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NEW QUESTION # 451
A patient has chronic cholesteatoma in the right middle ear. The otolaryngologist performed a tympanoplasty with a radical mastoidectomy, removing the middle ear cholesteatoma. Grafting technique was used to repair the eardrum without ossicular chain reconstruction.
What CPT code is reported for this surgery?
Answer: C
Explanation:
The procedure involves a tympanoplasty with a radical mastoidectomy and removal of a cholesteatoma from the middle ear, including grafting of the eardrum without ossicular chain reconstruction.
* Procedure Description:
* Tympanoplasty.
* Radical mastoidectomy.
* Removal of cholesteatoma from the middle ear.
* Grafting technique used to repair the eardrum without ossicular chain reconstruction.
* CPT Coding:
* 69645: Tympanoplasty with mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), radical or complete, with removal of cholesteatoma; with mastoid obliteration.
References:
* AMA's CPT Professional Edition (current year).
* CPT Assistant for detailed coding guidelines on otolaryngology procedures.
NEW QUESTION # 452
A 6-French sheath and catheter is placed into the coronary artery and is advanced to the left side of the heart into the ventricle. Ventriculography is performed using power injection of contrast agent. Pressures in the left heart are obtained. The coronary arteries are also selected and imaged.
What CPT code is reported?
Answer: D
NEW QUESTION # 453
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?
Answer: B
Explanation:
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.
CPT Professional Edition, AMA
NEW QUESTION # 454
Where is a Warthin's tumor found?
Answer: C
Explanation:
Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign tumor of the salivary glands, most commonly affecting the parotid gland. It typically presents as a painless, slow-growing mass near the angle of the jaw.
ICD-10-CM, medical dictionaries, and oncology textbooks
NEW QUESTION # 455
A patient had surgery a year ago to repair two extensor tendons in his wrist. He is in surgery for a secondary repair for the same two tendons with free graft. What CPT coding is reported?
Answer: B
Explanation:
1. Procedure Type: This scenario describes a secondary repair of two extensor tendons in the wrist with a free graft. According to CPT coding guidelines, the secondary repair with a free graft suggests a more complex repair than primary closure.
2. CPT Code Selection:
Code 25270 is used for a primary repair of an extensor tendon in the forearm or wrist. Since this is a secondary repair, 25270 does not apply, ruling out options A and C.
Code 25272 represents the repair of a single extensor tendon in the forearm or wrist, which includes both primary and secondary repairs. However, it does not involve free grafts, ruling out option D.
Code 25274 specifically addresses the secondary repair of an extensor tendon with free graft in the forearm or wrist, which is the correct scenario described in the question.
3. Applying the Code for Multiple Tendons:
Since the procedure involves two tendons, 25274 should be reported twice (25274 x 2) to account for the secondary repair on each tendon individually.
4. Reference from AAPC CPC Guidelines:
In AAPC CPC and CPT coding principles, tendon repair codes require careful distinction between primary repairs and secondary repairs with grafts. The guidelines specify that multiple tendons should be coded with individual codes when performed on separate anatomical structures, hence the use of 25274 twice for both tendons.
Therefore, the verified and precise answer based on CPT guidelines and AAPC coding standards is B. 25274 x 2.
NEW QUESTION # 456
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