Question 1

The physician performed an arthroscopy of TMJ with biopsy of soft tissue. What is the appropriate CPT code?

Accepted Answer

The appropriate CPT code is 29804 (Arthroscopy, Temporomandibular Joint, Surgical). The temporomandibular joint is also referred to as the TMJ. Code 29800 is used for a diagnostic arthroscopy with or without an synovial biopsy, but the biopsy performed in this procedure was a soft tissue biopsy. Code 21010 is only used if the procedure was an open procedure. In this case, the procedure was not considered an arthroscopic procedure.

Question 2

PROCEDURAL NOTE PATIENT: Trohoske, Janine
AGE: 62
DATE: 01/13/2017
PREOPERATIVE DIAGNOSIS: Degenerative Disc Disease
POSTOPERATIVE DIAGNOSIS: Degenerative Disc Disease
PROCEDURE: Arthrodesis of L4-L2 utilizing autogenous bone graft
An anesthetized patient was placed in the prone position on the operating table and draped in the usual manner. An incision was made along the spinal column, from the area of the L1 to L5, and skin and subcutaneous tissues were pinned back to allow access to the L4-L2 vertebral spaces. A separate fascial incision was made to obtain morselized bone graft segments for arthrodesis procedure. Posterior arthrodesis was then performed along the L4-L2 vertebrae. No additional fixation or instrumentation was placed. Incision was then closed, stapled together, and dressed with a sterile dressing. What is the appropriate code for this procedure?

Accepted Answer

The appropriate codes for this procedure are 22612 (Arthrodesis, Posterior or Posteriolateral Technique, Single Level; Lumbar) and add-on code 22614 (X2) (Additional Level of Arthrodesis). There were three levels of arthrodesis, L4, L3, and L2, so each level needs to be reported, which can be accomplished by using one 22612 and two 22614 codes. The additional code 20937 needs to be included on the claim to account for the morselized fascial bone graft performed at the same time as the primary procedure.

Question 3

A physician performed the following trigger point injections: Two injections into the flexor carpi muscle
One injection into the extensor carpi muscle
Three injections into the triceps brachii
One injection into the biceps brachii
What is the correct code for these injections?

Accepted Answer

The correct code for these injections is with 20553 (Injection(s); Single or Multiple Trigger Point(s), 3 or More Muscle(s)).20553 is the only code that needs to be reported because it allows for the multiple injections of each muscle and it allows (for three or more muscles). There were four muscles injected, two of which were injected multiple times.

Question 4

A patient suffered a comminuted fracture of the right arm due to a crush injury. The physician implanted three pins in a single plane above the fracture and two pins and one wire along the same plane under the fracture location on the humerus of the right arm. What is the correct code for this service?

Accepted Answer

The correct code for this service is 20690 (Application of a Uniplane (Pins or Wires in 1 Plane), Unilateral, External Fixation System). Although multiple pins were placed, the code description referred to multiple pins and/or wires. The pins/wires were placed along the same plane, making the fixation device a single plane, rather than multiple planes.

Question 5

PROGRESS NOTE PATIENT: FINKE, ISABEL
AGE: 15
DATE: 3/14/2015
NOTE: The patient states that she was riding her bicycle on the side of the road when a large dog ran out in front of her and forced her to crash into a drainage ditch. The patient hit her left arm on a cement drain pipe, suffering an oblique fracture to her left radius. The fracture was set with manipulation of the radial shaft. The arm was then casted in the usual fashion. The patient tolerated the procedure well and was asked to return to the office in one month for follow up x-ray and removal of the cast. How should you code for this fracture repair?

Accepted Answer

You should code for this fracture repair with code 25505 (Closed Treatment of Radial Shaft Fracture; with Manipulation).The fracture was set with manipulation; therefore the code 25500 is not appropriate. Code 25500 does not include manipulation of the fracture, while code 25505 does. Code 22515 is also inappropriate because the fracture repair was closed and code 22515 is used for an open repair of the fracture

Question 6

The patient returned to the office one month later for removal of cast on her left lower arm. The original attending physician removed the cast. The physician also examined the arm and determined that no further casting or follow-up was necessary. What is the appropriate code for this service?

Accepted Answer

No code should be reported for this service. According to CPT guidelines, the removal of a cast should only be reported when the application of the cast was performed by one physician and the removal of the cast by another physician. The physician who removed the cast was the same that applied the cast so no service should be reported

Question 7

What code would you use to report the enlargement and exploration of a penetrating 5 cm stab wound to the upper thigh, with ligation of minor muscular blood vessel, and appropriate intermediate closure?

Accepted Answer

You would use codes 20103 (Exploration of Penetrating Wound; Extremity) and 12032 (Repair, Intermediate, Wounds of Scalp, Axillae, Trunk and/or Extremities; 2.6 cm to 7.5 cm). According to CPT guidelines, the exploration of the penetrating wound should be coded in addition to the wound repair because the procedure required a "ligation or coagulation of minor subcutaneous and/or muscular blood vessel(s)" The intermediate repair should be coded separately because the wound exploration code does not include closure of the wound after dissection.

Question 8

A patient was suffering from severe hallux valgus of the right foot. The physician excised extraneous bone from the lateral end of the proximal phalanx and the medial eminence of the metatarsal bone. The physician inserted the implant in the lateral end of the proximal phalanx. What is the correct CPT code for this procedure?

Accepted Answer

The correct CPT code for this procedure is 28293 (Correction, Hallux Valgus, with or without Sesamoidectomy; Resection of Joint with Implant). Code 28290 is only used for a simple resection without implant. Code 28292 is used for the removal of the lateral end of the proximal phalanx and the medial eminence of the metatarsal bone, but it does not include the implant.

Question 9

A 15-year-old boy was pushed during a basketball game and landed face down, hitting the bottom bleacher with his nose. There was immediate swelling and bruising and the nose was displaced to the left. In the ER, the left nasal passage was not patent and the septum was deviated. The patient was taken to the operating room and closed treatment of the nasal fracture with stabilization was performed. Which code is correct for this procedure?

Accepted Answer

21320 is correct for a closed treatment of the nasal fracture with stabilization.
Code 21310 is incorrect because this was treatment without manipulation and code 21315 is incorrect because this was treatment without stabilization. Code 21325 is incorrect because this code is for the open treatment of a nasal fracture.

Question 10

A 67-year-old male has an intramuscular tumor of his right scalp over the parietal bone that is approximately 3 cm in diameter. It is getting larger and is causing him pain. He elects to have it removed and will have this excised in the OR as an outpatient procedure. Which procedure code is correct?

Accepted Answer

21014 is correct for excision of a soft tissue tumor of the scalp that is 3 cm.
Codes 21011 and 21012 are incorrect because they involve subcutaneous tumors of the face or scalp. Code 21012 is incorrect because this tumor is larger than 2 cm.

Question 11

A 76-year-old woman has noticed a growth along the left side of her neck that is increasing in size. Initially it looked like a mosquito bite, but has increased over the last three months to a dime size, approximately 1.8 cm. Her PCP believes it is a lipoma and sends her to surgery for assessment. It was removed in the office using local anesthesia. Which code is correct?

Accepted Answer

21555 is correct for an excision of a subcutaneous lesion smaller than 3 cm of the neck.
Code 21550 is incorrect because this code is for a biopsy. Codes 21552 and 21556 are incorrect because of the size and type of tumor present.

Question 12

A 25-year-old obese male has had right-sided flank pain for about two months and noticed a lump during work one day. He initially thought it was a muscle spasm and ignored it, but it has increased in size and has gotten more painful. He went through a CT scan, which showed an intramuscular mass consistent to the physical exam that is approximately 6 cm in diameter. Due to the size and presentation, it was decided to excise the tumor. What is the correct code to use for this procedure?

Accepted Answer

21933 is correct for the excision of a tumor that is 6 cm and is an intramuscular tumor.
Code 21931 is incorrect because although the size is correct, this is not a subcutaneous tumor. Code 21932 is incorrect because the size is too small and 21935 is incorrect because this did not involve a radical resection.

Question 13

A 35-year-old patient has a lipoma on her upper back over her scapula, which causes increased discomfort when her bra strap rubs against it. She has already met with her surgeon and this procedure will be performed in his office because it is only 2.75 cm in diameter and only involves the subcutaneous layer. What CPT code would you use for this procedure?

Accepted Answer

21930 is the correct code for a subcutaneous soft tissue tumor excision of less than 3 cm.
Code 21920 is incorrect because this was a removal and not just a biopsy of the tumor. Code 21931 is incorrect because of the size and 21932 is incorrect because this is not an intramuscular tumor.

Question 14

There is a large mass noted on a 56-year-old man's right flank. Due to the size and asymptomatic characteristics, a CT scan was performed and biopsy was recommended. This is a deeply rooted tumor and the patient will be sedated during this procedure. What code should you use for a deep tissue biopsy?

Accepted Answer

21925 is correct for a deep tissue biopsy of the flank mass.
Code 21920 is not correct because this wasn't a superficial tissue biopsy. Codes 21935 and 21936 are incorrect because these codes both involve a radical resection of the tumor.

Question 15

A 54-year-old female with degenerative disc disease at L4-L5 undergoes surgical repair with anterior approach for discectomy and fusion to try to prevent further discomfort. What CPT code would you use for this procedure?

Accepted Answer

22558 is the only lumbar code listed for anterior lumbar fusion and discectomy.
Code 22554 is incorrect because this is the code for cervical arthrodesis. Code 22556 is incorrect because this code is for thoracic discectomy and 22585 is incorrect because this is an "add-on" code for each additional interspace procedure performed, but there was only one performed on this patient.

Question 16

A 56-year-old man undergoes percutaneous vertebroplasty with vertebral augmentation to L2-L3 with unilateral injection. What is the correct CPT code for this procedure?

Accepted Answer

22511is correct because it is for a lumbosacral percutaneous vertebroplasty of one vertebral body.
Code 22510 is incorrect because is it for the cervicothoracic area. Code 22513 is incorrect because is more invasive, including cavity creation and mechanical device. Code 22526 is incorrect because it is the code for a percutaneous intradiscalelectrothermalannuloplasty

Question 17

A 37-year-old woman notices a lump in her left lower abdominal wall. A large, 6 cm tumor was found on CT scan along the musculature of the abdominal wall. This was removed and found to be a desmoid tumor. What is the code for this procedure?

Accepted Answer

22901 is correct because this tumor was 6 cm.
Code 22900 is incorrect because the size is larger than 5 cm. Codes 22902 and 22903 are incorrect because they involve a subcutaneous tumor, but this tumor is in the muscle of the abdominal wall.

Question 18

A 27-year-old woman began complaining about right lower-quadrant pain, was noted to have rebound discomfort, and positive pain over McBurney's point. A CT scan was ordered due to suspicion of appendicitis. The CT ruled out appendicitis but noted a 2.5 cm subcutaneous soft tissue mass in the right upper pelvis. She undergoes surgery to have this excised. What is the correct code for this procedure?

Accepted Answer

22902 is correct for the excision of a 2.5 cm subcutaneous tumor.
Codes 22900 and 22901 are incorrect because they are codes for intramuscular tumors. Code 22903 is incorrect because it is the code for a subcutaneous tumor larger than 3 cm.

Question 19

A 52-year-old man presents to the ER with severe abdominal pain. He has had abdominal pain for about six months, which has been coming and going. The pain increased one week ago, and today the patient was unable to bend without becoming short of breath due to the pain. A CT scan was performed and patient was noted to have a large, 7.5 cm soft tissue tumor attached to his abdominal wall. The patient underwent surgery to have it removed and it was found to be a sarcoma. During surgery, the patient also had a large margin removed from around the tumor site. What is the correct code for this procedure?

Accepted Answer

22905 is correct for the removal of a 7.5 cm sarcoma.
Codes 22902 and 22903 are incorrect because they involve subcutaneous tumors. Code 22904 is incorrect because of the size of the tumor that is being resected.

Question 20

A 78-year-old woman fell going up her steps and landed on her outstretched right hand. She fractured her proximal humerus. Unfortunately, this was a displaced fracture requiring open reduction and fixation. What is the correct code for this procedure?

Accepted Answer

23615 is the correct code for open treatment with internal fixation without prosthesis of the humerus.
Codes 23600 and 23605 are incorrect because both refer to closed treatment of the fracture. Code 23616 is incorrect because it involves prosthetic replacement.

Quiz 2: Series