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.

Question

Quizplus · Accepted Answer

The correct CPT code for the procedure described is 71250, which is for a CT scan of the chest without contrast. This is because the procedure mentions "Multiple tomograms of L. lung" which aligns with a CT scan of the chest. The ICD-10-CM codes include C79.51 for secondary malignant neoplasm of bone, reflecting the skeletal metastases mentioned, and Z85.3 for a personal history of malignant neoplasm of breast, indicating the patient's history of breast cancer.

Clinical Indication: Carcinoma of the Right Breast, Mastectomy and Chemotherapy