Question 1

Roger was in an altercation with his neighbor and he has 3 wounds. The first is a 15.5cm wound on the face that required a single layer closure, the second is a 25.5cm laceration of the left forearm that required a layered closure of the subcutaneous tissue, and the third laceration is a 10cm wound on the right external ear that required a layered closure. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The CPT codes 12036 and 12054 are for layered closures of wounds on the forearm and ear, respectively. The ICD-10-CM codes S51.802A, S01.301A, and S09.93xA correspond to the lacerations on the forearm, face, and ear.

Question 2

Mrs. Carmichael sees her foot and ankle surgeon with open ulcerated areas on the left lower leg and a separate lesion on the right lower leg. The surgeon documents staphylococcal carbuncles which need debridement. He proceeds to excise the skin, subcutaneous tissue, and muscle of a 4.0 cm × 3.0 cm, or 12 sq. cm, lesion in the right lower leg, and an excision of skin and subcutaneous tissue in the left lower leg of 3.0 cm × 8.0 cm, or 24 sq. cm. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT codes are 11043 for the excision involving skin, subcutaneous tissue, and muscle of the right lower leg lesion, and 11042-59 for the excision of skin and subcutaneous tissue of the left lower leg, with the -59 modifier indicating a distinct procedural service. The 11045 code is added for each additional 20 sq. cm, or part thereof, of debridement. The ICD-10-CM codes L02.435 and L02.436 specify the locations of the carbuncles on the right and left lower legs, respectively, and B95.8 identifies the staphylococcal infection as the cause of the conditions.

Question 3

A 62-year-old diabetic female underwent a Whipple procedure for carcinoma of the head of the pancreas. During the procedure, the patient was monitored by the CRNA. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The answer of A 62-year-old diabetic female underwent a Whipple...

Question 4

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 5

Mary, age 53, underwent a laparoscopic assisted vaginal hysterectomy for menometrorrhagia. Select the appropriate CPT and ICD-10-CM codes for the anesthesiologist.

Accepted Answer

The answer of Mary, age 53, underwent a laparoscopic assisted...

Question 6

A 26-year-old female was given an epidural during labor for pain management. As a result of cephalopelvic distortion, the decision was made to perform a cesarean section. Select the appropriate CPT and ICD-10-CM codes for anesthesia.

Accepted Answer

The answer of A 26-year-old female was given an epidural...

Question 7

A 6-hour-old critically ill infant undergoes on-pump anesthesia for emergency repair of transposition of the great vessels. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for anesthesia during procedures on the heart, pericardial sac, and great vessels of infants under 1 year of age is 00561. The additional code 99140 indicates anesthesia for emergency conditions (modifier -P5 for a patient with severe systemic disease that is a constant threat to life). The ICD-10-CM code Q20.3 specifically identifies transposition of the great vessels, making option B the most accurate choice.

Question 8

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 for anesthesia for lithotripsy with a water bath, with a physical status modifier P3 indicating a patient with severe systemic disease, and modifier 23 for unusual anesthesia. The ICD-10-CM codes are N20.1 for ureteral stones and Q90.9 for Down syndrome.

Question 9

A 3-year-old underwent plastic repair of her bilateral complete cleft lip. The CRNA was medically directed by the anesthesiologist. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for anesthesia for a cleft lip repair is 00102. The modifier P1 indicates a normal healthy patient. The modifier QX is used when a CRNA is medically directed by an anesthesiologist. The ICD-10-CM code Q36.0 is for bilateral cleft lip.

Question 10

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, as it specifies injection of a diagnostic or therapeutic substance into the cervical or thoracic epidural space without imaging guidance. The ICD-10-CM code D16.6, which refers to a benign neoplasm of the vertebral column, is appropriate for a spur located at C4-C5 causing polyneuropathy.

Question 11

An 8-month-old male, in otherwise good health, was brought to the OR today for surgical repair of bilateral cryptorchidism. The anesthesiologist supervised the procedure. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

00924 is the correct CPT code for bilateral cryptorchidism repair. 99100-P1 is the correct CPT code for the preoperative evaluation and management of the patient. Q53.20 is the correct ICD-10-CM code for cryptorchidism.

Question 12

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 correct CPT code for the surgical placement of a permanent transvenous pacemaker is 00530, and the additional code 99100-P3 is used for patients who are of extreme age, in this case, 75 years old. The correct ICD-10-CM code for symptomatic bradycardia as a result of a bundle branch block is I45.4.

Question 13

Clinical History: Symptoms of SOB, chest pain on inspiration, as well an oxygen saturation of 84.
Study performed: Ventilation and perfusion studies of the lungs.
Interpretation: Particularly positive ventilation and perfusion lung scan. There are no segmental defects to suggest a pulmonary embolus.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for a ventilation and perfusion lung scan is 78582, which includes both ventilation and perfusion studies. The symptoms described, shortness of breath (SOB) and chest pain on inspiration, correspond to the ICD-10-CM codes R06.00 (Dyspnea, unspecified) and R07.1 (Chest pain on breathing), respectively. The interpretation of the lung scan did not confirm a pulmonary embolus, so codes related to pulmonary embolism (I26.99) are not appropriate in this context.

Question 14

Clinical History: Patient presents with a diagnosis of temporomandibular joint dysfunction.
Study performed: Panoramic x-ray of the maxilla and mandible.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for a panoramic x-ray of the maxilla and mandible is 70355. The ICD-10-CM code for temporomandibular joint dysfunction is M26.69.

Question 15

Clinical History: Patient with neuropathy and pain in arm. Diagnosed with possible cervical disc.
Study performed: Cervical Myelogram -injection procedure and radiological supervision and interpretation.
Impression: Moderate ventral extradural defect C5-6 with bilateral C-6 root encroachments.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The answer of Clinical History: Patient with neuropathy and pain...

Question 16

Clinical history: Shortness of breath - crackles and change in sound in base of lungs.
Study performed: Chest X-ray, PA and lateral.
Impression: Poor inspiratory effort which accentuates the basilar lung markings and cardiac silhouette, partially limiting evaluation. Small vertically oriented linear infiltrate subsegmental atelectasis is noted in the L retrocardiac region adjacent to the diaphragm. There is minimal hazy increased density and decreased definition in the L costophrenic angle suggesting pleural effusion. Segmental atelectasis and some pleural effusion.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for a chest X-ray with two views (PA and lateral) is 71046. The ICD-10-CM codes J90 and J98.11 are appropriate for pleural effusion and segmental atelectasis, respectively, which are both mentioned in the impression.

Question 17

Clinical history: Carcinoma of the breast with skeletal metastasis.
Study performed: Total Body Bone Scan.
Impression: Abnormal total body bone scan with abnormalities noted in the ribs and spine and possibly within the skull.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

CPT code 78306 is for a total body bone scan, which matches the study performed. ICD-10-CM codes C79.51 and C50.919 are for secondary malignant neoplasm of bone and breast cancer, respectively.

Question 18

A 38-year-old male was seen today for complete and standing x-rays of L knee following injury sustained playing hockey. Impression: torn medial meniscus with degenerative joint disease, L. knee. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for complete and standing x-rays of the knee is 73564. The ICD-10-CM codes for a torn medial meniscus and degenerative joint disease of the left knee are S83.242 and M17.12, respectively.

Question 19

Clinical Indication: Carcinoma of the right breast, mastectomy and chemotherapy completed with no recurrence; now presents with skeletal metastases.
Procedure: Multiple tomograms of L. lung show no dominant nodules within the lung. Multiple osteolytic metastases are present in several of the ribs in posteriolateral aspect involving third, fourth, fifth, six, and seventh ribs. Small amount of pleural reaction is noted in the L costophrenic angle. Hilar shadows are unremarkable. Shadow for L breast is absent.
Impression: No definite metastatic nodules in L lung. Multiple mixed osteolytic and osteoblastic changes in several ribs in the L chest probably due to metastatic neoplasm.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The CPT code 71250 is for a CT scan of the thorax without contrast. The ICD-10-CM code C79.51 is for secondary malignant neoplasm of bone, indicating skeletal metastases. Z85.3 is for a personal history of malignant neoplasm of the breast, indicating the patient's history of breast cancer.

Question 20

The patient undergoes simple mastectomy today for adenocarcinoma of the R breast. While the patient was still on the table, and immediately after the removal of the breast, the patient received a concentrated dose of radiation to the tumor site using IORT electron methodology. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for a simple mastectomy is 19303. The appropriate CPT code for intraoperative radiation therapy (IORT) using electron methodology is 77425. The ICD-10-CM code for adenocarcinoma of the right breast is C50.911.

Quiz 27: Coding and Surgical Procedures