Question 1

A 54-year-old patient presented to the emergency room with a gunshot wound in the back exiting through the front. A CT scan shows some renal damage to the right kidney and a renal exploration is ordered. The surgeon has been called in and the patient is taken to surgery to examine the renal structure. Making an incision over the gunshot wound, the surgeon examines both the blood vessels and the kidney. The trauma has caused a hematoma to the kidney, which has not spread, so the surgeon closes and the patient is sent to the floor for observation. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for renal exploration due to trauma is 50010. The ICD-10-CM codes S31.001A (open wound of the front wall of the abdomen, initial encounter), S37.091A (other injury of right kidney, initial encounter), and W34.00xA (accidental discharge from other and unspecified firearms, initial encounter) accurately describe the patient's condition and the cause of the injury.

Question 2

Marc will be having a kidney transplant due to end stage renal disease caused by malignant hypertension. The donor is his cousin Sidney. Under general anesthesia, Sidney undergoes a radical nephrectomy; the surgeon then does his backbench work to dissect and remove any fat and prepares the ureters, veins, and arteries. Next the surgeon performs a renal nephrectomy and allo-transplantation on Will. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The CPT codes 50320, 50325, and 50365 are appropriate for the nephrectomy and transplantation procedures. The ICD-10-CM codes I12.0 and N18.6 are correct for malignant hypertension with end-stage renal disease.

Question 3

The patient undergoes repair of the renal pelvis to treat an ureteropelvic junction obstruction the patient has had since birth. An incision is made and an excision is performed on the (right) congenital kidney abnormality; a secondary pyeloplasty, solitary kidney or calycoplasty is performed on the left kidney. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT codes are 50400 for the repair of the renal pelvis (pyeloplasty) on the right side for the ureteropelvic junction obstruction, and 50405 for the secondary procedure on the left kidney, with modifiers -RT (right side) and -LT (left side) to specify the sides. The correct ICD-10-CM code is Q62.11, which specifies congenital ureteropelvic junction obstruction, indicating that the condition is congenital and affecting the ureteropelvic junction.

Question 4

ESWL was performed on Mrs. Wilson's left kidney 1 week ago; now ESWL is being performed on her right kidney. She has 4 stones being removed today: 2 in the renal pelvis and 2 in the calyx. Under local anesthesia, the ESWL is performed and all 4 stones are successfully destroyed. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for extracorporeal shock wave lithotripsy (ESWL) is 50590. The modifier -RT indicates the procedure was performed on the right side. The modifier -58 is used for a staged or related procedure by the same physician during the postoperative period. The ICD-10-CM code N20.0 is used for kidney stones (calculus of kidney).

Question 5

Patient underwent nasal endoscopy in the office of the ENT physician with removal of two pedunculated nasal polyps from the R nasal cavity. The patient tolerated the procedure well and was given an appointment to RTC in two weeks for follow up. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

31237 is the correct CPT code for nasal endoscopy with removal of polyps, and J33.0 is the correct ICD-10-CM code for polyp of nasal cavity.

Question 6

A 48-year-old female with a 20+ year smoking history is diagnosed with a pulmonary nodule growing in the left lower lobe of the lung. After discussion with her surgeon, the patient is brought to the OR for a laproscopic wedge resection of the nodule using VATS approach to obtain a frozen section. Following a pathology report of adenocarcinoma of the lung, a VATS lobectomy of the left lower lobe was performed. The patient tolerated the procedure and was sent to the surgical ICU in stable condition. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT codes are 32663 for the VATS lobectomy and 32668-LT for the wedge resection. The ICD-10-CM codes are C34.32 for adenocarcinoma of the left lower lobe and Z87.891 for a history of tobacco use.

Question 7

A patient was brought to the OR today for exploratory thoracotomy. Previous x-rays demonstrated a small foreign body in the pleural space. Exploration of the area revealed a small piece of shrapnel from a previous shooting accident. Under general anesthesia, the incision was made into the pleural space and the shrapnel was removed. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for the removal of a foreign body from the pleural space is 32150. The ICD-10-CM code Z18.89 is used for retained foreign body fragments.

Question 8

A patient with chronic recurrent acute sinusitis and nasal polyps presented to the outpatient surgical center for endoscopic frontal sinus exploration with osteomeatal complex resection, anterior ethmoidectomy, and removal of nasal polyps. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

31254 is for endoscopic frontal sinus exploration with osteomeatal complex resection, and 31276 is for anterior ethmoidectomy. J01.91 is for chronic sinusitis, and J33.9 is for nasal polyps.

Question 9

Joey, age 5, is taken to the OR today for removal of a small foreign body from his right nares. General anesthesia was required due to the significant level of anxiety displayed by the child, as well as the location of the small object. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The answer of Joey, age 5, is taken to the...

Question 10

Preoperative Diagnosis: Pericardial Cyst
Postoperative Diagnosis: Same
Procedure: Thorascopy, surgical: with excision of pericardial cyst. Using VATS, the cyst was visualized and removed. The patient was sent to the ICU in good condition.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The procedure performed was a thorascopy with excision of a pericardial cyst using VATS, which corresponds to CPT code 32661. The ICD-10-CM code I31.8 is used for other specified diseases of the pericardium, which includes pericardial cysts.

Question 11

Jane, a 75-year-old female, was brought to the OR today for operative ablation of her paroxysmal atrial fibrillation via a combined Wolff-Parkinson-White atrio-ventricular node tissue ablation and reconstruction of the atria using the MAZE procedure. Cardiopulmonary bypass was not required. The patient tolerated the procedure well and was sent to ICU for continued monitoring. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct codes are 33250 and 33258. 33250 is for the ablation of the paroxysmal atrial fibrillation, and 33258 is for the reconstruction of the atria using the MAZE procedure.

Question 12

Preoperative Diagnosis: puncture wound to the L. ventricle as a result of a stabbing presented with cardiac tamponade.
Postoperative Diagnosis: same
Operative Procedure: removal of knife from the left ventricle followed by on-pump exploratory cardiotomy and cardiorrhaphy. Patient survived procedure and was sent to ICU in critical condition.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for the described procedure is 33315, which is for repair of a cardiac wound. The ICD-10-CM codes accurately reflect the preoperative diagnosis: S26.021A for puncture wound of the heart with foreign body, S21.93A for unspecified open wound of the thorax without penetration into the thoracic cavity, and I31.4 for cardiac tamponade. These codes collectively describe the injury, the location, and the complication that necessitated the surgery.

Question 13

Preoperative Diagnosis: worsening effort angina with severe left ventricular failure.
Postoperative Diagnosis: same
Operative Procedure: endoscopic coronary artery bypass graft including harvesting of the saphenous vein X 3.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

33512 is for 3-vessel coronary artery bypass graft, and 33508 is for harvesting of the saphenous vein. I20.0 is for angina pectoris, and I50.1 is for severe left ventricular failure.

Question 14

George, a 73-year-old male, is hospitalized for epileptic seizure disorder. He experiences anoxic brain damage, and anesthesia was called to insert the endotracheal tube in order to put the patient on the ventilator. Select the appropriate CPT and ICD-10-CM codes for the anesthesiologist.

Accepted Answer

The correct CPT code for endotracheal intubation is 31500. The ICD-10-CM codes for anoxic brain damage and unspecified epilepsy are G93.1 and G40.909, respectively.

Question 15

Sam, a 26-year-old male with Down syndrome, undergoes lithotripsy with a water bath for lodged ureteral stones. The procedure was supervised by the anesthesiologist under general anesthesia due to the patient's Down syndrome and associated anxiety. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code is 00872-P3-23, which represents anesthesia for lithotripsy procedures. The ICD-10-CM codes are N20.1 for ureteral stones and Q90.9 for Down syndrome.

Question 16

Georgette, a 57-year-old female, experiences polyneuropathy in the right arm due to a spur located at C4-C5. She presents today in the pain clinic for epidural injection by the anesthesiologist of an anesthetic agent for the purpose of pain control. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for an epidural injection in the cervical or thoracic spine is 62320, which includes injection of diagnostic or therapeutic substances, not including neurolytic substances, without imaging guidance. The ICD-10-CM code D16.6 corresponds to a benign neoplasm of the vertebral column, which could be related to the spur causing the polyneuropathy.

Question 17

Fred, a 75-year-old male, undergoes surgical placement of a permanent transvenous pacemaker for treatment of symptomatic bradycardia as a result of a bundle branch block. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The answer of Fred, a 75-year-old male, undergoes surgical placement...

Question 18

Procedure: Debridement of 2nd degree burn, 200cm of right hand and wrist, excisional debridement of 3rd degree burns to 10% of the abdomen and 13% of the back.
General anesthesia was achieved and the patient was placed in the right lateral decubitus position. The left hip and lower back as well as the abdomen and right upper extremity were prepped and draped with Betadine. The 2nd degree blisters were completely debrided off all of the fingers and the hand. The area was then scrubbed thoroughly with a scrub brush, bleeding was controlled with a saline epinephrine soak, and the hand was thoroughly dried. A large biobrane glove was stretched over the hand and held in place at the wrist with staples. The ellipsis was drawn around the skin transversely at both the lower back as well as the abdomen. These areas were then excised with a number 10 blade. The burns were scrubbed and dressed with biobrane.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code is 16030 for excisional debridement of burns. The ICD-10-CM codes T21.34xA and T21.32xA represent 3rd degree burns of the abdomen and back, and T23.291A represents 2nd degree burns of the right hand and wrist.

Question 19

Jim went to the doctor for removal of his skin tags. The physician noted 32 skin tags on his back. Using a scalpel the physician removed all of the skin tags and gave Mr. Evans an antibiotic cream prescription to use for the next 7-10 days. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT codes for the removal of skin tags are 11200 for the first 15 skin tags and 11201 for each additional 10 skin tags or part thereof. Since 32 skin tags were removed, one would use 11200 for the first 15, and 11201 x 2 for the next 17 (as 11201 covers each set of 10 or part thereof after the first 15). The ICD-10-CM code L91.8 is appropriate for skin tags.

Question 20

The patient presented in the emergency room with a sudden outbreak of lesions on the face, bilaterally on arms and legs, and groin after taking her prescribed sulfa drugs. Several of the lesions had to be shaved: 2 on the leg, one 1.4cm on the groin, and 3 close to the ear. The physician concluded that this was dermatitis. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT codes for shaving of epidermal or dermal lesions are 11307 (for the 1.4cm lesion on the groin), 11300 (for the 2 lesions on the leg), and 11310 (for the 3 lesions close to the ear), with modifier -51 for multiple procedures. The correct ICD-10-CM codes are L27.0 for dermatitis due to drugs and medicaments taken internally, and T50.995A for adverse effect of other drugs, medicaments, and biological substances, initial encounter.

Quiz 27: Coding and Surgical Procedures