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NEW QUESTION # 127
View MR 005398
MR 005398
Operative Report
Preoperative Diagnosis: Nonfunctioning right kidney with ureteral stricture.
Postoperative Diagnosis: Nonfunctioning right kidney with ureteral stricture.
Procedure: Right nephrectomy with partial ureterectomy.
Findings and Procedure: Under satisfactory general anesthesia, the patient was placed in the right flank position. Right flank and abdomen were prepared and draped out of the sterile field. Skin incision was made between the 11th and 12th ribs laterally. The incision was carried down through the underlying subcutaneous tissues, muscles, and fascia. The right retroperitoneal space was entered. Using blunt and sharp dissection, the right kidney was freed circumferentially. The right artery, vein, and ureter were identified. The ureter was dissected downward where it is completely obstructed in its distal extent. The ureter was clipped and divided distally. The right renal artery was then isolated and divided between 0 silk suture ligatures. The right renal vein was also ligated with suture ligatures and 0 silk ties. The right kidney and ureter were then submitted for pathologic evaluation. The operative field was inspected, and there was no residual bleeding noted, and then it was carefully irrigated with sterile water. Wound closure was then undertaken using 0 Vicryl for the fascial layers, 0 Vicryl for the muscular layers, 2-0 chromic for subcutaneous tissue, and clips for the skin. A Penrose drain was brought out through the dependent aspect of the incision. The patient lost minimal blood and tolerated the procedure well.
What CPT coding is reported for this case?
Answer: A
Explanation:
The procedure involves a right nephrectomy with partial ureterectomy for a nonfunctioning right kidney with ureteral stricture.
Procedure Description:
Right nephrectomy (removal of the kidney).
Partial ureterectomy (removal of part of the ureter).
CPT Coding:
50220: Nephrectomy, including partial ureterectomy, any open approach.
AMA's CPT Professional Edition (current year).
CPT Assistant for detailed coding guidelines on nephrectomy procedures.
NEW QUESTION # 128
Mrs. Wilder presents with right and left leg swelling. Venous thrombosis imaging of each leg is done and shows deep venous embolism and thrombosis in each leg.
What CPTand ICD-10-CM codes are reported?
Answer: B
Explanation:
1. Procedure and CPTCode Selection:
The patient underwent venous thrombosis imaging of each leg to assess for deep venous thrombosis (DVT).
CPTCode 78457 is used for a venous thrombosis imaging study. This code is appropriate for imaging to detect DVT.
Modifier 50 is applied to indicate a bilateral procedure, as imaging was performed on both legs.
2. Diagnosis and ICD-10-CM Code Selection:
ICD-10-CM Code I82.403 is used for acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities. This code accurately describes the finding of DVT in both legs.
Other ICD-10-CM options, such as I82.401 and I82.402, specify unilateral lower extremity involvement, which does not accurately reflect the bilateral findings in this case.
3. Rationale for Excluding Other Options:
Code 78458 (in options A and D) is for a more comprehensive study, often cardiac or whole-body blood pool imaging, and is not specific to leg venous thrombosis.
Option C, which lists 78457 with individual RT and LT modifiers, is incorrect as Modifier 50 is appropriate for bilateral imaging on both legs.
4. AAPC and CPTCoding Guidelines:
According to AAPC and CPTguidelines, 78457 with Modifier 50 should be used for bilateral venous imaging studies, and I82.403 correctly captures bilateral DVT.
Thus, the correct answer is B. 78457-50, I82.403.
NEW QUESTION # 129
An inpatient, suffering from hypertension and chronic kidney disease, is administered continuous venovenous hemofiltration. The on-duty nephrologist performs a series repeated low-level evaluation and management services to monitor the patient's status.
What is the CPT and ICD-10-CM coding'
Answer: A
Explanation:
Procedure Code:
90945 - Continuous renal replacement therapy (CRRT), daily
Includes repeated low-level E/M monitoring
Correct for CVVH
Diagnosis Codes:
I10 - Essential hypertension
N18.9 - Chronic kidney disease, unspecified
Why others are incorrect:
90935 / 90937 - Intermittent hemodialysis
90947 - Pediatric CRRT
ICD-9 codes (112.9, 110) are invalid
NEW QUESTION # 130
From a left femoral access, the catheter is placed within the proper hepatic artery, dye is injected, and imaging is obtained. A stenosis within this artery is identified. A percutaneous transluminal angioplasty is performed on the proper hepatic (visceral) artery in the outpatient radiology department.
What CPTcoding is reported?
Answer: A
Explanation:
1. Procedure Details and CPTCode Selection:
The patient underwent a catheter placement in the proper hepatic artery (a visceral artery), followed by dye injection and imaging to identify a stenosis, and finally a percutaneous transluminal angioplasty of the artery.
Code 36247 is appropriate for selective catheter placement in the third-order or more selective branch of a visceral artery. Since the proper hepatic artery is a selective branch accessed from the left femoral artery, this code accurately describes the catheter placement.
Code 75736 is for angiography of a selective visceral artery following catheter placement, which matches the imaging procedure performed here.
Code 37248 describes a percutaneous transluminal angioplasty of a visceral artery, which is the therapeutic intervention performed to treat the stenosis in the proper hepatic artery.
2. Modifiers:
Modifier 26 is used with 75736 to denote the professional component of the imaging service.
Modifier 59 indicates that the imaging (75736) is a distinct procedural service, separate from the therapeutic angioplasty (37248).
Modifier 51 is applied to 37248 to indicate it was a secondary procedure in addition to the diagnostic imaging and catheter placement.
3. Exclusion of Other Options:
Code 36253 (in choices A and D) is for selective catheter placement in a different vessel and does not apply to the hepatic artery.
Code 75726 is for non-selective abdominal aortography, which does not match the specific selective imaging of the hepatic artery.
4. AAPC and CPTCoding Guidelines:
According to AAPC guidelines, each step in an angiographic and interventional radiology procedure is coded based on the level of vessel accessed, imaging performed, and therapeutic intervention completed, which is all accurately represented by 36247, 75736-26-59, and 37248-51.
Based on CPTand AAPC coding guidelines, the correct answer is C. 36247, 75736-26-59, 37248-51.
You said:
NEW QUESTION # 131
A pediatrician removes impacted cerumen using irrigation in the right ear and instrumentation in the left ear.
What CPT coding is reported?
Answer: A
Explanation:
69209 = Cerumen removal using irrigation
69210 = Cerumen removal using instrumentation
Different techniques on different ears require separate codes with laterality modifiers
NEW QUESTION # 132
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