Emergency Department and Outpatient Surgery Coding Quiz
True or False:
1.) If a patient is treated for a fracture in the ED with reduction and splint application – both the splint application and fracture reduction should be assigned CPT codes. ___________
2.) If injections and infusions are not billed via the chargemaster, then coding personnel should assign CPT codes for those procedures. ______________
3.) The coding of immunizations requires only one CPT code assignment. _____________
4.) If a bone graft is taken/obtained from the primary operative site (it is not taken from a separate incision site) and is used for grafting at that same site, it should be coded with an additional CPT code. _____________
5.) Probable, possible, and rule out diagnoses may be coded on outpatient cases. ____________
Assign CPT codes and modifiers to the following:
1.) Patient presented to the ER with a 2.5 cm laceration of the left calf and a 5 cm laceration of the right upper arm. The laceration of the calf was sutured using 3-0 Vicryl to close the skin. The 5cm in length wound was explored and irrigated with 200 cc's of saline. The subcutaneous tissues were closed with 3-0 Vicryl and the skin was closed with 5-0 Maxon subcuticular sutures. ________________________________________
2.) A split graft measuring 230 square centimeters is applied to a defect on the leg. How would this procedure be reported? ______________________
3.) A left radical mastectomy for breast cancer was performed which included pectoral muscle and axillary lymph node removal. Immediately following the mastectomy procedure, a saline breast prosthesis was inserted on the left. How would this procedure be reported? __________________________________________________________
4.) Right shoulder arthroscopy with decompression of subacromial space with partial acromioplasty with coracoacromial release. An open Mumford procedure was also performed. ___________________________________________________
5.) Patient was brought to the E.D. in cardiac arrest. CPR was carried out and countershocks were applied using an external defibrillator to no avail. The patient was pronounced approximately 45 minutes following presentation to the E.D.: ___________________
6.) Nasal Endoscopic approach, bilateral: Uncinate process was removed and an ethmoidectomy was performed on the anterior portion of the ethmoid cells. The middle turbinate was then partially resected and the ostium of the maxillary sinus was accessed. An antrostomy was carried out which included removal of diseased, mucopurulent and polypoid tissues. __________________________________________
7.) Initial rhinoplasty procedure with nasal tip work, rasping/filing of bony hump, and correction of deviated nasal septum. _____________________________
8.) An incision was made on the right forearm and the radial artery isolated. The artery was clamped above and below the clot. An incision was made into the artery and the clot removed. The radial artery was repaired/closed by suture technique, followed by layered closure of the subcutaneous tissue and skin. ____________________________
9.) Repair of a single chamber lead (electrode) in a cardioverter-defibrillator. ________________________
10.) Hemorrhoidectomy was performed for extensive internal and external hemorrhoids with fissurectomy and fistulectomy: ________________________________________
11.) Meatotomy and urethral calibration and dilation was performed. The cystoscope was inserted and urethrotomy was performed internally. This was followed by a transurethral resection of the prostate. _________________________________________
12.) Cystourethroscopy with manipulation of ureteral calculus yet stone was not removed. An indwelling ureteral double J stent was inserted and left in place. ________________
13.) A cone shaped portion of tissue was removed from the cervix utilizing laser technique. This was followed by a D&C. ________________________
14.) Hysteroscopy with excision of uterine fibroids and endometrial ablation was performed. Chromotubation was carried out. This was followed by laparoscopy with lysis of adhesions around the right ovary, removal of an additional uterine fibroid tumor and left salpingectomy with oophorectomy: ____________________________________________________
15.) RACZ procedure was performed thus epidurolysis (percutaneous lysis of epidural adhesions) was utilized to dissolve scar tissue around trapped nerves in spine. ___________________________________
16.) Diskectomy, anterior, for decompression of nerve roots, thoracic, T2-T3, T3-T4: _________________________________
17.) Patient presents for a steroid injection for a herniated lumbar disk. Marcaine and Aristocort were injected into the L2-L3 space: ___________________________
18.) Patient suffers from strabismus and requires surgery. Recession of the right lateral rectus muscle with adjustable sutures was performed:___________________________
19.) Patient with a traumatic rupture of the left eardrum repaired the tympanoplasty with incision of the mastoid. Repair of ossicular chain not required. _____________________
20.) Aphakia penetrating corneal transplant: _______________________________
Code the following scenarios with ICD-9-CM diagnosis and procedure, and CPT codes:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
1. 12032; 12001-51
2. 15100; 15101
3. 19200-LT; 19340-51-LT
4. 23120-RT; 29826-51-RT
5. 99291-25; 92950
6. 31254-50; 31267-51-50
12. 52330; 52332-51
13. 57520; 58120-51
14. 58561; 58661-51-LT; 58679-51
16. 63077; 63078
18. 67311-RT; 67335
870.0; 873.42?; 873.41; 910.0; E906.0-not CCS; E849.0-not CCS; 86.59; 12011
927.3; 816.02; E919.9—not CCS; 86.23; 11730; 86.59?; 12001?
173.3; 11640; 21.32; 14060?; 86.70?
537.0; 530.3; 42.92; 44.22; 43245; 43248
836.0; 836.1; 717.7; 717.6; 733.90; 29883; 29877-51; 20225-51; 76003; 81.47; 80.86; 80.16; 77.47
366.9 but no pre and pst dx given!; 13.41; 13.71; 66984