cpt surgery V exam

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Tarrant County College, Fort Worth *

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2346

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Medicine

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Oct 30, 2023

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1.Which of the following modifiers would be appended to a CPT code for repair of the right upper eyelid? E3 2.The correct code assignment for an extracapsular cataract extraction with insertion of lens, OS is 66984-LT. CPT code 69610 (tympanic membrane repair) is considered to be unilateral. 3. The patient had a total abdominal hysterectomy with bilateral salpingectomy. The coder selected the following codes 58150 and 58700. The assignment of these two codes together would be referred to as: Unbundling 4. What is the correct code assignment for a cervical conization with loop electrical excision? 57522 5. What is the correct CPT code assignment for hysteroscopy with lysis of intrauterine adhesions? 58559 6. The physician performs an exploratory laparotomy with bilateral salpingo- oophorectomy. What is the correct CPT code assignment for this procedure? 58720 7. A physician documented the following surgical procedure for treatment of chronic otitis media: "Myringotomy with insertion of ventilating tubes in both ears. Performed under general anesthesia." What is the correct CPT code assignment for this procedure? 69436-50 8.The patient has a diagnosis of benign prostatic hypertrophy. With the use of AquaBeam water ablation therapy, the enlarged prostate tissue was removed. 53854 9. Operative Report Preoperative Diagnosis: Abnormal uterine bleeding Postoperative Diagnosis: Same Procedure: Diagnostic hysteroscopy with D&C There was an approximately 8-mm polyp of the cervix. The remainder of the endocervix was unremarkable. Uterine cavity was somewhat difficult to visualize but no obvious abnormalities. Minimal tissue on D&C. Patient was taken to the OR with an IV in place, received general anesthesia and was placed on the operating table in semi- dorsolithotomy position with her legs held by staff. She was then prepped and draped. Pelvic exam was performed. Weighted speculum was placed and single tooth tenaculum placed anteriorly on the cervix. Visualization was good. Diagnostic hysteroscopy was introduced into the endocervix on direct visualization and into the intrauterine cavity. The above findings were noted with no obvious pathology. This was withdrawn and cervix dilated to #8 Hagar. Sharp uterine curette was introduced and the uterine cavity systematically curetted with minimal amount of tissue. Bleeding was negligible and procedure was terminated. Patient tolerated the procedure well and was taken to the recovery room in good condition. Estimated blood loss 15 cc. 58558 10.Operative Report Preoperative Diagnosis: Laceration of nerve and tendon, left 5th digit Postoperative Diagnosis: Ulnar nerve laceration, no tendon laceration, left 5th digit Operation: Repair of ulnar nerve Procedure: The patient was brought into the operating

room and prepared and draped in the usual sterile manner. A tourniquet was used and inflated to approximately 250 mm of mercury after exsanguination of the hand. Tendons were noted to be completely intact. The nerve was then isolated in both proximal and distal ends and with the use of an operating microscope 9-0 sutures were placed in the epineurium, six through and through sutures placed. When this was finished the nerve was checked for congruity. It should be stated that the nerve was trimmed and the fascicles were lined up end to end as best as possible. After this, copious irrigation was undertaken and bleeders were cauterized. The skin was then closed with 5-0 nylon and a sterile dressing was applied. The tourniquet was let down and a clam digger splint with a rubber band through the nail was placed to ensure range of motion. The patient was discharged to recovery room without complications and there was approximately 15 cc blood loss. No blood replacement. 400 cc of Ringers lactate was used in the case. 64836-F4, 69990 11.Operative Report Preoperative Diagnosis: Right hydrocele Postoperative Diagnosis: Right spermatocele Operation: Right spermatocelectomy Indications for Procedure: This 54-year-old male has a history of right-sided scrotal enlargement. Scrotal ultrasound preoperatively was consistent with right hydrocele. Operation: The patient was brought to the operative suite, placed in supine position and general anesthesia was administered. His scrotum was shaved. He was then sterilely prepped and draped in the usual manner. A transverse incision across the right hemiscrotum was then made approximately 3.5 cm in length using electrocautery to further dissect this area. The right-sided fluid sac was then exuded from the right hemiscrotum. It seems to be a right spermatocele. Using meticulous care and caution, the spermatocele was divided from the testicle and the vas deferens was identified. There as a moderate degree of difficulty as the spermatocele had separated the epididymis from the patient's right testicle. So using meticulous care, this was divided free from his spermatocele. The spermatocele was handed off intact to the scrubbed personnel. Hemostasis was achieved. The epididymis was then re-attached to the testicle. The testicle was then replaced into the right hemiscrotum. The wound was closed using a #2-0 locking running chromic stitch and the superficial skin was closed in a horizontal mattress fashion. Patient tolerated the procedure well and was sent to recovery in satisfactory condition. Pathology Report: spermatocele 54840 12 Operative Report Preoperative Diagnosis: History of recurrent foreskin infection Postoperative Diagnosis: Same Procedure: Circumcision Indications: The patient has had some evidence of recurrent foreskin infection and his wife has had recurrent infections and her gynecologist recommended that Mr. K. undergo circumcision. The patient presented at this time to complete that recommendation. Procedure: The patient was taken to the Operating Room and placed in supine position. General anesthetic was initiated. After good anesthesia was achieved the patient's penis was prepped and draped in the appropriate fashion. A straight hemostat was used to crush the foreskin on the dorsal aspect first. After it had been placed for a period of time the hemostat was released and the crushed segment was then divided. A similar action was performed on the ventral side. This was done down to the desired site of the circumcision. Then a #3-

0 chromic suture was placed on the dorsum ventral side connecting the cut ends of tissue. Curved hemostats were used circumferentially around the penis on the right side to the desired length of circumcision. After the tissue was crushed it was divided and then the excess foreskin was removed. Good hemostasis was achieved using the Bovie and the remaining cut ends of the tissue were reapproximated using interrupted #3-0 chromic suture. Similar action was done on the left side. Remaining cut edges of the tissue were reapproximated using interrupted #3-0 chromic sutures. Vaseline gauze was placed at the suture line followed by dry gauze. The patient tolerated the procedure well. There were no complications. The patient left the Operating Room in stable condition. Follow up: The patient will follow up in my office in 7 to 10 days. He was given a prescription for Darvocet N 100 mg. 54150-52 13. Operative Report. Diagnosis: Desires sterilization. Procedure: tubal banding. Scope was inserted, abdomen explored and tubes were identified bilaterally and banded with Silastic bands. Good ischemic at close of procedure. Abdomen deflated of gas and instruments removed. CPT Codes: 58615 occlusion of fallopian tubes by device. 58671 laparoscopy with occlusion of oviducts by device. 58671 14. Patient with menorrhagia had a laparoscopic lysis of adhesions of fallopian tube and excision of benign tumor of ovary. (58662) 15. Patient is being treated for a spontaneous abortion and the physician performs a D&C. 59812 A patient diagnosed with an ectopic pregnancy undergoes laparoscopic treatment of this condition that also requires removal of the fallopian tube. Report code _____. 59151 Left tympanostomy with insertion of a ventilating tube, under local anesthesia. Report code _____. 69433-LT Transabdominal biopsy, left adrenal gland, via open approach. Report code _____. 60540-LT Photocoagulation destruction of corneal lesion, right eye. Report code _____. 65450-RT Radiofrequency thermotherapy to treat benign prostate hypertrophy (BPH). Report code ____. 53852 Clamp circumcision of a 2-day-old infant. Report code _____. 54150 Reduction of two fetuses, with three fetuses left intact. Report code _____. 59866 Patient underwent placement of needles into his penis for subsequent interstitial radioelement application.

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55920 A patient underwent decompression of the spinal cord and nerve roots via transpedicular approach for herniated intervertebral disk, T1, T2, and T3. The patient tolerated the procedure well. Report code(s) _____. 63055, 63057, 63057 A patient diagnosed with meningioma undergoes posterior fossa craniectomy to remove the tumor. Report code _____. 61519 A child has a small metal toy lodged in her right ear. After multiple unsuccessful attempts are made to remove the object, the patient is taken to the ambulatory unit for removal. After discussion with the patient's parents, an informed consent is signed. The patient undergoes removal of the object, which is performed in the operating room after administration of general anesthesia. Report code _____. 69205-RT Complete removal of thyroid gland with radical neck dissection due to thyroid cancer. Report code _____. 60254 Carl is a 6-year-old male who is admitted to the ambulatory surgical unit of a local hospital on May 4 and who undergoes removal of bilateral ventilating tubes. Dr. White had inserted the tubes in November of the previous year. Dr. White removed them after administering general anesthesia to the patient. Report code(s) _____. 69424-50 Initial subdural tap of skull suture of a 15 day old infant. The operating microscope was used during the procedure. 61000, 69990 Removal of foreign body from the left external auditory canal, under general anesthesia. Report code 69205-LT A 75-year-old female diagnosed with a cataract in the right eye undergoes ECCE one- stage procedure to correct this problem. Report code(s) _____ 66984-RT Simple voiding pressure study with calibrated electronic equipment. Report code _____ 51728 Repair of meningocele, 4-cm diameter in newborn weighing 3 kilograms. Assign the CPT code. 63700 Three nerve grafts (includes obtaining graft), single strand, hand, 5 cm in length. Assign the CPT codes. 64891, 64901, 64901 Removal of previously implanted intrathecal catheter. Assign the CPT code. 62355 Staged intersex surgery, female to male. 55980-58 31. Plastic repair of the ________is surgical repair of the opening to the vagina. Colpotomy

32. An incision into the vagina to gain access to the pelvic cavity is _______. Colpocentesis 33. The insertion of a long needle into the back wall of the vagina to gain access to a peritoneal cul de sac abscess is _________________ _ Pessary 34. A vaginal support device is a(n) ________ False 35. When reporting the service of the introduction of a diaphragm, the cost of the diaphragm is included in the introduction. True or False? _________ Colporrhaphy 36. The term that describes the procedure in which the surgeon strengthens the wall of the weakened vagina by pulling together the weakened vaginal area with sutures is: ______ Colposcope 37. The microscope that is used to view the vagina is a(n) ________ General 38. The services described in the Manipulation category of the Vagina subheading require this type of anesthesia: Loop electrode excision procedure 39. LEEP means _____________ Sampling 40. Endometrial ___________ is a biopsy of the mucous lining of the uterus. Hysterectomy 41. What one procedure represents the majority of the codes in the Corpus Uteri subheading? True 42. Hydatidiform mole, also known as a "molar pregnancy," results from genetic abnormalities. True or False? _________ Radiology 43. A hysterosalpingography would have a component code from what section of the CPT manual? _________________ Diagnostic 44. The first rule of a laparoscopy is that a surgical laparoscopy always includes this type of laparoscopy: Oviduct/ovary 45. In what subheading would you find the codes to report fallopian tube services? Transection, occlusion 46. The three methods of tubal ligation are ligation, ______________________ and _________________. Trimesters 47. Gestation is divided into three time periods that are termed __________ 14, 14, 28, 28

48. The first gestation time period is LMP to less than _______________ weeks 0 days, the second is _____________ weeks 0 days to less than _____ weeks 0 days, and the third is ______________ weeks 0 days until delivery. Estimated date of delivery 49. What does EDD stand for? ___________ _____________ of ____________. Ripening 50. Preparation of the cervix for birth or dilation is termed cervical ____________ E/M 51. If a physician other than the attending provided only one office visit to a patient before delivery, a code from what section of the CPT manual would be used to report this service? Postpartum 52. The time after delivery is referred to as ___________________ CPT Code: 57400 53. Dilation of the vagina under anesthesia. CPT Code: 57230 54. Plastic repair of a urethrocele. CPT Code: 56441 55. Labial adhesions lysis. CPT Code: 56625 56. Simple complete vulvectomy. CPT Code: 58558 57. Surgical hysteroscopy with polypectomy and dilatation and curettage. CPT Code: 58825 58. Transposition of the left ovary. CPT Code: 58920 59. Bilateral wedge resection of ovaries. CPT Code:59001 60. Therapeutic amniocentesis with amniotic fluid reduction. CPT Code(s): 58800-LT 61. Drainage of a cyst of the left ovary using the vaginal approach. CPT Code(s): 59821 62. Surgical treatment of a second-trimester missed abortion. CPT Code(s): 59514 63. Cesarean delivery only. CPT Code(s): 59350 64. Hysterorrhaphy of a ruptured, pregnant uterus. CPT Code(s): 59020 65. Fetal contraction stress tests, antepartum. CPT Code(s): 58285 66. Radical vaginal hysterectomy. CPT Code(s): 56440 67. Marsupialization of Bartholin's gland cyst. CPT Code(s): 56740 68. Excision of Bartholin's gland.

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CPT Code(s):57065 69. Destruction of extensive vaginal lesions. CPT Code(s): 58100 ICD-I0-CM Code(s): C79.82, C80.1 70. Report 20 CPT Code(s): 59409 ICD-I0-CM Code(s): O76, O66.0, O70.1, Z37.0 71. Report 28 CPT Code(s): 59514, 58611 ICD-I0-CM Code(s): O34.211, Z30.2, Z37.0 72. Report 29 CPT Code(s): 59000 ICD-I0-CM Code(s): O09.293, Z36.89, Z87.448 73. Report 30 Incision __ and Excision are the two categories of codes contained in the subheading Ovary (58800-58960)? 280 For maternity and delivery, how many days are generally used when the estimated date of delivery is calculated? Introduction In what category are IUD removal codes found? __ Amniocentesis __ is the name of the procedure in which the physician inserts a needle into the pregnant uterus to withdraw amniotic fluid. curettage When an endometrial biopsy has failed or was inconclusive, dilation and __ is performed to determine the cause of abnormal bleeding or to locate a neoplasm. destroyed Pathology reports are not prepared when lesions are __. colpotomy __ involves cutting into the vagina to gain access to the pelvic cavity. Loop electrode excision procedure A(n) __ (four words) uses a heated wire to remove a slice of cervical tissue for pathologic review. 6 The global period for obstetric services begins on the day of the LMP and ends ______________________ weeks after delivery at the conclusion of the postpartum period. artificial insemination Preparation of sperm for __ (two words) is coded in the Introduction category under the Corpus Uteri subheading. O26.50 Maternal hypotension syndrome, onset minutes after delivery ovary

The anatomy in the Female Genital System subsection starts with the vulva and progresses upward to the: Skene's Incision and drainage of these glands is not reported using Female Genital System codes but is instead reported using Surgery section, Urinary System codes. size Vulvectomy codes are divided based on the ________ and extent of vulvar area removed during the procedure. LETZ, LEEP & cervical loop diathermy Loop electrode excision procedures are also referred to as: approach Hysterectomy codes are first divided in the CPT manual based on the ________ and then on any secondary procedure(s) that were done. salpingolysis Lysis of adhesions of the fallopian tube is termed a(n): Radiology You would expect to report a service for an amniocentesis using a code from the Female Genital System subsection and a code from the ________ section. 57020 Colpocentesis 58559 Surgical hysteroscopy with lysis of multiple intrauterine adhesions 59610 A patient who has had two previous deliveries via cesarean section receives complete obstetrical care and vaginal delivery services that include the postpartum care 59000 Diagnostic amniocentesis. Code only the procedure, not the radiological service. 59409 Vaginal delivery with episiotomy and use of forceps 57558 Dilation and curettage of cervical stump 59012 Intrauterine cordocentesis. Do not code the radiological portion of the procedure. 59841 Induced abortion by dilation and evacuation 59426 Antepartum care only after vaginal delivery, eight visits O24.419 Gestational diabetes, admitted for control, not delivered O21.1 Hyperemesis gravidarum at 16 weeks, with dehydration, not delivered O26.50 Maternal hypotension syndrome, onset minutes after delivery 58555 Code a diagnostic hysteroscopy. 59412

External cephalic version without tocolysis. 59515, 58611 Cesarean delivery with postpartum care and a ligation of fallopian tubes performed at the same operative session. 56821 Colposcopy of the vulva with biopsy. 59025 A fetal non-stress test is completed on a 36-week pregnancy. The correct code would be: 58150, 57265-51 Total abdominal hysterectomy with an anterior/posterior colporrhaphy and an enterocele repair. 58673 Patient presents for a laparoscopic salpingostomy. 59899 Unlisted procedure, maternity care and delivery. 57106 Partial removal of the vaginal wall, vaginectomy. 59830 Code the treatment of a septic abortion that was completed surgically. 59610 Total prenatal care for vaginal delivery after a previous cesarean delivery and postpartum services. 58558 Location: Inpatient Hospital OPERATIVE REPORTPRE/POSTOPERATIVE DIAGNOSIS: Postmenopausal bleeding with probable polyp seen on saline sonohysterogram. OPERATIVE FINDINGS: Endometrial polyp seen arising from the left cornual region. Otherwise, benign uterine cavity. PROCEDURE: The patient was taken to the operating room and a general anesthetic was administered. The patient was then prepped and draped in the usual manner in lithotomy position and the bladder was emptied with a straight catheter. A weighted speculum was placed to allow for visualization of the cervix, which was grasped anteriorly using single toothed tenaculum. The uterus was then sounded to 9 cm in depth. The cervix was dilated to allow for insertion of the diagnostic hysteroscope. The uterine cavity was then inspected. Immediately apparent was a polyp arising from the left cornual region. Remainder of uterine cavity was inspected and appeared to be benign. Minimal endometrial tissue was otherwise present. At this point, the hysteroscope was removed and polyp forceps were placed within the uterus. Attempt was made to grasp the polyp but this could not be grabbed with the polyp forceps. Therefore, a sharp curet was used and the polyp was thereby obtained and removed. A small amount of endometrial tissue was also obtained by curettage. Once this had been completed, the hysteroscope was reinserted and the cavity was re-inspected. It was

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confirmed that the polyp was removed. Otherwise, the endometrial canal then appeared normal. At this point, the procedure was terminated. Tenaculum was removed and good hemostasis was ensured at the cervix. The patient tolerated this procedure well. There were no complications. Fluid in was 325 cc and was equal to fluid out at the end of the procedure. Estimated blood loss was minimal. 58120 D&C was performed on a patient with dysfunctional uterine bleeding. 58260 Code the vaginal removal of a 230-gram uterus. 59812 Treatment of an incomplete abortion that was treated surgically during the second trimester. Intersex Surgery What Surgery subheading has only two codes?