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Integumentary System (10000 Series)
- Dr. Smith performed a cryosurgery to destroy three premalignant lesions for a patient. Which code(s) should you report for this procedure? a. 17106 b. 17260 c. 17003 x 3 d. 17000, 17003 x 2
- d. One way to locate this answer in the index of the CPT® Professional Edition is under "Destruction,""Skin," then "Premalignant." The add-on code 17003 has the word "each," which indicates the lesions are reported separately, not as a group.
- Which codes should be reported for the following case? Preoperative diagnosis: Lesion, left hand Confirmed by pathology postoperative diagnosis: Primary malignant carcinoma, left hand Procedure performed: Excision of malignant carcinoma, left hand Anesthesia: General; 40 ml of lidocaine was infiltrated into the wound prior to making the incision. Procedure: The patient was brought to the operative suite where the left hand was prepped and dressed. A circular incision was made to include the 1 - cm lesion with narrowest margins of 0.6 cm with dissection down to subcutaneous tissue. Homeostasis was obtained; the wound was closed with simple mattress sutures. The patient tolerated the procedure well and was returned to the recovery room in good condition with sterile dressing in place. a. 11603 b. 11622 c. 11423 d. 11403
- b. The CPT® Professional Edition guidelines with excision of malignant lesions indicate a simple closure is included and measurement for excision includes the lesion diameter plus the narrowest margins equal the excised diameter. The narrowest margins in this question are listed as a total of 6 cm and the lesion is 1 cm; therefore, the total excised diameter is 1.6 cm (narrowest margins + the clinical diameter of the lesion = total excised diameter).
- Nancy underwent a fine needle aspiration with imaging guidance for a lesion in the right breast. During the aspiration procedure, a percutaneous metallic clip was placed in the right breast. Which codes describe this procedure? a. 10022 - RT, 19081 - RT b. 10021 - RT, 19081 - RT c. 19081 - RT, 19297 - 59 d. 19295-59, 10021-RT
- a. The fine needle aspiration is listed as the primary procedure with the add-on code reporting the metallic clip. An add-on code should not be listed as a primary procedure, nor should modifier - 59 be appended to add-on codes. Review the definition of modifier - 59 in Appendix A of the CPT® Professional Edition to help determine placement of modifiers.
- Which of the following procedures could be coded with a breast reconstruction with free flap?
a. Harvesting of the flap b. Micro vascular transfer c. Closure of the donor site and inset shaping the flap into a breast
d. None of the above
- d. One way to find this answer in the index of the CPT® Professional Edition is the main term "Reconstruction,""Breast," then "with Free Flap." Once the code is located, cross-reference to review the parenthetical notes below the code description for bundled or included procedures.
- Barry underwent a complex incision and drainage due to a postoperative wound infection, which required an extensive secondary closure of the surgical site. Which codes describe this procedure? a. 13160, 10081- 59 b. 10121, 12020 - 51 c. 13160, 10180 - 51 d. 10061, 12021- 59
- c. The parenthetical note below code 10180 provides guidance for surgical wound closure codes. Because this question indicates a postoperative infection and secondary closure, it is important to review the codes carefully for proper assignment. Modifier - 51 is used to indicate multiple procedures.
- Stephanie discovered a lesion on her trunk and was referred to Dr. Ralph, a trained Mohs surgeon, for treatment. Stephanie had no prior pathology of this lesion; therefore, Dr. Ralph completed a diagnostic skin biopsy with frozen section prior to the surgery. After reviewing the biopsy results, Dr. Ralph took the patient to the procedure suite and performed a Mohs surgery that same day. Dr. Ralph’s final report indicated the procedure required three stages, including five tissue blocks in each stage. He had to take an additional four blocks in stage two to verify margins and cell structure. Which codes should Dr. Ralph report for this entire encounter? a. 17313, 17314 x 2, 17315 x 4, 11100 - 59, 88331- 59 b. 17313, 17314 x 2, 17315 - 59 c. 17311, 17312 x 2, 17315 d. 17311, 17312 x 4, 17315 - 59, 11101 - 51, 88331 - 51
- a. The biopsy and frozen sections are reported with modifier - 59 because there was no prior pathology of the lesion and the Mohs surgery occurred on the same day. Selection of Mohs surgery codes is based on an atomic location and number of stages, which include five tissue blocks. Code 17315 is reported for additional tissue blocks after the first five, any stage.
- Mark cut his hand and arm while working on his car. Dr. Bill applied sutures to both the arm and hand wounds. An intermediate closure of 16 cm was placed in the arm and a simple closure of 3.6 cm was placed in the hand. Which codes should Dr. Bill report? a. 12004, 12035- 59 b. 12035, 12042- 59 c. 12035, 12002 - 51 d. 13132, 12036- 51 7.c. Repair (closure) guidelines indicate the most complicated repair should be coded as the primary procedure and modifier - 51 should be reported when more than one classification of wound is repaired. It is important to review the anatomic groupings associated with repair codes.
- A patient underwent an excision of a 2.1-cm diameter malignant lesion on her nose. An 11.2-sq- cm adjacent tissue transfer was required to repair the primary and secondary defect sites. How should you code this procedure? a. 11643, 14061- 59 b. 14061 c. 11646, 13152 - 51, 13153 - 51 d. 11443, 12054- 59
tendon. According to the modifier - 51 definition in the CPT® Professional Edition, this modifier should not be appended to add-on codes.
- Which code(s) should you report for the following case? Preoperative diagnosis: Procedures: Left knee medial collateral ligament tear Exam under anesthesia Anterior cruciate ligament tear Diagnostic arthroscopy of left knee Possible meniscus tear Left knee arthroscopic repair of lateral meniscus Postoperative diagnosis: Same Tourniquet time: 2.5 hours Procedure: The patient was taken to the operating room and positioned, and an epidural anesthetic was placed. Once the anesthetic had taken effect, the patient’s left leg was examined under anesthesia and noted to have increased valgus laxity with end point, a positive Lachman test, and positive pivot-shift test. The patient was prepped and draped in the normal fashion, exsanguinated, and the tourniquet applied to a 350 mmHg. The knee was then insufflated and irrigated with fluid. Using the arthroscopic sheath, visualization of the knee joint began. Attention was turned to the lateral meniscus where the tear was debrided. Using the arthroscope, the lateral meniscus was sutured with two mattress-type sutures of non-absorbable 2 - 0 material. The sutures were then tied and visualized with arthroscopy to reveal the meniscus to be in excellent shape and stable position. The 3.5-cm wound was thoroughly irrigated and closed with intermediate subcutaneous sutures. A sterile compression dressing was applied. The patient was placed in a TED hose and Watco brace, setting the brace between 40º and 60º of free motion. He was then taken to the recovery room in stable condition. The instrument, sponge, and needle counts were correct. a. 29882, 29877-52, 29870 - 51 b. 29866, 29868 c. 29870, 29882, 12032 d. 29882 13.d. This is a surgical arthroscopy procedure, which includes the diagnostic arthroscopy. You can find the coding note related to diagnostic and surgical arthroscopies multiple times in the CPT® Professional Edition. Specifically, this note can be found under the subcategory heading "Endoscopy/Arthroscopy" with this code set. The wound closure is included with the procedure and should not be coded separately.
- Two weeks ago, Sam underwent an open repair of his lower femur due to a traumatic fracture suffered whiles now skiing. His leg is healing as expected, and no new treatment is required to the femur. Today, he returns as planned for an application of a new long leg cast. The cast application is completed by the same physician who performed the surgery. How should today’s services be reported? a. 29345-58, Z46. b. 99024, Z46. c. 29345, 29700 - 59, 99024, Z46.89, M84.48XD d. 29345-76, 821.22, Z46. 14. a. The casting would be coded for the application of a new cast by the same physician who completed the surgery. As stated in the question, this was a planned application; therefore, modifier - 58 should be appended. The guidelines are listed under the subheading for application of casts and strapping in the CPT® Professional Edition.
- What type of soft tissue tumor resection is commonly used for malignant tumors or very aggressive benign tumors? a. Manipulative soft tissue resection b. Radical soft tissue resection c. Residual soft tissue resection
d. Manageable soft tissue resection
15. b. You can find the definition of a radical resection of soft tissue tumors in the CPT® Professional Edition at the beginning of the section on the musculoskeletal system. 16. A patient was stabbed in the right arm. A surgeon took the patient to an operating suite and completed wound exploration. The surgeon widened the wound to achieve proper visualization and completed subcutaneous debridement and ligation of minor subcutaneous blood vessels. No further procedures were required for this wound exploration. The arm wound was closed and dressed in the usual fashion. The patient tolerated the procedure well and was returned to the recovery room in good condition. How would you report this procedure? a. 20103, 11011- 51 b. 20103 c. 20103, 11011 - 59 d. 11043, 12036-59, 20103 - 51
- b. You can find this answer in the index of the CPT® Professional Edition under "Exploration," "Extremity," then "Penetrating Wound." The exploration of wound subcategory guidelines list the procedures that are included or bundled. This was a wound exploration only; therefore, no other codes would be reported, according to the subcategory guidelines.
- A patient underwent an anterior inter body arthrodesis with discectomy, osteophytectomy, fusion, and decompression of nerve roots at level C3, C4, and C5. The fusion was explored and then stabilized with application of anterior instrumentation placed from C3 to C5. Which codes would you use to report this procedure? a. 22551, 22585 x 2, 22845 - 51, 22830 - 59 b. 22554, 22585 x 2, 22845, 22830- 51 c. 22600, 22614, 22842, 22830 - 59 d. 22551, 22552 x 2, 22845, 22830- 51
- d. Careful review of the approach and level of spinal surgery is important to determine the correct code selection. Modifier - 51 should not be appended to add-on codes for spinal instrumentation; however, guidelines with spinal fusion exploration indicate modifier - 51 should be appended to this code when performed with a definitive procedure.
- Which code(s) would you report for an aspiration and injection of a ganglion cyst to the bone of the left great toe? a. 20600 b. 20612 c. 20615 d. 20600, 20612- 59
- c. This question is specifically for a bone cyst. There is no mention of an arthrocentes is in this question.
- A patient suffering from a non healing knee tendon underwent a platelet-rich plasma injection under imaging guidance. How should you report thisprocedure? a. 0232T b. 20551 c. 20551, 77002 d. 0232T, 20551, 77002
Preoperative diagnosis: Atherosclerotic heart disease Postoperative diagnosis: Same Anesthesia: General Procedure: The patient was brought to the operating room and placed in the supine position. With the patient under general intubation anesthesia, the anterior chest, abdomen, and legs were prepped and draped in the usual fashion. Review of a postoperative angiography showed severe, recurrent, two-vessel disease with normal ventricular function. A segment of the femoropopliteal artery was harvested using endoscopic vein- harvesting technique and prepared for grafting. The patient was heparinized and placed on cardiopulmonary bypass. The patient was cooled as necessary for the remainder of the procedure and an aortic cross-clamp was placed. The harvested vein was anastomosed to the aorta and brought down to the circumflex and anastomosed into place. An artery was anastomosed to the left subclavian artery and brought down to the left anterior descending and anastomosed into place. The aortic cross-clamp was removed after 55 minutes with spontaneous cardio version to a normal sinus rhythm. The patient was warmed and weaned from the bypass without difficulties after 104 minutes. The patient achieved homeostasis. The chest was drained and closed in layers in the usual fashion. The leg was closed in the usual fashion. Sterile dressings were applied and the patient returned to intensive care recovery in satisfactory condition. How should Dr. Manning report his services for Monday and Tuesday in this case? a. Monday: 99255 - 57; Tuesday: 33511, 33517, 35600 b. Monday: 99215 - 57; Tuesday: 33533, 33517-51, 35572 - 80, 33530 - 51 c. Monday: 99255 - 57; Tuesday: 33533, 33510, 33572, 33530 d. Monday: 99215 - 57; Tuesday: 33533, 33517, 35572, 33530
23. d. The patient requested the consult in this question; therefore, evaluation and management consult codes are not reported. Modifier - 57 is applied to the evaluation and management code because the decision for surgery was made during this visit. The bypass surgery in this question is a combination procedure using one artery and one vein; therefore, the combination (add-on) code is reported in addition to the arterial grafting code. The venous grafting codes are reported when only veins are used in a procedure. The add-on code for reoperation would be reported since the primary procedure (or first operation) was more than one month prior to the subsequent bypass surgery. Additionally, the add-on code for harvesting the femoropopliteal vein would be reported. The use of modifier - 51 would not be appropriately appended to add-on codes per the Appendix A of the CPT® Professional Edition.
- A patient had a temporary transvenous pacemaker system inserted with electrodes placed in the right atrial and ventricular chambers. How should you report this service? a. 33211 b. 33208 c. 33213, 33208 - 51 d. 33211, 33208- 51
- a. This question deals with the placement of a dual temporary pacemaker; therefore, codes for permanent pacemaker systems would not be reported.
- Marvin, a 51-year-old patient, required a conversion of a single-chamber pacemaker system to a dual-chamber system. The previously placed electrode was removed transvenously. The skin pocket was opened and the pulse generator removed. The skin pocket was then relocated and a dual system was placed with transvenous electrodes in both the right atrial and ventricular chambers. The system was tested and the new skin pocket was then closed. The patient tolerated the procedure well. How should you report these services?
a. 33208, 33234-51, 33233 - 51, 33222 - 51, 33214 - 51 b. 33208, 33214-51, 33223 - 51 c. 33208, 33234 - 51, 33233 - 51, 33222 - 51 d. 33214, 33222- 51
- d. This is an upgrade from a single to dual pacemaker system. Code 33214 includes removal of the old system, testing, and insertion of the new system. In this question, a revision of the skin pocket would be reported separately.
- A patient required a battery change for a single-chamber pacing cardioverter-defibrillator system. The battery was taken out in a subcutaneous fashion and a new battery placed. The cardioverter- defibrillator was then reattached to the electrodes, which were intact and tested, and the skin pocket was then closed. How should these services be reported? a. 33244, 33241-51, 33240 b. 33241, 33240- 51 c. 33236, 33202 - 51, 33206 - 51 d. 33241, 33240-51, 33233 - 51
- b. According to the CPT® Professional Edition subcategory guidelines with pacemaker and pacing cardioverter-defibrillator, when the "battery" of one of these systems is replaced, it is actually the pulse generator that is changed.
- Dr. Lim completed an external ECG with 48 - hour continuous rhythm testing during which analysis was performed for Mr. Brown. The report was reviewed and interpretation completed for evaluation of change to the pacemaker system. The report conclusion stated predominant rhythm of atrial fibrillation with non controlled left ventricular rate. Dr. Lim scheduled Mr. Brown for placement of a biventricular pacemaker, which will be connected to his current pacemaker system. How should Dr. Lim report her services for the cardiovascular monitoring? a. 33224 b. 33244, 93224- 59 c. 93224 d. 33208, 33225-51, 93225 - 59
- c. This question focuses on the cardiovascular monitor testing. The placement of the biventricular pacemaker is scheduled, but not stated as completed; coding for services not completed would be incorrect.
- A patient had an endarterectomy during the same surgical session for a repair to a coronary arteriovenous chamber fistula. The fistula repair did not require cardiopulmonary bypass to complete the procedure. How should these services be reported? a. 33572, 33501 b. 33500, 33572- 59 c. 33501 d. 33507, 33501- 59
- c. This repair includes an endarterectomy or angioplasty when completed with the basic procedure. This note can be found in the CPT® Professional Edition under the "Coronary artery anomalies" subheading.
- A patient suffering from chronic inflammation of the maxillary sinus underwent a surgical endoscopic transnasal balloon dilation procedure to restore normal sinus function. During this procedure, maxillary antrostomy with removal of tissue was completed. How should you report these procedures?
c. 43215 d. 43135
- a. One way to find this procedure in the index of the CPT® Professional Edition is under the main term "Esophagus," "Removal," and "Foreign Bodies." In this question, an esophagotomy was completed; therefore, you should not report a code for an endoscopic approach.
- An otherwise healthy 22 - year-old patient was scheduled for repair of an incarcerated bilateral recurrent inguinal hernia. The patient was taken into a same-day OR, where she was prepped, positioned, and draped in the usual fashion. The anesthesiologist administered general anesthesia and indicated the patient was ready for the surgery to begin. The surgeon created the incision and started the procedure. At this point, the patient went into shock due to the surgery and the procedure was halted. The patient was stabilized and returned to the recovery room. How should the surgeon report this procedure? a. 49507-74, T81.10XA, K40.30, Z53. b. 49521-53, K40.33, T81.10XA, Z53. c. 00830 - P1, 49521 - 51, K40.30, T81.10XA, Z53. d. 49521-47, K40.33, T81.10XA, Z53.
- a. This question indicates anesthesia was started and then the condition of the patient changed. Modifier - 74 indicates a discontinued procedure after administration of anesthesia and is appended to the surgery code.
- How would the following case be coded? Preoperative diagnosis: Lesion, buccal submucosa, right lower lip Postoperative diagnosis: Same Procedure performed: Excision of lesion, buccal submucosa, and right lower lip Anesthesia: Local Procedure: The patient was placed in the supine position. A measured 7x8 mm hard lesion is felt under the submucosa of the right lower lip. After application of 1% Xylocaine with 1:1000 epinephrine, the lesion was completely excised. The lesion does not extend into the muscle layer. The 8-cm wound was closed with complex mattress sutures to the submucosal level and dressed in typical sterile fashion. The patient tolerated the procedure well and returned to the recovery area in satisfactory condition. a. 40816, D10. b. 40814, 40831-51, D10. c. 40814, K13. d. 40814, D10.
- c. The complex repair is included with this excision code and should not be reported separately. The diagnosis in this question is a lesion, not a neoplasm.
- A patient underwent an EGD with transendoscopic ultrasound-guided transmural fine needle aspiration. How should you code this procedure? a. 43242, 76942- 26 b. 43242 c. 43235, 43238 - 59 d. 43235, 43242-51, 76942 - 26
- b. Code 43242 includes the ultrasound. Review the parenthetical notes with this code to help determine correct reporting.
- A patient underwent a laparoscopic repair of a paraesophageal hernia with fundoplasty with implantation of mesh. During the procedure, a laparoscopic esophageal lengthening was completed. Which codes capture this procedure? a. 43327, 43282- 59 b. 43333, 43283- 51 c. 43281, 43282 - 59, 43283 - 51 d. 43282, 43283
- d. One way to find this procedure in the index of the CPT® Professional Edition is under the main term "Laparoscopy," then "EsophagogastricFundoplasty" and/or "Esophageal Lengthening." Review the definition for modifier - 51 in Appendix A of the CPT® Professional Edition to help determine placement of this modifier.
- A patient underwent an enterectomy in the small intestine with four resections and anastomoses. How should you report this type of procedure? a. 44130 b. 44120 x 4 c. 44111 d. 44120, 44121 x 3
- d. The add-on code 44121 is reported for each additional resection and anastomosis of the small intestine. In this case, four total resections and anastomoses were completed; therefore, report the add- on code with three units.
- Veronica, a 55 - year-old patient, has left upper quadrant pain with a negative ultrasound. Veronica’s physician explains the need for a diagnostic and possible surgical procedure to determine the cause of this pain. She agrees to the procedure, completes overnight fast and prep, signs a consent for surgery, and is then taken to a procedure room. After nasal spray of 2% Xylocaine is administered, the tube is introduced through one nostril, down the back of the throat, and positioned into the stomach as the patient swallows. The diagnostic duodenal intubation and aspiration is completed. However, the physician decides to reposition the tube under fluoroscopic guidance and obtain multiple duodenal fluid specimens during the same operative session. The patient tolerates the procedure well and is moved to the recovery suite. How would you report the physician services? a. 43757 b. 43756, 43757- 52 c. 43755 d. 43755, 43756-59, 43757 - 59
- a. The diagnostic procedure is included with the surgical procedure and should not be reported separately.
- A patient has an adjustable gastric restrictive device component removed and replaced via a laparoscopic procedure. How should you code this procedure? a. 43773 b. 43772, 43773- 51 c. 43888 d. 43845
- a. One way to locate this answer in the index of the CPT® Professional Edition is under the main term "Laparoscopy," then "Gastric Restrictive Procedures." Once the code range is located, cross-reference for correct code selection.
a. 53855 x 2 b. 52282 x 2 c. 52281, 53855 - 59 d. 52282 x 2, 52305 - 59
- b. Code 52282 indicates stent (singular); therefore, when more than one stent is placed, the units should be reported.
- What modifier should be reported with the procedure code for transurethral resection of residual, or regrowth of, obstructive prostate tissue when the procedure is performed by the same physician during a postoperative period? a. - 22 b. - 52 c. - 77 d. - 78
- d. The parenthetical notes provided in the CPT® Professional Edition with procedure code for resection of residual prostate tissue indicate modifier - 78 would be appended if the procedure is performed by the same physician during a postoperative period.
- Dr. Laura completed a vaginal delivery in the hospital for Stephanie, a 30 - year-old patient. This is Stephanie’s first child and she delivered a healthy baby boy. Dr. Laura has taken care of Stephanie during the entire pregnancy and followed her through the postpartum period. Dr. Laura’s documentation stated that during the delivery admission, Stephanie required prophylactic antibiotics because she has mitral valve prolapse. How should Dr. Laura report the delivery care and diagnosis for this patient? a. O80, I34.1, Z38.00, 59400 b. I34.0, I34.1, Z37.0, 59510 c. O99.42, I34.1, Z377.0, 59400 d. I34.1, O99.42, Z37.0, 59614
- c. The routine obstetric care, including the ante- and postpartum care with vaginal delivery, is reported with code 59400. The diagnosis codes for this case are assigned for the pregnancy complicated by cardiovascular disease. The mitral valve prolapse is then reported as the specific condition.
- Diane suffered a spontaneous incomplete miscarriage during the second trimester and required surgical completion ofthis event. How should this procedure be reported? a. 59812 b. 59820 c. 59821 d. 59840
- a. One way to find this answer in the index of the CPT® Professional Edition is under the main heading "Miscarriage," then "Incomplete Abortion."
- An established patient required medical attention for removal of an impacted foreign body from the vaginal canal. Her physician documented a detailed history, detailed examination including enlargement of the vaginal opening with introduction of speculum, and identification of the foreign body as a tampon. The patient was asked to return to the office if she had any complications, fever, or abnormal discharge or heavy bleeding. How should you report the procedure? a. 99214-25, 57415 b. 99214 c. 57415 d. 57415- 52
- b. The CPT® Professional Edition provides a parenthetical note below code 57415 that references use of evaluation and management codes for impacted vaginal foreign body removal without anesthesia. This is an example of reading carefully to select the correct answer. The question does not ask for the evaluation And management code, only the procedure; therefore, answer A is not correct.
- One week ago, Marion underwent a surgical laparoscopy with vaginal hysterectomy including removal of a 275-g uterus tube and ovaries due to cancer of the endometrium. Today she was admitted for a planned insertion of a vaginal radiation after loading apparatus for clinical brachytherapy. During this procedure, the surgeon inserted the device and took x-rays to ensure placement. Once the device was in the proper location, it was fixed into position by tightening the applicator base plate and locking mechanism. Marion tolerated the procedure well and was sent to the recovery suite in satisfactory condition. How should today’s professional services be reported? a. 58554, 57156 - 58 b. 57156 - 59, 77316 - 26 c. 58554, 57156 - 59, 77316 - 26 d. 57156 - 58
- d. According to CPT®, this new code includes x-ray confirmation for location of the apparatus.
Endocrine, Nervous System (60000 Series)
- A 43 - year-old patient who suffers from severe intermittent vertigo has been definitively diagnosed with Meniere’s disease. After a year of various treatments, medications, tests, and behavior/lifestyle changes that have failed to lessen the symptoms, she now presents for a transcanal chemical labyrinthotomy to the right ear. Dr. Miller visualizes the tympanic membrane with an operating microscope, cleans the ear canal, and makes a small incision into the tympanic membrane. Gentamicin is delivered into the right ear. The patient is repositioned with the right ear up and monitored by the nurse. The perfusion is repeated to achieve the maximum result. The ear is suctioned, cleaned, and carefully examined for bleeding. The patient tolerated the procedure well and is returned to the recovery area in satisfactory condition. How would Dr. Miller report his professional services? a. 69801 x 2, 69990 - 51 b. 69905 x 2, 69990 - 51 c. 69801, 69990 d. 69905, 69990
- c. The patient in this question underwent a labyrinthotomy (incision), not a labyrinthectomy (excision). Refer to the notes in the CPT® Professional Edition for correct reporting. The parenthetical notes under code 69801 provide instructions for reporting once per day, and notes provided with the add-on code for the operating microscope indicate modifier - 51 should not be reported with this code.
- What code(s) would be reported for the following case? Preoperative diagnosis: Bilateral impacted ventilating tube Postoperative diagnosis: Same Anesthesia: General Procedure performed: Removal and replacement of new tubes, bilaterally via tympanostomy Procedure: Sammie, a 16 - year-old patient, was admitted and taken to the operative suite and placed under general anesthesia by inhalation. When adequate sedation was achieved, a 3.8-mm speculum was inserted into the left ear, wax removed, and speculum removed. The impacted tube was then removed.
deep sutures and skin staples. Carl tolerated the procedure well and was returned to the recovery suite in stable condition. Which code(s) should be reported for today’sservices? a. 61885, 64568- 59 b. 64568 c. 61531 d. 64570, 61888-59, 64568 - 59
56. b. This was an initial implantation for the neurostimulator array and pulse generator. Code 64568 includes the creation of the skin pocket and testing of the system, according to CPT® Changes: An Insider’s View 2017.
- A 6 - month-old patient required a bilateral subdural tap through a suture. How would this initial procedure be reported? a. 61000 b. 61001- 63 c. 61000 - 50 d. 61020-63, 61000- 50
- a. This procedure code is described as unilateral or bilateral; therefore, modifier 50 is not required. Additionally, the description includes an infant and suture site.
- A patient with Bell’s palsy is unable to squint, blink, or close her left eyelid. To protect the eye, Dr. Risser completes a temporary tarsorrhaphy with a Frost suture technique. How would you report this procedure? a. 67875 - LT b. 67710 - LT c. 67840 - LT d. 67950-LT
- a. Tarsorrhaphy is used to help patients who are unable to close their eyelids. In patients with Bell’s palsy (or other conditions that impede the ability to blink or close the eyelids), this procedure keeps the eyes protected and lubricated until the patient recovers from aparalysis condition.
- What code(s) should be reported with the following case? Preoperative diagnosis: Total retinal detachment, right eye Postoperative diagnosis: Same Procedure performed: Complex repair of retinal detachment with photocoagulation, scleral buckle, sclerotomy/vitrectomy Anesthesia: Local Procedure: The patient was placed, prepped, and draped in the usual manner. Adequate local anesthesia was administered. The operating microscope was used to visualize the retina, which has fallen into the posterior cavity. The vitreous was extracted using a VISC to complete the posterior sclerotomy. Minimal scar tissue was removed to release tension from the choroid. The retina was repositioned and attached using photocoagulation laser, a gas bubble, and a suture placement of a scleral buckle around the eye. The positioning of the retina was checked during the procedure to ensure proper alignment. Antibiotic ointment was applied to the eye prior to placement of a pressure patch. The patient tolerated the procedure well and returned to the recovery suite in satisfactory condition. a. 361.05, 67113 - RT, 67107 - 51, 67145 - 51, 66990 - 51
b. 361.05, 67113 - RT, 69990 - RT c. 361.00, 67113 - RT, 66990 - RT d. 361.00, 67113 - RT, 67107 - 51, 67145 - 51, 66990 - 51
- b. Code 67113 includes multiple procedures related to complex repair of a retinal detachment. These inclusive procedures, if performed, would not be reported separately. The use of the operating microscope would be reported without a modifier - 51.
- A patient had a bilateral strabismus surgery involving the medial and lateral rectus muscles. The surgeon explored and repaired a detached extraocular muscle in the right eye and placed bilateral posterior fixation sutures with muscle recession. How should you report this procedure? a. 67316 - 50, 67332 - RT, 67334- 50 b. 67316 - 50, 67332 - RT, 67335 - 50 c. 67312 - 50, 67340 - RT, 67334 - 50 d. 67312 - 50, 67340 - RT, 67335 - 50
- d. The CPT® Professional Edition provides multiple illustrations with strabismus surgery. These illustrations are helpful for review of anatomic locations of muscles. Codes for strabismus surgery are selected by the number and type of muscles used during a procedure. Additionally, add-on codes are provided to help define other conditions or procedures that may be completed at the time of the surgery.
Radiology (70000 Series)
- How should you report services for a 3-D radiation therapy simulation field setup? a. 77290 b. 77295 c. 77263 d. 77280, 77295
- b. You can find this answer in the index of the CPT® Professional Edition under the main term "Radiation therapy," then "Field Set-up."
- A patient with a history of family breast cancer is now suffering from swelling in both arms and under- goes a bilateral lymphangiography. How should the professional services and diagnoses be reported for this procedure? a. 75807 - 26, M79.89, Z85. b. 75801-26, M79.89, Z80. c. 75803 - 26, M79.89, Z85. d. 75803-26, M79.89, Z80.
- d. This is a bilateral lymphangiography to the extremities (arms), which is stated in code 75803. Carefully select diagnosis codes that account for personal histories vs. family histories. In this question, the patient has a family history of breast cancer.
- Angela, a 28-year-old patient, is pregnant with triplets. She is in her second trimester and is being evaluated by transabdominal ultrasound with real-time imaging for fetal sizes. This is her third follow- up ultrasound to ensure the adequacy of fetal growth, development, and weight. How would you report this service? a. 76816, 76816-59, 76816 - 59 b. 76816, 76810 x 2 c. 76830, 76830 - 59, 76830 - 59
a. 19281, 77067- 50 b. 19281 x 2, 77066 - LT c. 19281 x 2, 77065 - LT d. 19281, 77065-LT
- c. This question asks about unilateral diagnostic mammography. The other possible answers to this question either identify the wrong type of mammography or underreport the needle placement procedure.
- A patient completed three radiation treatment sessions for two separate treatment areas with use of multiple blocks. Each session consisted of 8 MeV of radiation being delivered. How should these technical services be reported? a. 77407 x 3 - TC b. 77407 x 3 c. 77407 - TC d. 77412 x 3 – TC
- b. Radiation treatment delivery is reported by MeV (mega electron volts). Each session should be reported separately. These codes are inherently technical as stated in the CPT® Professional Edition; therefore, modifier - TC is not appended to these services.
- A 35 year old mother carrying twin gestations, who has a three year old child with down syndrome, comes in for a prenatal screening. She is in her 12th week of pregnancy and the physician requests that the amount of fluid behind the necks of the fetuses be measured. A transabdominal approach was used. a.76801, 76802 b.76811, 76812 c.76813, 76814 d.76816, 76816 - 59
70. C – The fluid at the back of the fetuses’ neck is also known as the nuchal fold or the nuchal
translucency. When this is too thick it is an indication the fetus may have Down syndrome. Option A
describes an ultrasound for both the fetuses and the mother. In our scenario only the fetuses are
being evaluated though, so this eliminates option A. Option B also includes a maternal evaluation, so
this too is incorrect. Option C correctly describes the first trimester, fetus evaluation only, is specific
to the nuchal translucency, and includes a transabdominal approach. Add-on code 76814 is also
correct when reporting multiple gestations, (per. notations beneath code 76814, it should be used in
conjunction with code 76813 when reporting multiple gestations). Option D describes a re-
evaluation to confirm a prior finding. In our scenario there is no mention of a prior screening.
Laboratory and Pathology (80000 Series)
- Which code(s) should be reported for the following case? Clinical history: Mass in the body of stomach Gross description: Cavity effusion – two Diff-Quik four smears prepared with simple filter and interpretation Specimen received: Stomach mass touch prep Adequacy: Specimen satisfactory for cytological evaluation Diagnosis: Primary malignant neoplasm – body of the stomach Notes: Cytology completed on specimen. The malignant cells show subjective features suggestive of small-cell carcinoma; however, cell size is more attuned with non-small-cell carcinoma. a. C16.2, 88108
b. D3A.092, 88104 c. R19.00, C16.2, 88106 d. D3A.092, C16.1, 88108
- a. The diagnosis code is reported from the diagnosis description section of this report or the definitive findings. The clinical history indicates why the cytology is being evaluated. The procedure code is reported with the simple filter preparation and interpretation as stated in the question.
- Dr. Ross, a pathologist, completed both gross and microscopic surgical pathology after a lung wedge biopsy. Dr. Miles, the surgeon, sent a single specimen to the laboratory after the completion of a limited biopsy by thoracotomy. How would Dr. Ross reporther services? a. 88300, 88307 b. 32151, 88305- 26 c. 88307 d. 88307- 26
- c. The specimen evaluated in this question was from a lung wedge biopsy. Review the codes in the surgical pathology section based on anatomy and/or location of the specimen, absence or presence of disease reported, and/or physician’s description of specimen received and studied.
- Robert was sent to a local laboratory for pre-employment drug screening. He provided a urine sample to the laboratory technologist. The technologist completed a qualitative screening, including one procedure for multiple drug classes using non-chromatographic methods with a multiplexed kit. The test was negative and results were sent back to the requesting employer. How should you report this laboratory service? a. 80307 x b. 80305 c. 80306 d. 80307
- d. This is a new code for 2017 CPT.
- Jane underwent a combined rapid anterior pituitary evaluation panel with multiple exposures and suppressions and had a hepatic function panel. How should these tests be reported? a. 82024 x 4, 83002 x 4, 83001 x 4, 84146 x 4, 83003 x 4, 82533 x 4, 84443 x 4 b. 80418, 80076 c. 80418, 82024, 83002, 83001, 84146, 83003, 82533, 84443 d. 80076
- b. One way to find this code in the index of the CPT® Professional Edition is under the main term "Evocative/ Suppression Test." Review of the code range provided will lead to the combined rapid anterior pituitary evaluation panel. This panel code includes all the codes listed with the panel.
- Dr. Thomas received a request for consultation that included records and specimens. Dr. Thomas did not see the patient, but documented the patient as inpatient status with a comprehensive family history of colon cancer. The patient takes multiple medications and is at high risk of complications due to weight loss, chronic diarrhea, and a continued fever. His confirmative opinion, based on the review of specimens and records, indicates positive small-cell cancer. Dr. Thomas sent his written report back to the requesting physician. How should Dr. Thomas report hisservices? a. 99254 b. 88325 c. 99254 - 25, 88325 - 26 d. 88323
