37 terms

CPT coding module 5

True or false:
A chest tube may be used as an indwelling method of draining the accumulated fluid in the pleural space.
True or false:
Thoracoplasty is a procedure that is performed to separate the inside of the chest cavity from the lung to permit the collapse of the lung.
true or false:
All "sinus" codes are reported as bilateral procedures only.
true or false:
When multiple therapeutic procedures are performed through a scope during the same operative session, only the major (most extensive) procedure should be reported.
true or false:
A "direct" laryngoscopic procedure means that the physician uses a tongue depressor to hold the tongue down and view the epiglottis with a mirror.
true or false:
A surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy.
Endoscopic procedures are reported on the ____ place(s) to which the scope is advanced.
A diagnostic endoscopic procedure is reported only when:
no surgical procedure is performed during the same operative session
Because most third-party payers do not pay for cosmetic surgery, the physician must carefully document ____ to ensure reimbursement for noncosmetic procedures.
medical neccesity
What is the method that a physician uses to control a nosebleed?
all of the above
If the physician performs a lavage of the maxillary sinus, what is he/she doing?
washing the maxillary sinus
Thoracentesis is performed to withdraw fluid from the pleural space for a variety of conditions including:
respiratory failure
Select the term that describes a procedure in which a scope is placed into a body cavity.
Which of the following terms does not describe the nasal turbinates?
The procedure in which a scope is passed into the larynx so the physician can look at the larynx is what type of laryngoscopy?
In what Surgery subsection would you find the code for the incision and drainage of a nasal abscess using an external approach to the abscess?
Integumentary System
The name of the procedure in which mucus is removed from the sinuses by flushing a saline solution through the sinus cavities is ____. For example, the Proetz procedure (saline irrigation combined with suction).
This surgical procedure is performed to reshape the nose.
What is the name of the surgical procedure for the rearrangement of the nasal septum?
The term that describes destruction by removing, usually by cutting, is:
The term that describes obtaining a tissue sample is:
Which modifier would you use if polyps were removed from both the left and the right sides of the nose?
The physician views the trachea using a bronchoscope placed through an established tracheostomy. The physician examines the conducting airways. The bronchoscope is removed.
CPT Code: ____________________
Simple excision of a nasal polyp.
CPT Code: ____________________
A 14-year-old boy presents at the Emergency Department experiencing an uncontrolled anterior nosebleed. The ED physician packs his nose with gauze and within 10 minutes the nosebleed stops.
CPT Code: ____________________
Three-year-old Hannah is playing with a marble and sticks it in her nose. Her mother is unable to dislodge the marble so she takes Hannah to the physician's office. The physician removes the marble with hemostats.
CPT Code: ____________________
A physician performs an emergency transtracheal tracheostomy to remove a foreign object.
CPT Code: ____________________
The physician removes fluid from the chest cavity by puncturing through the space between the ribs. Using an aspirating needle attached to a syringe, the physician carefully passes the needle over the top of a rib, punctures through the chest tissues, and enters the pleural cavity. With the end of the needle in the chest cavity, the physician withdraws the fluid from the chest cavity by pulling back on the plunger of the syringe.
CPT Code: ____________________
Endoscopic segmental lobectomy.
CPT Code: ____________________
Endoscopic biopsy of the lung.
CPT Code: ____________________
Bronchoscopy with placement of catheter for intracavitary radioelement application.
CPT Code: ____________________
Reshaping of the nasal septum to correct airway obstruction.
CPT Code: ____________________
The physician uses an endoscope for a diagnostic evaluation of the nose. A polyp is identified and removed using forceps.
CPT Code: ____________________
The physician uses an endoscope for surgical access to decompress the optic nerve in the posterior orbit.
CPT Code: ____________________
Location: Inpatient Hospital


INDICATION: Cardiogenic shock and the need to initiate mechanical ventilation.


ANESTHESIA: Versed and fentanyl.

PROCEDURE: After the procedure was explained and consent was obtained from the patient's family, the patient was prepped for an endotracheal intubation. The patient was premedicated with Versed and fentanyl. After adequate anesthesia and analgesia was achieved, the patient's vocal cords were directly visualized with the aid of a laryngoscope using a Miller 3 blade. A size 8.5 endotracheal tube was then inserted and passed through the vocal cords atraumatically and without any difficulty. The CO2 monitor did confirm correct placement of the tube. The cuff was then inflated and the tube secured around 22 cm at the lips.

The patient tolerated the procedure well. There were no acute complications. A chest x-ray had been ordered to confirm correct placement of the endotracheal tube.

CPT Code: ____________________
Location: Outpatient Hospital


INDICATION FOR THE PROCEDURE: Patient with chronic emphysema and chronic obstructive pulmonary disease, and a significant smoking history.

PROCEDURE: Bronchoscopy procedure

PREPROCEDURE MEDICATIONS were given: Atropine 0.5 mg and codeine 60 mg intramuscularly, and then also hydroxyzine. Topical anesthesia was applied with cocaine mix along with the Lidocaine topically into the throat. He was lying supine in the fluoroscope unit and with video monitoring, the bronchoscope was introduced through the nose and into the upper airway. The vocal cords were visualized. There were no endobronchial lesions noted. The vocal cords were moving equally with phonation and respiration. The bronchoscope was introduced through the vocal cords and negotiated into the trachea; the left upper lingula and lower lobe branches were visualized. No endobronchial lesions were noted. The right main, middle, lower, and upper lobe bronchi up to subsegmental branches were visualized; no endobronchial lesions were noted either. The procedure was uneventful. He did not have any significant cough during the procedure.

CPT Code: ____________________
Location: Outpatient Hospital





OPERATIVE NOTE: The patient was admitted through same day surgery department and taken to the operating room and was administered general anesthetic by intravenous injection and was intubated endotracheally. His nose was decongested with 4 cc of 4% cocaine solution on nasal pledgets. A small amount of Afrin was also used. The patient was draped in the usual fashion. The packing was then removed and the left septum was injected with 1% lidocaine with epinephrine. A left hemitransfixion incision was created with a Beaver blade and a mucoperichondrial flap was elevated on this side; this was extended posteriorly over the perpendicular plate of ethmoid and vomer, extended inferiorly over a septal spur. We then separated the bony and cartilaginous septum to elevate it on the opposite side. We elevated on either side of the maxillary crest. A 4-mm osteotome was used to remove this. A portion of inferior cartilage was also removed. Once this was completed we laid the mucosa back into position and the septum was nicely reduced. We closed the caudal hemitransfixion incision with interrupted 3-0 Chromic suture. The septum was closed with 4-0 plain gut suture. Doyle splints were then placed on either side of the nose. The patient was then allowed to recover from the anesthetic and taken to the postanesthesia care unit in stable condition. There were no complications during this procedure.

CPT Code: ____________________