CPT Medical Coding: Surgery - Ch 4

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procedures, local anesthesia, one related E/M encounter prior, immediate post op care, order prep, evaluation of patient in recovery, typical post op follow up care

What 7 items are included in the surgical package?

procedure, pre op services prior, post op follow up, complications, post surgical pain management, insignificant surgical procedures not done in operating room

What six items are included in the Medicare surgical package for major surgeries?

procedure, pre op services prior, post op follow up

What three items are included in Medicare surgical package for minor surgeries?

90 days

For major surgeries, Medicare allows post op follow up care for up to _____.

10 days

For minor surgeries, Medicare allows post up follow up care for up to _____.

False

True or False. Treatment for any complications that occur during the post op period are included in the surgical package.

National Correct Coding Initiative

NCCI stands for

CMS

Who developed NCCI?

correct coding, inappropriate unbundling

The NCCI was created to promote ______ nationwide and prevent ________.

comprehensive component edits

Coding edits that pertain to HCPCS that should not be used together

mutually exclusive edits

Coding edits that apply to improbable or impossible combinations of codes

skin, nails, breasts

Body parts that are included in the integumentary subsection

type of lesion, site, size, type of closure

What information must be known to accurately code excision of lesions (4)?

margins

When taking into account the size of an excised lesion, you should always include ______.

9cm

The surgeon records that he excised a 5cm lesion with 2 cm margins. How big was the total excision?

tissue transfer, rearrangement, excision

The adjacent tissue transfer codes include the _______ or ______ and _____.

simple

This type of wound repair primarily involves the epidermis, dermis or subcutaneous tissues without involvement of deeper structures.

simple

This type of wound repair requires the suturing of only one layer.

intermediate

This type of would repair involves one or more of the deeper layers of subcutaneous tissue and superficial fascia and skin.

intermediate

This type of wound repair is closed in layers.

intermediate

If a wound requires closure of the subcutaneous tissue or more than one layer beneath the dermis, it is considered an ______ repair.

intermediate

A one layer wound that is heavily contaminated and requires extensive cleaning would be an _____ repair.

complex

This type of wound repair goes beyond layered closure and requires scar revision, debridement, undermining, stents, or retention sutures.

type of repair, site, extent of wound, length of repair

What information is needed to code wound closures (4)?

prolonged cleansing, removal, tissue, separately

Debridement can be reported separately from wound repair when it requires _____, _____ of considerable amounts of _______, or if it is carried out _____.

same classification, same anatomic groups

When coding repairs of multiple wounds you add together the lengths of wound in the _____ from the _______.

complicated

When sequencing codes for multiple wound repairs the most ______ is reported first.

no

Are superficial wounds closed only with Steri strips and bandages reported with simple repair codes?

skin grafting

This involves treating damaged or lost skin in which a piece is taken from another area and transplanted to damaged or missing section.

z plasty

This type of skin grafting involves making an incision above, through, and below scar or defect.

z plasty

This type of skin grafting is used to reposition a scar so it more closely conforms to the natural lines and creases of the skin.

w plasty

This type of skin grafting involves a series of triangular flaps; two are removed and then the other two are moved together and sutured into place.

v y plasty

This type of skin grafting involves a v shaped incision with advancement and stretching of the skin. The defect is then covered and forms a Y when sutured.

rotational flap

This type of skin grafting involves a curved or semicircular incision of the skin and subcutaneous tissues.

advancement

This type of skin grafting involves the sliding of a pedicle graft into the new position.

13cm, 5cm

The physician records 3cm, 4cm, and 6cm simple wound repairs of the elbow and forearm. He also records a 5 cm intermediate wound repair of the arm. What is the total length of the simple would repair to be coded? What is the total length of the intermediate wound repair?

pedicle graft

This type of skin grafting involves grafted tissue that remains connected to the vascular bed.

allograft

This type of skin grafting is obtained from a genetically dissimilar individual.

xenograft

This type of skin grafting is obtained from a different species.

free skin graft

This type of skin grafting involves a piece of skin taken from a donor and place on the damaged area.

pedicle flap graft

This type of skin grafting involves the removal of skin leaving one end still attached; the skin is then folded over the damaged area.

skin substitute

This type of skin grafting involves applying biomaterial engineered tissue to substitute for skin autograft or allograft.

flap

This is a piece of skin cut away near site and transferred with the base attached.

mohs micrographic surgery

Used for skin cancer, this treatment involves excising the tissue all the way down until no cancer is found; involves several stages with histologic exam of 100% of the surgical margins.

excisional

This type of breast biopsy removes the entire lesion.

incisional

This type of breast biopsy removes only a portion of the lesion.

modifier 50

How are procedures performed on both breasts indicated?

open treatment

This involves fixing a fracture by exposing the site via surgical incision.

closed treatment

This involves fixing a fracture without surgical excision.

manipulated

When a fracture is treated with reduction or restoration it is _________.

replacement casts, pain relief

Additional codes for casts and strapping would apply for ________ or to afford ______.

restorative treatment, same physician, treatment, another physician, treatment

Additional codes for casts and strapping would apply for initial casts without __________, when __________ does not perform ______, when ______ provides or will provide _______.

surgical

If a patient had both diagnostic and surgical arthroscopy, which procedure would be coded?

diagnostic

_______ endoscopic procedures are automatically included as part of the code when the patient has a surgical endoscopic procedures.

surgical

When a diagnostic and surgical endoscopy is performed during the same operative episode which procedure(s) do you report?

modifier 50, unilateral

If a procedure from 31231-31294 (nasal sinus endoscopy) is reported as bilateral, you will need ______ because these codes are assumed ______.

indirect

This type of laryngoscopy uses a small mirror to visualize the vocal chords.

direct

This type of laryngoscopy uses a scope to visualize the vocal chords.

yes

Would the use of an operating microscope affect your code choice when coding laryngoscopy?

separate code

When an operating microscope is used during a laryngoscopy, a _______ is used.

selective arterial catheterization

______ requires that the catheter be removed, manipulated, or guided into a part of the arterial system other than aorta or the vessel punctured.

nonselective arterial catheterization

______ involves the placement of a catheter or needle directly into an artery or it is negotiated only into the thoracic or abdominal aorta from any approach.

selective venous catheterization

_________ includes catheter placement in those veins that rise directly from the vena cava or the vein punctured directly (primary) and any subsequent (secondary) branches of the primary venous branches.

non selective venous catheterization

______ involves direct puncture of peripheral veins and the vena cava; or placement of the catheter in the inferior or superior vena cava by any route.

leads, generator

What are the two components of a pacemaker?

two

How many codes need to be assigned to fully code arterial-venous bypass grafting?

central insertion

When a small, flexible tube is placed in large veins for frequent access, it is called a ______.

peripheral insertion

When a tube is placed in the arm and advanced into the larger subclavian vein, it is called a ______.

non tunneled

________ catheters are fixed in place at the site of insertion, with the catheter and attachments protruding directly.

tunneled

______ catheters are passed under the skin from the insertion site to a separate exit site, where the catheter and its attachments emerge from underneath the skin.

av fistula

This is a passageway between an artery to a vein which is surgically created for hemodialysis treatments.

Thrombectomy

This is the surgical removal of a clot.

no

Is a CPT code assigned if the nurse inserts the catheter?

no

Is a CPT code assigned if removal of a catheter involves pulling it out at the bedside?

EGD

This is a scope of the upper gastrointestinal region including the esophagus, stomach and upper duodenum.

proctosigmoidoscopy

This is a scope of the rectum and sigmoid colon.

sigmoidoscopy

This is a scope of the rectum, sigmoid, and portion of descending colon.

colonoscopy

This is a scope of the entire colon, from the rectum to cecum.

53

What modifier is assigned if a patient is prepped for a colonoscopy, but the procedure was incomplete?

type or site, initial or recurrent, age, clinical presentation, surgical treatment

What information is needed in order to assign CPT codes for hernia repairs(5)?

body part, procedure

What methodology is used to categorize genitourinary endoscopies(2)?

one

How many codes would be assigned for a procedure involving a hysteroscopic biopsy and dilation and curettage of the uterus?

dilation and curettage

What is commonly performed with a hysteroscopic biopsy?

site, substance

To code spinal injections, coders need to determine what two things?

surgical approach, location, procedure

To code spinal surgery, coders need to determine what three things?

one

How many codes are used for cataract extraction with the insertion of intraocular lens prosthesis during the same operative episode?

intracapsular

Type of cataract extraction where the lens with capsule are removed.

extracapsular

Type of cataract extraction where the lens is removed without the capsule.

tympanostomy

What term should you use if a physician performed a myringotomy for the insertion of a ventilating tube?

separate procedure

This phrase, which is in parentheses after code description, allows you to code a procedure if it is not an integral part of another procedure.

physicians, hospitals

The national correct coding initiative applies to _____ and _____.

quarterly

NCCI updates _______.

deepest level, size

For debridement, coding decisions are based on _____ and _____.

depth

For debridement, the surface area of multiple wounds can be added if they are the same _____.

electrosurgery, cryosurgery, laser, chemical treatment

Destruction of lesions include what four methods?

square centimeters

Skin grafts are measured in _____.

no

For fractures, do you code for the initial cast?

single chamber

Type of pacemaker with a pulse generator and one electrode inserted in either the atrium or ventricle.

dual chamber

Type of pacemaker with a pulse generator and electrodes inserted into both the atrium and ventricle.

type of procedure, central or peripheral, tunneled, age

When coding central venous access procedures, what are four things that must be considered?

endovascular revascularization

Procedures designed to improve blood supply to an area.

iliac, femoropopliteal, tibial/peroneal

Endovascular revascularization is differentiated by which three territories?

Endoscopic retrograde cholangiopancreatography

This type of endoscopy is used to visualize the liver, gallbladder, bile ducts, and pancreas.

incisional, ventral

Mesh code may only be used as an add on code if used for _____ or _____ hernia repair.

cystourethroscopy

When physician uses cysto, look under _____.

selective catheterization

When a catheter is placed into (not at or near the origin) a branch off the aorta or the access vessel. Each of these vessels arising from the aorta or access vessel represents different vascular families.

nonselective catheterization

Refers to a catheter that remains in the accessed vessel or that has made it into the aorta.

debridement

Surgical method in which a patient's dead, damaged, or infected tissue is removed to assist in the healing process.

moles, cysts, keloids, warts, skin tags

Skin lesions can include which five types?

shaving, paring, excising, laser

Lesion removal can be done with which four methods?

excision of skin lesion, musculoskeletal

For excisions, if a lipoma extends into the dermis, use code for ______. If a lipoma extends into the soft tissue, use a code from the _______ section.

repair

Repairs with tissue adhesives like Dermabond are reported using the appropriate code from the ______ category.

percutaneous

Type of biopsy that involves the insertion of a hollow needle to remove a biopsy specimen of breast tissue.

partial

Type of mastectomy that refers to the partial removal of part of the breast tissue, leaving the breast almost intact.

lumpectomy, lobectomy

A partial mastectomy is also called a ______ or _____.

simple complete

Type of mastectomy for the excision of all the breast tissue, with the lymph nodes and muscles left intact.

subcutaneous

Type of mastectomy used for excision of breast tissue with the skin and nipple intact

radical

Type of mastectomy referring to the excision of breast tissue including pectoral muscles and axillary lymph nodes.

modified radical

Type of mastectomy used for the excision of breast tissue including axillary lymph nodes with or without pectoralis minor muscles, but pectoralis major muscles are left intact.

location of electrode, type of procedure, type of approach

When coding for a pacemaker, you should consider what three elements?

inserting, replacing, repositioning

Three types of procedures to consider when coding for a pacemaker.

epicardial, transvenous

Two approaches for placing electrodes for a pacemaker.

excision

With regard to lesions in the colon, when doing a biopsy on a lesion and then excising it, you should code for _____ only.

biopsy, excision

With regard to lesions of the colon, when doing a biopsy on one lesion and excising a another, assign a ______ code for the first lesion and a _____ code for the second lesion.

internal, external, both, columns/groups

Surgical incision codes for hemorrhoidectomy is differentiated by whether hemorrhoids were _____, _____, or _____ and the number of ______.

epigastric

Type of hernia above the navel

umbilical

Type of hernia at the navel

spigelian

Herniation usually above the inferior epigastric vessel along the outer border of the rectus muscle.

reducible

Protruding organs can be returned to normal position by surgical manipulation.

sliding

The colon or cecum is part of the hernia sac.

incarcerated

Hernia cannot be reduced without surgical intervention.

strangulated

The hernia is an incarcerated hernia in which the blood supply to the contained organ is reduced - medical emergency.

51

Modifier _____ should be reported when multiple procedures are performed on urinary tract.

male genital system

Codes for removal of lesions of the penis is located in the ______ subsection.

turp

Prostatectomy involving the use of a scope inserted through the urethra to remove prostate tissue piece by piece.

perineal

Prostatectomy involving an incision between the back of the scrotum and anus.

retropubic

Prostatectomy involving an incision in the front wall of the abdomen above the pubic bone to reach the prostate.

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