Question 1

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 of the left lower lobe and 32668-LT for the laparoscopic wedge resection with a modifier LT indicating the procedure was performed on the left side. The ICD-10-CM code C34.32 specifies adenocarcinoma of the left lower lobe of the lung, and Z87.891 indicates a personal history of tobacco use, which is relevant given the patient's smoking history.

Question 2

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 procedure described is 32150, which is for thoracotomy with removal of foreign body from pleural space. The ICD-10-CM code Z18.89 is used for retained foreign body fragments, which is appropriate given the shrapnel was from a previous incident.

Question 3

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

The correct CPT codes are 31254 for anterior ethmoidectomy and 31276 for endoscopic frontal sinus exploration with osteomeatal complex resection. The ICD-10-CM codes are J01.91 for acute recurrent sinusitis and J33.9 for nasal polyps.

Question 4

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

30310 is the correct CPT code for removal of a foreign body from the nose. S00.35 is the correct ICD-10-CM code for a foreign body in the nose.

Question 5

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

32661 is the correct CPT code for thoracoscopic excision of a pericardial cyst. I31.8 is the correct ICD-10-CM code for other specified diseases of pericardium, which includes pericardial cyst.

Question 6

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 atrioventricular node and 33258 is for the ablation of the Wolff-Parkinson-White syndrome.

Question 7

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 removal of a foreign body from the heart with cardiopulmonary bypass is 33315. The ICD-10-CM codes include S26.021A for the puncture wound to the left ventricle, S21.93A for the unspecified open wound of the chest, and I31.4 for cardiac tamponade. These codes accurately reflect the preoperative diagnosis, the operative procedure, and the postoperative diagnosis.

Question 8

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

The answer of Preoperative Diagnosis: worsening effort angina with severe...

Question 9

Preoperative Diagnosis: thoracoabdominal aortic aneurysm
Postoperative Diagnosis: same
Operative Procedure: Patient placed on bypass pump after which the surgeon repaired the aneurysm using a graft.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for the described procedure is 33877, which is for the repair of a thoracoabdominal aortic aneurysm using a bypass and graft. The appropriate ICD-10-CM code is I71.6, which specifically identifies a thoracoabdominal aortic aneurysm without rupture, matching the preoperative and postoperative diagnosis.

Question 10

Preoperative Diagnosis: atherosclerosis of right iliac artery
Postoperative Diagnosis: same
Operative Procedure: Transluminal peripheral atherectomy of right iliac artery via percutaneous approach
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The CPT code 0238T is used for atherectomy procedures performed on the iliac artery via a percutaneous approach. The ICD-10-CM code I70.201 is for atherosclerosis of the right iliac artery.

Question 11

Preoperative Diagnosis: End Stage Renal Disease
Postoperative Diagnosis: End Stage Renal Disease
Operative Procedure: Creation of right cephalic vein arteriovenous fistula for dialysis.
Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for the creation of a right cephalic vein arteriovenous fistula for dialysis is 36818. The appropriate ICD-10-CM code for End Stage Renal Disease is N18.6.

Question 12

A 39-year-old female patient is seen at the ambulatory surgery center for excision for 6 uterine fibroid tumors. The tumors weighed a total of 268 grams. The OB-GYN used an abdominal approach. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for the excision of multiple uterine fibroid tumors using an abdominal approach is 58146, which is specifically for the removal of uterine leiomyomata (fibroids) when the total weight of the leiomyomata removed is 250 grams or more. The appropriate ICD-10-CM code for uterine fibroids without specification of type is D25.9.

Question 13

A 26-year-old female patient with uterine polyps is sent for a hysterosalpingography. Under contrast the full uterus and fallopian tubes are visualized. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for catheterization for hysterosalpingography is 58340, and the appropriate ICD-10-CM code for uterine polyps is N84.0. There is no need for the additional codes provided in the other options, making option A the correct choice.

Question 14

A 34-year-old infertility patient with a history of repeated miscarriages and dysmenorrhea is being seen today to evaluate the patency of her fallopian tubes. The physician suspects that there might be occlusions that are preventing the egg from implanting or preventing sperm from moving through. A transcervical catheter is used to view the fallopian tubes for patency, and a hysterosalpingography is also performed. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct codes are 58345 (Hysterosalpingography) and 74742 (Transcervical catheterization for tubal patency). The patient has a history of repeated miscarriages and dysmenorrhea, which suggests that there may be occlusions in the fallopian tubes. The transcervical catheterization and hysterosalpingography are both procedures that can be used to evaluate the patency of the fallopian tubes.

Question 15

Smith is performing a vaginal hysterectomy, with removal of tubes and ovaries, for a 59 year old patient. Her diagnoses include menorrhagia and ovarian endometriosis. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

58262 is the correct CPT code for a vaginal hysterectomy with removal of tubes and ovaries. N92.4 is the ICD-10-CM code for menorrhagia, and N80.1 is the code for ovarian endometriosis.

Question 16

A colposcopy is performed on patient, age 42, for cervical dysplasia. The pathology report later showed the specimen was negative for carcinoma. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The CPT code 57455 is for a colposcopy with biopsy, which is appropriate for cervical dysplasia. The ICD-10-CM code N87.9 is for cervical dysplasia, unspecified, which matches the pathology report indicating no carcinoma.

Question 17

Tina, age 31, gravida 2, Para 1, is pregnant with twins and has been seeing Dr. Smidley. At 41 weeks she experiences labor and is taken directly to the hospital by her husband. After 14 hours of extremely hard labor the first twin is born; it is a male weighing 6lbs 3ozs. Dr. Petrowski, the attending OB-GYN, orders a cesarean section because the second twin is large for dates, causing cephalopelvic disproportion. The second twin, a female weighing 9lbs 2ozs, was delivered via C-section. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct codes are 59514 for the cesarean delivery of the second twin, 59409 for the vaginal delivery of the first twin, O30.003 for twin pregnancy, third trimester, O33.5xx2 for maternal care due to disproportion of fetus and pelvic size, and Z37.2 for twins, both liveborn. This combination accurately reflects the scenario of a twin pregnancy with one vaginal delivery and one cesarean delivery due to cephalopelvic disproportion, with both twins being liveborn.

Question 18

Patient undergoes a uterine evacuation and curettage for a hydatidiform mole and severe vaginal bleeding, which is complicated by a urinary tract infection caused by E. coli. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The answer of Patient undergoes a uterine evacuation and curettage...

Question 19

A 43 year old patient has an in situ malignant neoplasm of the left kidney. He is scheduled for a left nephrectomy with partial ureterectomy by open approach. Select the appropriate CPT and ICD-10-CM codes.

Accepted Answer

The correct CPT code for a nephrectomy with partial ureterectomy by open approach is 50220. The ICD-10-CM code for an in situ malignant neoplasm of the kidney is D09.19.

Question 20

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

50010 is the correct CPT code for renal exploration, not involving the renal vasculature, which matches the procedure described. S31.001A and S37.091A correctly identify the gunshot wound locations and the renal injury, respectively. W34.00xA is the correct ICD-10-CM code for an accidental gunshot wound.

Quiz 27: Coding and Surgical Procedures

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.

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.

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.

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.

Preoperative Diagnosis: thoracoabdominal aortic aneurysm Postoperative Diagnosis: same Operative Procedure: Patient placed on bypass pump after which the surgeon repaired the aneurysm using a graft. Select the appropriate CPT and ICD-10-CM codes.

Preoperative Diagnosis: atherosclerosis of right iliac artery Postoperative Diagnosis: same Operative Procedure: Transluminal peripheral atherectomy of right iliac artery via percutaneous approach Select the appropriate CPT and ICD-10-CM codes.

Preoperative Diagnosis: End Stage Renal Disease Postoperative Diagnosis: End Stage Renal Disease Operative Procedure: Creation of right cephalic vein arteriovenous fistula for dialysis. Select the appropriate CPT and ICD-10-CM codes.