Medical Coding Scenerios with answers

Case 1
Chief complaint: Multiple dog bites to face.
HPI: 4 year old female who was over at a friend's house when she went to pet their dog and was accidentally bitten. She sustained a 2.5cm laceration to the left upper eyelid and eyebrow, a smaller, more superficial puncture wound to the right cheek measuring approximately 1 cm and an additional puncture wound of the lower cheek measuring 5mm.
PMH: Non-contributory.
Allergies: None
Medications: None
PE: Well-developed white female, alert and oriented. HEENT: Multiple abrasions and scratches to left cheek with lacerations as described above. The left upper eyelid, eyebrow laceration will require primary repair. The puncture wounds are best left cleaned and allowed to close secondarily and these will be revised at a later date if nece3ssary. There is no injury to the orbit itself and extraocular muscles are intact.
Procedure note: The wound was prepped and draped in the usual sterile fashion and infiltrated with 1% lidocaine with epinephrine. The wounds were thoroughly irrigated. Next, the lid laceration was debrided and closed with 6-0 Vicryl and 6-0 Prolene sutures. All wounds were dressed with Polysporin ointment.
Disposition: The patient will be discharged on Augmentin 250 mg po tid and she will be seen back in follow-up in five days for suture removal and reassessment of remaining wounds.
Codes: _________________________________________________________________

Case 2
Chief Complaint: Smashed left thumb
HPI: Patient complains of an injury to the right thumb a few hours ago. The patient states that he got his finger smashed in a machine at work. Last tetanus over 5 years ago.
Allergies: None
Medications: None
ROS: The review of systems is otherwise unremarkable for major signs and symptoms of acute illness or injury for constitutional, HEENT and other significant systems reviewed, except as noted above.
PMH: Generally well.
Social History: The patient smokes 1 ½ packs a day, non-drinker.
Family History: None pertinent to the present complaint.
PE: Vital signs: Review Nurse's notes.
Finger: Left thumb. There is a laceration vertically through the 1/3 or the lateral nail involving a small portion of the tip of the finger. Nonswollen. Range of motion: full. No deformity. Neurovascular status: normal.
Treatment section:
X-ray: Left thumb: tuft fracture.
The affected area was prepped with Betadine. 0.25% Sensorcaine without epi digital block. Nail was removed. The laceration was explored to its base. There was no foreign body in the wound. Irrigated and scrubbed with normal saline and Betadine. Wound repaired with 4-0 nylon and 4-0 Vicryl. Vaseline gauze applied. Sterile dressing and aluminum finger splint applied. Ancef 1 gram IM given.
Codes: _________________________________________________________________

Case 3
Preop Dx: Basal cell carcinoma of the nasal tip.
Postop Dx: Basal cell carcinoma of the nasal tip.
Procedure performed: Wide excision of basal cell carcinoma, frozen section control of the margins and dorsal nasal flap coverage.
Anesthesia: General
Description of Procedure: Following suitable general anesthesia Lacri-Lube was placed in both eyes. The area was marked for excision, prepped with Betadine and draped sterilely. Infiltrated with Marcaine and epinephrine. After suitable waiting period, this was incised circumferentially of the 12 and 3 o'clock position marked and sent for frozen section. Frozen section revealed the margins to be clear. Following this, the dorsal nasal flap based on the right nasal labial crease vessels was marked, extended into the glabella in a V type fashion, carried down to the nasal periosteum and elevated in a left to right fashion with bleeding points being grasped and elevated. It was rotated into position and then temporarily closed. The defect was then closed with buried interrupted 4-0 undyed Vicryl followed by interrupted 5-0 Prolene. After the frozen section revealed the areas to be clear, it was then inset with 4-0 Vicryl. The margins were then trimmed and closed with 5-0 Prolene. All layers were cleansed with saline and dried. The patient tolerated the procedure well.
Codes: _________________________________________________________________

Case 4
Preoperative diagnosis: Pyloric stenosis
Postoperative diagnosis: Same with esophageal stenosis
Operative procedure: Video EGD and balloon dilation of the pylorus and esophageal dilatation to 46 with straight dilator.
Procedure: The patient was given Demerol, 50; Phenergan, 12 ½ and Versed, 2mg and Cetacaine spray. The scope was passed down with little difficulty. The GE junction was at 42 cm. The scope was advanced and had difficulty getting through the pylorus. I thought it was strictured. I was able to finally get through it and get around to the second portion of the duodenum. I then passed the 54 French balloon into the pylorus and dilated it for 30 seconds. After I removed the balloon, I could then easily pass through the pylorus. I felt there might be a slight stricture at the distal part of the esophagus. A picture was taken of it and dilated the esophagus to 54 over a guidewire. Pictures were then taken of the GE junction, also retroflexed. No other lesions were seen. The patient tolerated the procedure well and went to recovery in satisfactory condition.
Note: The French scale is not identical to the metric system of measurement. Each French unit is equal to 1/3mm; for example, a 24 French sound is equal to 8mm in diameter.
Codes: _________________________________________________________________

Case 5
Preop Dx: Right knee torn medial meniscus and proximal tibial lesion.
Postop Dx: Torn medial and lateral menisci; chondcromalacias, grad 3 of medial femoral condyle, lateral femoral condyle, and patella; proximal tibial lesion; loose body.
Procedure Performed: Diagnostic arthroscopy with debridement of partial torn lateral and partial torn medial menisci; chondroplasty of medial and lateral femoral condyles of patella; removal of loose body and fluoroscopically controlled biopsy of proximal tibia.
Anesthesia: General
Description of Procedure: The arthroscope was introduced with the scope in the anterolateral portal and the probe in the anteromedial portal. The joint was investigated, and she was found to have synovitis throughout the knee. She had grade 2 and 3 chondromalacia over most of the surface of the patella. The medial and lateral femoral condyles ahd grade 3 lesions with some delamination. There was a parrot beak type tear in the posterior horn of the medial meniscus and a degenerative type tear in the lateral meniscus. There was also a loose body in the lateral compartment which was removed with a pituitary rongeur. The motorized cutter and the Arthrocare wand were then used to take the chondral defects on the medial and lateral femoral condyles down to stable cartilage base and rim. Excess carbonization was removed with the motorized cutter. Medial and lateral menisci were then trimmed back to a stable cartilage base and rim. The opening for the lesion on the position tibia near the posterior cruciate ligament insertion was not visible from inside the joint. Chondroplasty was also performed on the patella and was taken down to stable cartilage base and rim.
The arthroscopic portion was then terminated and through an open incision, a guide pin was placed into the tibia, and under fluoroscopic control, was angled into the cystic lesion. A 6.5mm drill was then drilled just short of this, and a Craig needle was used to take a biopsy of the lesion. This was sent to pathology. The knee was instilled with 27 cc of 0.25% Marcaine with epinephrine, and she was placed in a bulky bandage. She was awakened and returned to the recovery room in satisfactory condition. Estimated blood loss was none. There were no complications.
Codes: _________________________________________________________________

Case 6
Procedure: ECCE
After routine prep and drape, a small fornix-based conjunctival flap was raised superiorly. Bleeding points were cauterized. A 7mm step incision was made above. The anterior chamber was entered under the flap with a 5531 blade. The anterior capsule was removed under Healon with a cystotome. The nucleus was emulsified in the posterior capsule. Cortex was removed with the I&A tip. The posterior capsule was vacuumed. Healon was placed in the anterior chamber and capsular bag. The wound was extended to 7mm. A 23.5 diopter, 3161B lens was positioned in the bag horizontally. The wound was closed with a shoelace 9-0 nylon suture. After the Healon was removed from the anterior chamber with I&A tip, intracameral Miostat was injected. The wound was tested for water tightness. Superior rectus suture was removed. Vasocidin ointment was applied along the lid margins. An eye shield was applied. The patient tolerated the procedure well and was taken to the recovery room in good condition.

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Answers:

Case 1
870.0; 873.42?; 873.41; 910.0; E906.0-not CCS; E849.0-not CCS; 86.59; 12011
Case 2
927.3; 816.02; E919.9—not CCS; 86.23; 11730; 86.59?; 12001?
Case 3
173.3; 11640; 21.32; 14060?; 86.70?
Case 4
537.0; 530.3; 42.92; 44.22; 43245; 43248
Case 5
836.0; 836.1; 717.7; 717.6; 733.90; 29883; 29877-51; 20225-51; 76003; 81.47; 80.86; 80.16; 77.47
Case 6
366.9 but no pre and pst dx given!; 13.41; 13.71; 66984