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問題 #237
A 60-year-old male has three-vessel disease and supraventricular tachycardia which has been refractory to other management. He previously had pacemaker placement and stenting of LAD coronary artery stenosis, which has failed to solve the problem. He will undergo CABG with autologous saphenous vein and an extensive modified MAZE procedure to treat the tachycardia.
He is brought to the cardiac OR and placed in the supine position on the OR table. He is prepped and draped, and adequate endotracheal anesthesia is assured. A median sternotomy incision is made and cardiopulmonary bypass is initiated. The endoscope is used to harvest an adequate length of saphenous vein from his left leg.
This is uneventful and bleeding is easily controlled. The vein graft is prepared and cut to the appropriate lengths for anastomosis. Two bypasses are performed: one to the circumflex and another to the obtuse marginal. The left internal mammary is then freed up and it is anastomosed to the ramus, the first diagonal, and the LAD. An extensive maze procedure is then performed and the patient is weaned from bypass. At this point, the sternum is closed with wires and the skin is reapproximated with staples. The patient tolerated the procedure without difficulty and was taken to the PACU.
Choose the procedure codes for this surgery.
答案:A
解題說明:
The CABG procedure involved multiple bypasses, with the use of autologous saphenous vein grafts and the left internal mammary artery, along with an extensive modified MAZE procedure. CPTcode 33535 describes a coronary artery bypass using arterial grafts, including at least three coronary artery bypasses.
CPTcode 33259-51 is for the MAZE procedure for supraventricular tachycardia, with the -51 modifier indicating multiple procedures. CPTcode 33519-51 is for an additional vein graft, and CPTcode 33508-
51 describes the endoscopic harvesting of the vein.
References:
* AMA's CPTProfessional Edition (current year), Codes 33535, 33259-51, 33519-51, 33508-51
問題 #238
A 45-year-old has a dislocated patella in the left knee after a car accident. She taken to the hospital by EMS for surgical treatment. In the surgery suite, the patient is placed under general anesthesia. After being prepped and draped, the surgeon makes an incision above the knee joint in front of the patella. Dissection is carried through soft tissue and reaching the patella in attempt to reduce the dislocation. When the patella is exposed, it is severely damaged due to cartilage breakdown. The tendon is dissected and using a saw the entire patella is freed and removed. The tendon sheath is closed with sutures.
What procedure code is reported for this surgery?
答案:C
解題說明:
CPT code 27566 involves excision of the patella. Given the surgical description provided, this code is appropriate as the patella was severely damaged and removed entirely.
* Patient's Condition: Dislocated patella with cartilage breakdown and severe damage.
* Surgical Procedure: The surgeon made an incision, dissected through soft tissue, exposed, and completely removed the patella.
* Coding Decision: CPT 27566 is chosen because it specifies excision of the patella. The modifier LT indicates the procedure was performed on the left side.
References:
* AMA's CPT Professional Edition (current year).
* ICD-10-CM for corresponding diagnosis codes if needed.
問題 #239
A 42-year-old male is diagnosed with a left renal mass. Patient is placed under general anesthesia and in prone position. A periumbilical incision is made and a trocar inserted. A laparoscope is inserted and advanced to the operative site. The left kidney is removed, along with part of the left ureter. What CPT code is reported for this procedure?
答案:A
解題說明:
* Laparoscopic nephrectomy: A minimally invasive surgical procedure to remove a kidney.
* Part of the ureter: Removal includes part of the ureter.
* 50220: Nephrectomy (open procedure), which doesn't apply since the procedure was laparoscopic.
* 50548: Nephrectomy, partial, laparoscopic, which doesn't match the full nephrectomy performed.
* 50543: Laparoscopy, surgical; nephrectomy with total ureterectomy.
50543 is the correct CPT code for the laparoscopic removal of the kidney along with part of the ureter, fitting the scenario described.
References:
* AMA's CPT Professional Edition (current year)
* ICD-10-CM (current year), HCPCS Level II (current year)
問題 #240
View MR 099405
MR 099405
CC: Shortness of breath
HPI: 16-year-old female comes into the ED for shortness of breath for the last two days. She is an asthmatic.
Current medications being used to treat symptoms is Advair, which is not working and breathing is getting worse. Does not feel that Advair has been helping. Patient tried Albuterol for persistent coughing, is not helping. Coughing 10-15 minutes at a time. Patient has used the Albuterol 3x in the last 16 hrs. ED physician admits her to observation status.
ROS: No fever, no headache. No purulent discharge from the eyes. No earache. No nasal discharge or sore throat. No swollen glands in the neck. No palpitations. Dyspnea and cough. Some chest pain. No nausea or vomiting. No abdominal pain, diarrhea, or constipation.
PMH: Asthma
SH: Lives with both parents.
FH: Family hx of asthma, paternal side
ALLERGIES: PCN-200 CAPS. Allergies have been reviewed with child's family and no changes reported.
PE: General appearance: normal, alert. Talks in sentences. Pink lips and cheeks. Oriented. Well developed.
Well nourished. Well hydrated.
Eyes: normal. External eye: no hyperemia of the conjunctiva. No discharge from the conjunctiva Ears: general/bilateral. TM: normal. Nose: rhinorrhea. Pharynx/Oropharynx: normal. Neck: normal.
Lymph nodes: normal.
Lungs: before Albuterol neb, mode air entry b/l. No rales, rhonchi or wheezes. After Albuterol neb.
improvement of air entry b/l. Respiratory movements were normal. No intercostals inspiratory retraction was observed.
Cardiovascular system: normal. Heart rate and rhythm normal. Heart sounds normal. No murmurs were heard.
GI: abdomen normal with no tenderness or masses. Normal bowel sounds. No hepatosplenomegaly Skin: normal warm and dry. Pink well perfused Musculoskeletal system patient indicates lower to mid back pain when she lies down on her back and when she rolls over. No CVA tenderness.
Assessment: Asthma, acute exacerbation
Plan: Will keep her in observation overnight. Will administer oral steroids and breathing treatment. CXR ordered and to be taken in the morning.
What E/M code is reported?
答案:D
解題說明:
* 99222: This code is used for initial hospital care, per day, for the evaluation and management of a patient, which requires a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making of moderate complexity.
* The documentation shows a detailed history (including HPI, ROS, PMH, SH, and FH) and a detailed examination (covering multiple organ systems). The medical decision making involves the management of an acute asthma exacerbation, which includes admitting the patient to observation status, administering oral steroids, and planning for further diagnostic testing.
References:
* CPT Professional Edition, AMA
問題 #241
A patient with malignant lymphoma is administered the antineoplastic drug Rituximab 800 mg and then 100 mg of Benadryl.
Which HCPCS Level II codes are reported for both drugs administered intravenously?
答案:B
解題說明:
The patient with malignant lymphoma is administered Rituximab (800 mg) and Benadryl (100 mg) intravenously.
Procedure Description:
Administration of Rituximab (800 mg) intravenously.
Administration of Benadryl (100 mg) intravenously.
HCPCS Level II Coding:
J9312: Injection, Rituximab, 10 mg.
For 800 mg, report 80 units of J9312.
J1200: Injection, Diphenhydramine HCl, up to 50 mg.
For 100 mg, report 2 units of J1200.
HCPCS Level II Code Book (current year).
HCPCS Level II coding guidelines for intravenous drug administration.
問題 #242
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