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The respiratory system subsection is arranged how?

By anatomic site, then by procedure (incision, excision).

How are endoscopy codes listed?

Throughout the subsection, according to anatomic site.

Procedures performed on the throat and mouth are listed where?

Digestive System subsection

Why is it important to note the extent of the cosmetic repair in the medical record?

So you do not report the same service more than once & unbundle a code. Be sure to report the service with the code that describes the furthest extent of the service provided.

How are endoscopic procedures performed?

Scope is placed through an existing body orifice or a small incision is made into a cavity for scope placement. Most sinus endoscopies are listed as unilateral, unless description indicates bilateral. Some codes include multiple sinus procedures commonly performed in the same operative session.

When coding endoscopic procedures, what is it important to remember?

May start at one site and follow through to another site. Choose the code that most appropriately reflects the farthest extent of the procedure (furthest anatomical site). Only code when an endoscope is used in the procedure.

Why is it important to code the correct approach for the procedure?

The same surgical procedure may be performed using different approaches.

Multiple endoscopic procedures may be performed through the scope during the same operative session, how would this be coded?

With modifier -51 placed on subsequent and lower priced (least resource-intensive) procedures. Not necessary when the CPT manual offers a code for which the description includes all separate elements of the procedure in one code.

Would you code a diagnostic endoscopy separately from a surgical endoscopy?

No-diagnostic endoscopy is always bundled into a surgical endoscopy if performed in the same space. If diagnostic sinus endoscopy is performed on the right maxillary sinus and surgical endoscopy is done on the left, both are reportable with LT and RT modifiers.

What is the difference in indirect and direct approach when coding laryngoscopic procedures?

INDIRECT-physician uses a tongue depressor to hold the tongue down and view the epiglottis. DIRECT-endoscope is passed into the larynx & physician can look directly at the larynx through the endoscope. Operative note will indicate either direct or indirect.

Finding endoscopy codes in the CPT index

Under ENDOSCOPY, then under ANATOMIC SUBTERM of the site. Also, by the ANATOMIC ENDOSCOPY TITLE (bronchial biopsy using endoscopy is listed under Bronchoscopy then under subterm biopsy.

Segmental resection is what type of procedure

Surgical, removal of part of an organ or structure. Segmental-removal of part of lobe of lung

How are incision codes for a nasal abscess divided?

Whether the abscess is on the nasal mucosa or the septal mucosa.

Coding a nasal abscess depends on the approach used, what are the approaches and how does the coding differ?

External Approach (outside the nose) - coded from the INTEGUMENTARY SYSTEM and Internal Approach (from inside the nose)-coded from the Respiratory System subsection. Medical record will describe the approach.

When coding an incision for a nasal abscess from the Respiratory system subsection, what items are included in the code?

Insertion & removal of tube (drainage) and/or gauze, and any required sutures and/or anesthesia. If supplies are used over and above the normal procedure code, these should be coded with 99070 (medicine code for supplies).

Nose biopsy codes in the Respiratory subsection are used for what type of procedure

Intranasal (inside the nose) if external used code from Integumentary system.

Codes for excision or destruction of lesions inside the nose are divided how?

By approach, internal or external. All methods of lesion destruction (including laser), are included in the Excision codes. Of bilateral use modifier -50

Bones on the inside of the nose

Turbinates

Three sections of the turbinate bones

Inferior, middle, and superior. May be removed for cosmetic reasons. Must document the medical necessity for non-cosmetic procedures to ensure payment.

Introduction codes are used for what purpose?

INJECTION (therapeutic, used to shrink nasal tissue to improve breathing), DISPLACEMENT THERAPY (saline solution flushed into the sinuses to remove mucus or pus), INSERTION (i.e. nasal button to repair a hole in the septum-deviated septum- w/out grafting)

Where would you find plastic surgery procedures in the Respiratory Subsection?

In the Repair category (rhinoplasty, septoplasty, and septal dermoplasty)

Procedure used to reshape the nose internally, externally, or both.

RHINOPLASTY-codes are divided based on the extent (minor, intermediate, major), on whether the septum was also repaired (septoplasty), and on whether the procedure was an initial or secondary (done after an initial) procedure.

Procedure name for rearrangement of the nasal septum

Septoplasty - commonly performed on patient with deviated septum

Nasal Destruction codes are used for what purpose?

Remove excess nasal mucosa or to reduce inflammation. Uses either ABLATION (cutting removal ) or CAUTERIZATION. Codes are divided based on the extent of the procedure (Intramural or Superficial)

Difference between Intramural and Superficial

INTRAMURAL (ablation or cauterization of the deeper mucosa). SUPERFICIAL (ablation or cauterization which involved only the outer layer of mucosa)

Other Procedure codes are used for what purpose?

Nasal hemorrhage (codes are divided according to the type and extent of control required) and therapeutic fractures (fracture and repositioning of nasal turbinate bone, used to alleviate obstructed airflow caused by a previous fracture that has healed out of alignment & resulted in deviation of nose).

Lavage (washing of an organ) codes for the sinus are found in what Respiratory category?

INCISION- washed with a saline solution introduced using a hollow tube called a CANULA to remove infection. LAVAGE can be done to maxillary and sphenoid sinuses.

Procedure in which the physician enlarges the passage or creates a new passage from the nasal cavity into a sinus.

Sinusotomy-used when patient has chronic sinus infections, codes are divided according to extent of the procedure.

Incision made over the larynx to expose the larynx to view

Laryngotomy - performed alone as a diagnostic procedure or in conjunction with a surgical procedure (thyrotomy).

Codes from the laryngotomy category with the tracheostomy codes in the Trachea and Bronchi/Incision category differ how?

Depending on the purpose of the procedure. Laryngotomy is used when surgeon performs a thyrotomy for purpose of exposing the larynx. Codes in Trachea and Bronchi /Incision category are used when surgeon performs only a tracheostomy, usually to establish airflow with no procedure or exposure to the larynx planned or involved.

Establishment of an airway in a patient is called what?

Intubation

Most common procedure in the Trachea and Bronchi Incision category

Tracheostomy-can be planned (done when need for prolonged ventilation support beyond level of support provided by endotracheal intubation or patient cannot tolerate intubation) or performed as an emergency.

Difference between emergency transtracheal and cricothyroid tracheostomy

Represent 2 different approaches to establishing an airway. TRANSTRACHEAL - transverse (across or horizontal) incision. CRICOTHYROID - vertical incision to access the trachea.

Trachea and Bronchi/Introduction codes are used for what purpose?

Catheterization, instillation, injection, and aspiration of the trachea and placement of tubes in the trachea.

Tracheoplasty

Surgical repair of a damaged trachea

Bronchoplasty

Repair of the bronchus, may use grafting repair or stents. Chest tube used after the procedure to drain is not reported separately. Grafting is included in the code.

Thoracotomy

Procedure of making incision into the chest wall & opening area to view of the surgeon. Major surgery using general anesthesia. If chest tube inserted for drainage, placement of tube is bundled into the surgical procedure.

Thoracocentesis

Used to withdraw fluid from the pleural space accumulated as a result of conditions such as congestive heart failure, pneumonia, tuberculosis, or carcinoma. Can also be done to insert a chest tube to drain fluid from the pleural space.

Pleurectomy

Chest cavity is open to full view and parietal pleura is removed. If done as part of another more major procedure, would not report the pleurectomy separately.

Pneumonocentisis

Withdrawal of fluid from the lung by means of an aspirating needle.

Pneumothorax

Air or gas in the pleural cavity, caused by trauma or rupture.

Codes for removal of a lung are based on what?

How much of the lung removed. SEGMENTARY (1 segment), LOBECTOMY (1 lobe), BILOBECTOMY (2 lobes, total PNEUMONECTOMY (entire lung). Also based on the extent of procedure and approach.

Thoracoplasty

Portion if internal skeletal support is removed, major surgery. Stages after code are for removal of the packing.

Pneumonolysis

Performed to separate the inside of the chest cavity from the lung to permit the collapse of the lung.

Pneumothorax injection

Therapeutic procedure, air injected in the pleural cavity used sometimes to treat tuberculosis. Chest tube may be used and is not reported separately.

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