Question 1

A 48-year-old woman fell off her horse, tearing her rotator cuff. This required open surgery to repair the right rotator cuff. What is the CPT code for this procedure?

Accepted Answer

23410 is the correct code for an acute injury that involves an open procedure for repair of the rotator cuff.
Code 23412 is incorrect because it is for a chronic rotator cuff repair, but this was due to an acute injury. Code 23415 is incorrect because this code is for a ligament release and code 23420 is incorrect because it is for reconstruction of a complete shoulder cuff avulsion

Question 2

A 12-year-old boy arrives to his pediatrician's office complaining of right arm pain around the elbow. Two days prior, he fell during football practice. An x-ray was obtained and it was noted that he had a displaced fracture of the capitellum at the radial head. This was a closed fracture requiring manipulation. Which CPT code is correct?

Accepted Answer

24655 is the correct code for closed treatment of radial head fracture with manipulation.
Code 24600 is incorrect because it is for an elbow dislocation and 24620 is incorrect because this is the code for closed treatment of an ulna fracture with radial head dislocation. Code 24640 is incorrect because it is the code for radial subluxation.

Question 3

An 85-year-old woman fell directly on her elbow resulting in a complex fracture. It was recommended to have a total elbow arthroplasty performed to give her range of motion and use of this joint. Which code is correct?

Accepted Answer

24363 is the correct code for a total elbow replacement, including distal humerus and proximal ulnar prosthetic replacement.
Code 24360 is incorrect because this code is for an elbow arthroplasty with membrane. Code 24361 is incorrect because this code is for elbow arthroplasty with distal humeral prosthesis and 24362 is incorrect because this code includes ligament reconstruction.

Question 4

A 54-year-old woman has noticed a pea sized lesion on the top of her left wrist. Her PCP diagnosed it as a ganglion cyst, approximately 1 cm in diameter. He referred her to surgery for removal, as it was becoming painful. What is the correct code for surgical removal of this cyst?

Accepted Answer

25111 is the correct code for initial ganglion cyst excision.
Code 25112 is incorrect because this code is for recurrent cyst excisions. 25115 is incorrect because it is for excision of the bursa and synovia of the wrist and 25130 is incorrect because it is for the excision of bone cysts or tumor of the carpal bones.

Question 5

A 25-year-old construction worker has been diagnosed with trigger finger of his right 2nd digit. He has received three steroid injections over the last year, but it continues to flare. He is referred to surgery for further evaluation. The surgeon recommends a tendon sheath incision and this is scheduled as an outpatient. What is the correct CPT code for this procedure?

Accepted Answer

26055 is the correct code for incision of the tendon sheath to release the trigger finger.
Code 26060 is incorrect because this is for a percutaneous tenotomy. Code 26160 is incorrect because this is for an excision of a lesion of the tendon sheath. 26170 is incorrect because this code is for excision of the tendon.

Question 6

A 3-year-old girl was born with two polydactylous digits on her right hand. One digit was soft tissue only and was able to be tied off at birth. The second digit included bone and skin and was unable to be treated at birth. Because she is now three years old, this extra digit will be removed, leaving her with five digits total. What is the correct code for this procedure?

Accepted Answer

26587 is the correct code for reconstruction of polydactylous digit including soft tissue and bone.
Codes 26560 and 26561 are incorrect because they both involve the repair of syndactyly. 26590 is incorrect because this is the code for macrodactylia repair.

Question 7

A 27-year-old male was cutting wood, using a circular saw, when he accidentally cut off the end of his 3rd digit. On x-ray it showed that he cut the distal phalange and partially cut the middle phalange of the 3rd digit. Due to bone splinters and need for debridement, the 3rd digit middle phalange was amputated back to the proximal phalange, leaving a wide border of healthy bone and tissue. What is the correct CPT code for this procedure?

Accepted Answer

26951 is the correct code because this was an amputation of the finger with a specific phalanx noted.
Code 26910 is incorrect because this code is for amputation of the metacarpal with finger or thumb amputation. Code 26952 is incorrect because this code involves local flaps indicating a larger repair. 26989 is incorrect because this code is for an unlisted procedure and the procedure above has a specific code available.

Question 8

A 56-year-old man with severe osteoarthritis in his hips follows up with orthopedics for worsening pain in his right hip. At this time, he opts for a total hip replacement on the right hip and begins the process for surgery and rehab afterwards. What code would you use for a total hip replacement?

Accepted Answer

27130 is the correct code for arthroscopy of the acetabular and proximal femoral prosthetic replacement also known as "total hip replacement."
Code 27125 is incorrect because this is the code for a partial hip replacement and 27134 is incorrect because it is for a revision of a total hip arthroscopy. Code 27236 is incorrect because this code is for open treatment of a femoral fracture with prosthetic replacement.

Question 9

A 27-year-old female fell off the tailgate of a truck, landing on her coccyx. She sustained a compound fracture and needs surgery for it to be removed. Which code is correct?

Accepted Answer

27080 is correct for coccygectomy (removal of coccyx).
Code 27070 is incorrect because this code is for a partial excision of the wing of the ilium. Codes 27200 and 27202 are incorrect because these are used for closed or open treatments of coccygeal fractures not requiring removal of the bone.

Question 10

A 24-year-old college football player injured his knee during practice. The MRI shows a torn medial and lateral meniscus. The orthopedist reviewed the films and decides to proceed with an arthroscopy with meniscectomy to remove the torn pieces of the meniscus from the knee. What is the best code for this procedure?

Accepted Answer

29880 is the correct code because this football player tore both his medial and lateral meniscus and the procedure was meant to clean up both sides of his knee.
Code 29879 is incorrect because this code is used for an arthroplasty instead of an arthroscopy which is what this patient had done. . Code 29881 is for one side or the other, not both medial and lateral meniscus. Codes 29882 and 29883 are both codes for repairing the meniscus, which in this football players case, was not an option because both were completely torn.

Question 11

An 18-year-old soccer player falls while running and dislocates his knee. He was taken to the ER with significant edema. He is found to have a significant patellar dislocation, which will be reduced in the ER with conscious sedation. Which code is the best code for this procedure?

Accepted Answer

27562 is correct because it was a closed treatment of patellar dislocation with conscious sedation, which is considered anesthesia.
Codes 27550 and 27552 are both incorrect because they are referring to knee dislocations. Code 27560 is incorrect because this code is for a reduction without anesthesia.

Question 12

A ballet dancer completely ruptured her left Achilles tendon during a production. She requires open repair without grafting. What is the best code for this procedure?

Accepted Answer

27650 is the correct code for a primary repair of a ruptured Achilles tendon.
Code 27652 is not correct because this code includes grafting. Code 27654 is incorrect because it is for a secondary repair and 27658 is incorrect because this code is for the repair of a flexor tendon and not the Achilles tendon.

Question 13

A 56-year-old type 2 diabetic has been battling diabetic ulcers and poor perfusion in his feet and toes. Due to an infection that was not quickly treated he developed gangrene in the tip of his right 3rd digit and the metatarsal had to be amputated to leave healthy tissue and promote healing. It was amputated up to the proximal phalange. What is the correct code for this procedure?

Accepted Answer

28825 is the correct code for an amputation that was taken up to the proximal phalange.
Code 22805 is incorrect because this amputation goes up to the transmetatarsal. Code 28810 is incorrect because it is an amputation of the metatarsal and 28820 is incorrect because it is up to the metatarsophalangeal joint involving the entire toe instead of just a portion of the toe.

Question 14

A 52-year-old woman who has rheumatoid arthritis is suffering with her right second toe bending upward in the middle. It is causing her to not be able to wear her shoes and she is having pain when walking. Her rheumatologist referred her to orthopedics to have the hammertoe looked at and possibly corrected. She is going to have surgery to correct the hammertoe by doing an interphalangeal fusion. What is the correct code for this procedure?

Accepted Answer

28285 is the correct code and can be used for any correction of hammertoe, including interphalangeal fusion or partial/total phalangectomy.
Code 28280 is incorrect because this code is for syndactylization. Code 28286 is incorrect because this code is for cock-up fifth toe with plastic skin closure and 28290 is incorrect because this code is for the correction of bunions.

Question 15

A 3-year-old male presented to the pediatrician's office after the patient's mother discovered that the boy had inserted a jelly bean into his nose. The mother, when trying to remove the jelly bean, ended up pushing the bean further into the patient's nose to the point that it is no longer visible. Upon presentation, the patient was extremely agitated and anxious, and was experiencing pain and swelling in the left nasal sinus. The pediatrician determined that due to the patient's emotional state and the depth of the jelly bean, the patient would have to be anesthetized in order to remove it. The pediatrician admitted the patient into the hospital and performed the removal of the foreign body under general anesthesia. At one point, a lateral rhinotomy was considered but ruled out, as the physician was finally able to grasp the foreign body. How should the pediatrician code for this service?

Accepted Answer

The pediatrician should code for this service with 99214, for the office visit evaluation and management service. This code should be appended with modifier -57 to indicate that this procedure resulted in a decision for surgery, which was performed later that day. Code 30310, for the removal of the foreign body under general anesthesia, also needs to be included to bill for the removal of the jelly bean from the nose. Code 30320 is incorrect because it includes the removal of a foreign body by lateral rhinotomy. Although the pediatrician considered the lateral rhinotomy, it was not performed, and therefore cannot be billed on the claim

Question 16

A patient with chronic sinus pain and swelling presented to the office for a diagnostic endoscopy of the nasal sinuses. During the procedure, the surgeon excised two polyps on the left sphenoid sinus. What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 31237 (Nasal/Sinus Endoscopy, Surgical; with Biopsy, Polypectomy or Debridement). Code 31235 describes only a diagnostic endoscopy, which would have been the case had the physician not excised the polyps. The diagnostic endoscopy was converted to a surgical endoscopy; therefore the only code that needs to be included on the claim is the surgical endoscopy, which in this case is 31237. Code 31231 only codes for a diagnostic endoscopy, not surgical.

Question 17

A 2-month-old male with diphtheria presented to the hospital with severe respiratory distress. The emergency department physician performed a pulse oximetry and discovered that the patient's blood oxygen level was in the 60's. The on-call physician ordered an emergency endotracheal intubation to restore oxygen flow to the infant. Once the airflow was established, care was transferred to the on-call pediatrician. What is the appropriate code for the emergency department procedure(s)?

Accepted Answer

The appropriate code for the emergency department procedures are 31500 for (Intubation, Endotracheal, Emergency Procedure) and 94760, for the pulse oximetry. The pulse ox was a multiple procedure, so it should be appended with modifier -51. Code 31603 is not the appropriate code because it refers to a tracheostomy. These two procedures are often confused in coding but the code for an endotracheal intubation is within the larynx section and the code for the tracheostomy is within the trachea section.

Question 18

A 47-year-old male patient with advanced cancer of the lower left mandible presented to the hospital for surgical removal of the lower left jawbone with secondary insertion of mandibular prosthesis. In order to perform surgery, the patient had to be intubated through a tracheostomy. After anesthesia, the surgeon performed the tracheostomy by incising the cricothyroid membrane horizontally along the trachea and inserting the intubation device. The surgeon completed the primary surgical procedure on the patient's mandible. What is the correct code for the intubation?

Accepted Answer

No code should be used for the intubation procedure. The correct code in this case is 31600 (Tracheostomy, Planned (Separate Procedure)).This code is designated as a separate procedure, so it should only be reported if it was the only procedure performed during a surgical session. The primary procedure performed was the mandibular excision and reconstruction; therefore the tracheostomy should be bundled into the major procedure. The intubation should not be reported separately.

Question 19

What term is used for the two-layered protective membrane that surrounds the heart and the roots of the great vessels?

Accepted Answer

The term used for the two-layered protective membrane that surrounds the heart and the roots of the great vessels is the pericardium. In order to perform some open cardiac procedures, the surgeon must puncture or remove the pericardium in order to access the heart. The pleural sac is the membrane that surrounds each one of the lungs. The atrium is a chamber of the heart and the aorta is the large vessel at the top of the heart.

Question 20

A cardiovascular surgeon implanted a temporary pacemaker system in a patient with cardiac arrhythmia. The implanted system contained transvenous dual chamber pacing electrodes. What is the correct code for the procedure?

Accepted Answer

The correct code for this procedure is 33211 (Insertion or Replacement of Temporary Transvenous Dual Chamber Pacing Electrodes). Codes 33216 and 33217 are in appropriate because they are used for permanent pacemaker systems. Code 33210 is also in appropriate because it is used for a single chamber pacemaker.

Quiz 2: Series