprocedure? CPT®code(s): [a] ICD-10-CMcode(s): [b] , [c] SpecifiedAns werfor:a (^0)

00

SpecifiedAns werfor:b 9

N

SpecifiedAns werfor:c

Z

Question 6.66667outof10po CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 52000 CorrectAnswersfor:b EvaluationMethod CorrectAnswer ExactMatch N32. CorrectAnswersfor:c EvaluationMethod CorrectAnswer ExactMatch Z85.

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CASE

Preoperativediagnosis: Intrinsicsphincterdefic iency.StressIncontine nce. Postoperativediagnosis: Intrinsicsphincterdefic iency.StressIncontine nce. Procedure: CystoscopywithDurasphereinjection.Esti mated BloodLoss:Less than5cc. Complications: None.Counts:Co rrect. Indications:Thisisa verypleasantfemalewithintrinsicsphincterdeficiencycausing urinaryincontinence.Sheunderstoodtherisksandbenefitsoftheprocedure,and sheelectedtoproceed.ProcedureDescription:Thepatientwasbroughttotheope ratingroomandplacedontheoperatingroomtableinthesupineposition.Afterade quateLMAanesthesiawasaccomplished,shewaspreppedanddrapedintheusual sterilefashion. A 21-French cystoscope was introduced in the patient’s urethra. Her urethra was fairly pale, not wellapproximated,andwaspatulous.Weinjected2½syringesofDuraspheremate rialintotheurethrabutwereunabletogetanymorethanthatamountintothetissue. Therewasmoderateapproximationoftheurethralmucosa. Thebladder wasemptiedandlidocainejellyinstilled.Shewasextubatedandtakentotherecov eryroomingoodcondition. Disposition:Thepatientwastakentothepostanesthesiacareunitandthendisc hargedhome.WhataretheCPT® andICD-10-CMcodesforthis procedure? CPT®code(s): [a]

ICD-10-CMcode(s): [b] , [c] SpecifiedAns wer

for:a (^15) SpecifiedAns wer

N36.

for:b (^4) SpecifiedAns wer

N39.

for:c (^3) Respon seFeed back: CPT® code: For this procedure there is an endoscopic injection of synthetic material in the urethraand bladder neck to prevent urinary incontinence. In the index, look forUrethra/Endoscopy/InjectionofImplantMaterial.Thisguidesyouto51715.Th ecystoscopy(52000)wouldnotbereportedseparatelybecausethiscode isa separateprocedure.Codeswiththe“separateprocedure”designation CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 51715 CorrectAnswersfor:b EvaluationMethod CorrectAnswer ExactMatch N36. CorrectAnswersfor:c EvaluationMethod CorrectAnswer ExactMatch N39.

a r e n o r m a l l y n o t r e p o r t e d w h e n a n o t h errelated procedureisperformedatthesametime.Durasphereisabulkingagentusedtorel ievethesymptomsofincontinencewheninjectedinto thetissues of theurethra. TheDurasphereis notreportedby thephysicianasthefacilitysuppliesit. ICD-10-CM codes: In the ICD-10-CM Alphabetic Index, look for Deficiency,deficient/intrinsic/sphincterN36.42.Thereisanoteundersubcateg oryN36.4touseadditionalcodetoidentifyassociatedurinarystressincontinenc e(N39.3).ThiscanbefoundintheAlphabetic

IndexbylookingforIncontinence/urine(urinary)/stress(female) (male)N39.3.VerifycodeselectionintheTabularList. Question 10outof10points CASE Preoperativediagnosis:Grosshematuria.P ostoperativediagnosis:Bladder/ Prostatetumor. Operation: Transurethral resection bladder tumor (TURBT) large (5.3 cm).Anesthesia:General. Findings:Thepatienthadextensiveinvolvementofthebladderwithsolidandede matous- appearinghemorrhagictumorcompletelyreplacingthetrigoneandextendingint othebladderneck andprostatictissue.Theureteralorificeswerenotidentifiable. Digital rectalexaminationrevealednodular,firmmass perrectum. Proceduredescription:Thepatientwasplacedontheoperating roomtablein thesupineposition,andgeneralanesthesiawasinduced.Hewasthenplacedintheli thotomypositionandpreppedanddrapedappropriately. Cystoscopywasdonewhichshowedevidenceoftheurethraltraumaduetothetrau maticremovalofthe Foley catheter (patient stepped on the tubing and the catheter was pulled out). The bladder itselfshowedextensiveclotretention.Therewaspapillaryandnecrotic- appearingnodulartissuemassextensively involving thetrigoneand thebladderneckand theprostatearea. Theureteralorificeswerenotidentified. After consulting with the patient’s wife and obtaining an adjustment to the surgical consent, thetumorwasresectedfromthetrigone,bladderneckandprostate.Obvioused ematousandhemorrhagictissuewasremoved.Extensiveelectrocauterizatio nwasdoneforbleedingvessels.Severalareasofnecrotic- appearingtissuewereevacuated.Carewastakentoavoidextendingresection intotheareaoftheexternalsphincter. Digital rectal examinationrevealedthefirm,nodularmass intheanterior CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 52240 CorrectAnswersfor:b EvaluationMethod CorrectAnswer

rectum. No impactedstoolwasidentified. Attheendoftheprocedure,hemostasisappearedgood.Tissuechipswereevacuat edfromthebladder.Foleycatheterwasinserted. Patientwastakentotherecoveryroom insatisfactorycondition. Addendum: The patient had a previous partial prostatectomy and had been found to have T2b N0 MXprostate cancer. On the physical examination today and on the endoscopic exam, it was unclear as towhetherthetumormasswasrelatedtothebladderorrecurrentprostatecancer. Pathology revealed bladder carcinoma in the trigone and bladder neck, and recurrent prostatecancer. WhataretheCPT®andICD-10- CMcodesforthisprocedure?CPT®code: [a] ICD-10-CMcodes: [b] , [c] , [d] SpecifiedAns wer

for:a (^40) SpecifiedAns wer

C67.

for:b (^0) SpecifiedAns wer

C67.

for:c (^5) SpecifiedAns werfor:d

C

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Questio n9 (^) 10outof10poin ts Preoperative diagnosis:Transitional cell carcinoma in the bladder.Postoperativediagnosis:Transitionalcellcarcinomainthe bladder. Procedure:Cystoscopy;Excisionbladdertumor -1cm.Bilateralretrogradepyelogram. Cytology of bladder.Anesthesia:Ge neral.EstimatedBloodL ExactMatch C67. ExactMatch C67. ExactMatch C CorrectAnswersfor:c EvaluationMethod CorrectAnswer ExactMatch C67. ExactMatch C ExactMatch C67. CorrectAnswersfor:d EvaluationMethod CorrectAnswer ExactMatch C ExactMatch C67. ExactMatch C67.

oss:10cc.Complication s:None. Counts:Correct. Indications: The patient is a 58 year-old male status post partial cystectomy for transitional cellcarcinomaof thebladder. Heunderstood therisks andbenefits oftoday’s procedure,andelected toproceed. ProcedureDescription:Thepatientwasbroughttotheoperatingroom,placedonth eoperatingroomtable,andplacedinthesupineposition.AfteradequateLMAanest hesiawasaccomplishedhewasput inthe dorsal lithotomypositionandprepped anddraped intheusual sterilefashion. A21-Frenchrigidcystoscopewasintroducedthroughtheurethraandathorough cystourethroscopywasperformed.A1cmtumorwasnotedontheposteriorbladde rwall.Thetumorwasresectedwithoutcomplications. Weobtainedbladdercytologyandperformedaretrogradepyelogram,whichshow ednofillingdefectsorirregularities. The bladder was emptied, and lidocaine jelly was instilled in the urethra. He was extubated and takentotherecoveryroomingoodcondition. Disposition.Thepatientwastakentothepostanesthesiacareunitandthendischar gedhome.BilateralRetrogradePyelogramInterpretation A bilateral retrograde pyelogram was performed, which showed no filling defects or irregularities.WhataretheCPT®andICD-10-CMforthisprocedure? CPT®codes: [a] , [b] ICD-10-CMcode: [c]

SpecifiedAn swerfor:a SpecifiedAn swerfor:b SpecifiedAnswe rfor:c

74420-

C67.4

Question10 CASE10 Preoperativediagnosis: Large rightinguinal hernia.Bilateralundesc endedtestes. 8.33333outof10po ints Postoperativediagnosis: Bilateralinguinalhe CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch^52234 CorrectAnswersfor:b EvaluationMethod CorrectAnswer ExactMatch 74420-26 CorrectAnswersfor:c EvaluationMethod CorrectAnswer ExactMatch C67.4

rnias. Undescendedteste s. Procedureperformed:Bilateral orchiopexy andbilateral inguinalherniarepairsas wellas circumcisionona10year-oldpatient. Estimatedbloodloss:Lessthan5ml.C omplications:None. Descriptionofprocedure:Afterinformedconsenthadbeenobtainedpreviouslyan dreviewedagaininthepreoperativearea,thepatientwasbroughtbacktotheOR,pl acedsupineandgeneralanesthesiawas induced without problems. It was somewhat difficult to find an IV site, because of the patient’sbody habitus. However, there were no complications with anesthesia. The patient was thenappropriatelypaddedandpreppedanddrapedinsterilefashion.0.25%Marca ineplainwasusedforbilateral inguinal blocks aswellas injectedin thesub- qintheinguinal crease. Ibeganontheright- handside,wherehehadanintermittentrightinguinalbulgeforseveralmonths.Asc alpelwasusedtomakeaskinincisionfollowingthecreasesandthiswasextendeddo wnthroughverygeneroussubcutaneousfatandScarpa’sfasciatoexposetheexter nalobliqueaponeurosis.Theexternalringwasidentifiedaswas theilioinguinalligament.Thering wasopenedforashortdistance.The testiswashighinthescrotumandwasbroughtthrough.Thegubernaculumwasthe ndivided.Averylargeherniasac was carefullyopenedandvery carefullydissecteddowntothelevel of theinternal ring. Theredidnotappear tobeabdominalcontents withinthe herniasac.,It wasthentwistedandsutureligatedatthebase.Theherniasacwasthensenttopatho logy.Thetestiswaspinkandviable.Adartospouchwascreatedandthetestisbrough tthroughit.Theneckofthepouchwastightenedwitha few interrupted sutures of 3-0 Vicryl. Care was taken to make sure it did not twist the testicle thatthetestislayina normalanatomical position.Thescrotalincisionwasthen closedwith 5-0plaingut.The external ringwas recreatedby approximatingtheaponeurosis oftheexternal oblique. Theunderlyingilioinguinalnervewasidentifiedandspared.Scarpa’swasapproxim atedwith3-0Vicrylandtheskinclosedwith5-

0Monocrylinarunningsubcuticularstitch.Steri- stripsanddressingwereplacedoverthis. Ontheleft-handsideinitially his testiswas felt to bealmostnonpalpablebut onexamunderanesthesiaitagainwaswithinthehighscrotum.Withgentlepressur e,Icouldmakethisessentiallydisappearintohisabdomensuggestingalargecom municatinghydrocele.Imadethedecisionto

proceedwithinguinalherniarepairandexploration.Again,hehadaMarcaineinguinal blockandtheskinwasalsoanesthetizedwith0.25%Marcaine.Amatchingincisionwas madewithascalpelfollowingtheskincreases.Thiswasextendeddownthroughsubcut aneoustissuesandScarpastoexposetheexternalobliqueandtheexternalring.Itwast hentwistedandsutureligatedatthebasewith 3-0 Vicryl. The hernia sac was also sent to pathology. At this point, there was sufficient length toeasilybringthetestisintothescrotum.Adartospouchwascreatedandthetestiswas broughtintoitwith care taken to make sure we did not twist the cord structures. The neck of the pouch wastightened with 3-0 Vicryl, and then the scrotal incision closed with 5-0 plain gut in an identicalfashion. The external oblique was approximated with a few interrupted sutures of 3-0 Vicryl, torecreatethering.Again,carewas takentopreservetheunderlyingilioinguinalnerve.Scarpa’swasapproximated3- 0Vicryl,aswell,andtheskinwasclosedwithMonocryl.Steri- Stripsanddressingwereplacedover,thisaswell. 0.25%Marcaineplainwasthenusedforapenileblock.Acircumcisingincisionwasmad eapproximately3mmbelowthecoronalmarginandthepenispartiallydegloved.Meti culoushemostasiswasobtainedwithBoviecautery.Theexcessprepucewastrimmed .Itwasthendiscarded.Theskinedgeswereapproximatedwith5- 0plaingutinarunningfashionx2.Hemostasiswasexcellent.Theglansheadappeared normal.AdressingofconformandVaselinegauzewasapplied. The patient was then extubated and sent to the recovery in stable condition. Nocomplications. WhataretheCPT®andICD-10-CMcodesforthisprocedure? CPT®code(s): [a] , [b] , [c] ICD-10-CMcode(s): [d] , [e] , [f] SpecifiedAns werfor:a

49505-

SpecifiedAns wer

54640-

50-

for:b (^51) SpecifiedAns (^) 54161- CorrectAnswersfor:a EvaluationMethod CorrectAnswer ExactMatch 49505-50 CorrectAnswersfor:b EvaluationMethod CorrectAnswer ExactMatch 54640-50-51 ExactMatch 54640-51-50 CorrectAnswersfor:c EvaluationMethod CorrectAnswer ExactMatch 54161-51 CorrectAnswersfor:d EvaluationMethod CorrectAnswer ExactMatch K40.20 ExactMatch Q53.2 3