Question 1

A 66-year-old woman has been having a chronic cough for three years, which is worsening. She was finally sent to pulmonology where a chest x-ray indicated inflammation. A flexible bronchoscopy was scheduled to be performed with multiple bronchial biopsies performed. This was done under fluoroscopic guidance in the OR and the patient tolerated the procedure well.

Accepted Answer

31625 is the correct CPT code for a flexible bronchoscopy with bronchial biopsies.
Code 31622 is incorrect because it was not just a simple bronchoscopy. Code 31623 is incorrect because there were no brushings taken and 31624 is incorrect because there was no alveolar lavage performed.

Question 2

A patient has empyema. What CPT code would you use for a thoracostomy with rib resection?

Accepted Answer

Code 32035 is for a thoracostomy with rib resection for empyema.
Code 32036 is incorrect because there was no flap drainage performed. Codes 32096 and 32097 are incorrect because they are for thoracotomies with biopsies for lung infiltrates, nodules or masses.

Question 3

A long-time smoker is undergoing bilobectomy of his right lung due to cancer. He will have the middle and lower lobes removed during his procedure. What CPT code should be used to indicate that not just one lung or one lobe of the lung was removed?

Accepted Answer

32482 is the correct code for a pneumonectomy of two lobes of the lung, which is called a bilobectomy.
Code 32440 is for a pneumonectomy and 32480 is for a single lobe or a lobectomy. Code 32484 is for a segmentectomy where just a single segment of a lobe is removed.

Question 4

A 78-year-old woman has to have biopsies done of her right lower lung infiltrate. She is scheduled for a thoracoscopy where a wedge biopsy will be taken of the right lower lobe. Which code should you use for this procedure?

Accepted Answer

32607 is the correct code for a unilateral infiltrate and requires a thoracoscopy with wedge biopsy.
Code 32601 is incorrect because this is for a thoracoscopy without biopsies. Code 32608 is incorrect because this includes a biopsy of masses or nodules. Code 32650 is incorrect because this code is for a surgical thoracoscopy with pleurodesis.

Question 5

An 8-year-old boy has a massive over the handlebar accident on his bicycle, lacerating his spleen. He requires a total splenectomy to control the hemorrhaging. What CPT code would be used?

Accepted Answer

38100 is the correct code for a total splenectomy.
Code 38101 is incorrect because this was a total, and not a partial, splenectomy. Code 38102 is incorrect because this is an add-on code. Code 38115 is incorrect because there was no repair done to the spleen during this procedure.

Question 6

Mr. Johnson, a 46-year-old male, has smoked cigars for the last 20 years of his life. He has a suspicious lesion on his lower lip and is being seen for treatment. The physician suspects that it may be malignant. The physician performed a shave biopsy of the patient's lower lip. What is the correct code for this procedure?

Accepted Answer

Code 40490 (Biopsy of Lip) is the correct code for this procedure. Code 40500 (Vermilionectomy (Lip Shave), with Mucosal Advancement) is not correct because it is a more extensive procedure than what was performed at the visit, which was just a biopsy. Code 11100 (Biopsy of Skin) is also not correct because the code 40490 is used for the lip, which is more specific.

Question 7

The physician performed a needle biopsy of salivary gland and sent the aspirate out to pathology for study. What is the correct CPT code for the physician to report?

Accepted Answer

The correct CPT code for the physician to report is 42400 (Biopsy of Salivary Gland; Needle). Code 42405 is not correct because it allows for an incisional biopsy of the salivary gland, whereas this procedure was done via needle. It is also not correct to code for the pathology service using codes 88172 or 88173 because the physician sent the sample out to the lab. The lab should code for the pathology service not the physician.

Question 8

PROCEDURAL NOTE PATIENT: Ortiz, Pamela
AGE: 13
DATE: 01/19/2016
PREOPERATIVE DIAGNOSIS: Oropharyngeal Hemorrhage s/p Tonsillectomy
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE: Control of oropharyngeal hemorrhage
The patient was seen in the emergency room one day after tonsillectomy due to uncontrolled oropharyngeal hemorrhage. The patient was admitted to the hospital for control of nasal hemorrhage and observation. The suture site from tonsillectomy was visualized and the pharynx was packed with gauze to control any additional bleeding. The patient remained in hospital for an additional 24 hours under observation and to control any additional hemorrhaging. The physician recommended the patient schedule a follow-up appointment in two days to check the sutures.
How should you code this procedure?

Accepted Answer

You should code this procedure using code 42961 (Control Oropharyngeal Hemorrhage, Primary or Secondary (e.g. Post-Tonsillectomy); Complicated, Requiring Hospitalization). The notes indicate that the patient was admitted to the hospital for observation, so the code 42960 (Simple Control) is not appropriate. In addition, code 42962 refers to a secondary surgical intervention, but in this case, no other surgical interventions were noted.

Question 9

A physician performed a thoracoabdominal diaphragmatic hernia repair on 45-year-old male patient with the implantation of prosthetic mesh for support. What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 43337 (Repair, Paraesophageal Hiatal Hernia, via Thoracoabdominal Incision, Except Neonatal; with Implantation of Mesh or Other Prosthesis). Code 39531 was deleted and replaced with code 43337, as indicated by the notes within the mediastinum and diaphragm section. Code 43336 is inappropriate because it does not take into account the implantation of mesh, while code 43337 does.

Question 10

A 5-year-old patient received a gastric intubation from physician after ingesting approximately 5 tablespoons of carpet cleaning detergent. The gastric tube was orally inserted through the esophagus and into the stomach and lavage was performed to evacuate the stomach contents. What is the correct CPT code?

Accepted Answer

The correct CPT code is 43753 (Gastric Intubation and Aspiration(s) Therapeutic, Necessitating Physician's Skill, including Lavage if Performed). Code 43752 is only for the placement of a naso- or oro-gastric tube and does not include lavage and evacuation of the stomach contents. Code 43754 includes the placement of the gastric tube and aspiration of stomach contents, but for diagnostic purposes not for treatment of a poisoning.

Question 11

A physician performed a revision of a gastrojejunostomy with intestine resection and vagotomy. What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 43865 (Revision of Gastrojejunal Anastomosis (Gastrojejunostomy) with Reconstruction, With or Without Gastrectomy or Intestine Resection; With Vagotomy). Code 43860 is used for the same procedure, but without the vagotomy. In this case, a vagotomy was performed, making code 43865 the more appropriate code. Codes 43850 and 43855 are used for a gastroduodenostomy not a gastrojejunostomy.

Question 12

Where are codes for the pancreas located in the CPT manual?

Accepted Answer

Codes for the pancreas are listed in the digestive system section of the CPT manual (40490 to 49999). Although there is a subheading within the endocrine section titled "Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body," there are no codes for the pancreas within that section. There is subsection, code range (48000 to 48999), within the digestive system that is designed specifically for the pancreas.

Question 13

A 7-year-old boy fell from a treehouse, cutting open his upper lip across the upper vermilion border. Due to the vermilion border being involved, repair of the lip was performed by plastic surgery. What CPT code should be used for repair of the lip over the vermilion border?

Accepted Answer

40650 is the only code specific to the vermilion border repair of the lip.
Code 40652 is incorrect because it is for a lip repair, up to half of the vertical height. Code 40654 is incorrect because the repair did not involve more than one half of the vertical height and was not listed as complex. Code 40700 is incorrect because there was no mention of cleft lip repair.

Question 14

A newborn needed a frenectomy, due to a tongue tie, to allow her to breastfeed properly. What CPT code should be used for this procedure?

Accepted Answer

Code 40819 Code 40820 is the code for excision or destruction of the frenum.
Code 40806 is the code for incision of the labial frenum. Code 40820 is the code for destruction of lesions or scars in the vestibule of the mouth and 40899 is the code for unlisted procedures of the vestibule of the mouth.

Question 15

A 10-year-old involved in a MVA lacerated his posterior tongue. Laceration was 2.4 cm in length. What code should be used for repair of this child's tongue?

Accepted Answer

41251 is the correct code because this is for a laceration less than 2.5 cm and involves the posterior tongue.
Code 41250 is incorrect because it involves the anterior tongue. Code 41252 is incorrect because the laceration is not more than 2.6 cm or complex. Code 41599 is incorrect because there is a listed code that works for this procedure.

Question 16

A 25-year-old smoker has a lesion on the right anterior portion of his tongue. He needs to have a biopsy done of this lesion. What CPT code should be used for this procedure?

Accepted Answer

41100 code is the only code for biopsy of the tongue involving the anterior two-thirds of the tongue.
Code 41105 is incorrect because it is for biopsy of the posterior one-third of the tongue. Code 41108 is incorrect because this is for a biopsy of the floor of the mouth. Code 41112 is incorrect because this is for excision of the lesion with closure of the anterior two-thirds of the tongue and this procedure was only for a biopsy.

Question 17

A patient has been having recurrent ulcerations on his uvula. He is scheduled for a biopsy of these ulcerations. What CPT code should be used?

Accepted Answer

42100 is the correct code for uvula biopsy.
Code 42000 is incorrect because there was no drainage of an abscess performed. Code 42104 is incorrect because there was no excision of a lesion performed. Code 42140 is incorrect because there was no uvulectomy performed.

Question 18

A newborn needs to have a cleft palate repaired. His cleft involves the soft and hard palates only. What CPT code would you use for a palatoplasty for this child?

Accepted Answer

42200 is correct because this code is for a palatoplasty of the soft and/or hard palates only.
Code 42205 is incorrect because there was no closure of the alveolar ridge. Code 42210 is incorrect because there was no bone graft of the alveolar ridge. Code 42215 is incorrect because there was no major revision performed.

Question 19

A 70-year-old woman has an abscess on her soft palate that needs to be drained. She is able to have this procedure done in the ER by otolaryngology. What CPT code should be used?

Accepted Answer

42000 is the correct code for drainage of an abscess of the palate or uvula.
Code 42100 is incorrect because this code is for a biopsy of the palate or uvula. Code 42104 is incorrect because this is for excision of a lesion and 42140 is incorrect because this code is for auvulectomy.

Question 20

What CPT code should be used for complicated abscess drainage of the parotid gland?

Accepted Answer

42305 is the correct code for complicated abscess drainage of the parotid gland.
Code 42300 is incorrect because this is for a simple drainage of parotid gland abscess. Code 42310 is incorrect because this is for an intraoral drainage of an abscess in the submaxillary or sublingual glands. Code 42320 is incorrect because this is for the external drainage of an abscess in the submaxillary gland.

Quiz 2: Series