Level II Codes Are Not Used to Report Services for Patients in This Setting?

Level II codes are not used to report services for patients in this setting?

inpatient

Subjective: Six-year-old girl had her arm twisted on the play ground. She is seen in the ED complaining of pain in her wrist.Objective : Vital Signs: stable. Wrist: A lot of tenderness laterally. X-ray is normalAssessment: Wrist sprainPlan: Anaprox. Give twice daily with hot packs. Recheck if no improvement.What would the E/M code be for this visit?

Codes: 99281

Which of the following would be used to code drugs?

Codes: J codes

Margaret has a cholecystoenterostomy with a Roux-en-Y; five hours later she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and peritonitis was setting in. What is the correct coding for the subsequent services on this date of service? The same surgeon who performed the original operation took her back to the OR.

Codes: 49402-78

A patient is issued a 22-inch seat cushion for his wheelchair.

Codes: E2602

PRE-OPERATIVE DIAGNOSIS: Persistent menorrhagia leading to profound anemia; submucous uterine fibroidPOST-OPERATIVE DIAGNOSIS: Persistent menorrhagia leading to profound anemia; submucous uterine fibroidOPERATION: Total abdominal hysterectomy and bilateral salpingo-oophorectomyANESTHESIA: General with endotracheal intubationGROSS FINDINGS: Upon entering the abdominal cavity, the lower abdominal wall was greatly distorted from a previous TRAM flap surgery. Much of the abdominal musculature on the right aspect of the lower abdomen was missing from the surgery and had been replaced with surgical mesh. Upon entering the peritoneal cavity, an enlarged, lobulated, approximately 12-week sized uterus was noted. There was evidence of bilateral tubal ligation in the past. Both ovaries were normal size. Some ovulatory type cysts were evident. Generalized examination of the abdomen was otherwise unremarkable.OPERATIVE PROCEDURE: Following administration of general anesthesic, the patient was positioned frog-legged, a Betadine vaginal preparation performed, and a Foley catheter inserted. She was then repositioned in the dorsal supine position. Her abdomen was prepared with Betadine and draped in the usual manner with sterile drapes. Using a scalpel blade, a 7" transverse lower abdominal incision was made excising the lowest of the patient’s multiple surgical scars. This was carried down through the subcutaneous tissue and opening the rectus fascia and transecting through a segment of surgical mesh. The overlying fascia was then dissected off the underlying musculature using the Bovie. Rectus muscles were split in the midline, peritoneum elevated, entered, and opened longitudinally. Following a general examination of the abdomen, an O’Connor-O’Sullivan retractor was placed in the abdomen and the bowel packed away with moist lap sponges. A Mass General clamp was placed on the fundus of the uterus and uterus elevated towards the incision. The round ligaments were then bilaterally clamped, cut, doubly sutured, ligated with #1 chromic, left long, and tagged. A bladder flap was formed by incising the uterovesical peritoneum with Metzenbaum scissors and dissecting the bladder downwards using a sponge suck. The infundibulopelvic ligaments were bilaterally skeletonized a short distance and then were bilaterally clamped, cut and doubly suture litgated with #1 chromic. At this point, the fundus of the uterus was removed using a scalpel blade. The cervical stump was then grasped and the procedure continued. Using straight Heaney clamps, the cardinal ligaments were bilaterally clamped, cut, suture ligated with the #1 chromic and left long. An additional bite was taken bilaterally piecing up portions of the uterosacral ligaments and these were similarly cut, ligated , left long and tagged. The vagina was entered anteriorly using a scapel blade and utilizing Jorgensen scissors and staying within the vaginal fornices, the cervix was excised off the vaginal cuff. The angles of the cuff were grasped and then the cuff run with interlocking baseball stitch of #0 chromic. The cardinal ligament and uterosacral ligaments were then plicated back into the angles of the vagina using free Mayo needles. The cuff was further reduced in size with several simple sutures of 2-0 chromic. A Jackson-Pratt T-tube drain was placed in the cuff and brought out through the vagina. Pelvis was irrigated and suctioned dry and the pelvic peritoneum reapproximated with a continuous running stitch of 2-0 chromic. Pelvis was reirrigated, bowel replaced into his physiologic position, and all the counts are correct and instruments were removed from the abdomen. The abdominal peritoneum was closed with a continuous running stitch of #0 chromic. The rectus musculature was reapproximated with a continuous running stitch of the same suture material. The rectus fasciola and mesh were then reapproximated with a continuous running stitch of Prolene. Subcutaneous tissue was irrigated and suctioned dry and the skin edge was reapproximated with a series of skin staples followed by a series of vertical mattress sutures of 4-0 Rapide placed between every staple to maintain good skin eversion. Sterile dressing was applied. Select the appropriate code for this procedure:

Codes: 58150-22

A 65-year-old male Medicare patient presents for a digital rectal examination and a total prostate-specific antigen (PSA) screening test. His father and brother had prostate cancer.

Codes: G0102, G0103, V76.44, V16.42

A 46-year-old white male suffered back pain after heavy lifting and was found to have bilateral disk herniation. The patient was placed prone and general anesthesia given. Incision was then made with a 10-blade knife and dissection was carried downward through the thick adipose tissue to the fascia in a subperiosteal plane. The paraspinous muscles were reflected off L5 and S1. A laminotomy was drilled with the Midas Tex AMB on the inferior end of L5 on both sides. The thecal sac was retracted medially. A microscope was brought in, direct with microdissection. There was a massive disk herniation on the right side underneath the nerve root as well as the left. The disk was incised with an 11-blade knife and was cleaned out first on the right and then on the left with a series of straight and angled curets and rongeurs. The disk was intertwined with the posterior longitudinal ligament. The space was cleaned out, the foramina were checked and no further compression was found on any of the neural elements. What are the correct codes for this procedure?

Codes: 63030-50

Dr. Smith is treating a 72-year-old female with a ureteral obstruction caused by a stricture from post operative and post radiation scarring from treatment of transitional cell cancer. The patient requires removal and replacement of an internal dwelling ureteral stent. Dr. Smith advances a diagnostic catheter under conscious sedation into the bladder and injects contrast to opacity the bladder. A guide wire is advanced into the bladder and the diagnostic catheter is exchanged for a larger catheter to allow the use of a snare device. Under the fluoroscopic guidance the snare device is negotiated into the bladder through the sheath and used to grasp the pigtail portion of the double-J ureteral stent tube within the bladder and the indwelling stent tube is pulled out of the bladder and urethra far enough to allow retrograde introduction of a guide wire through the stent, directed into the renal pelvis. Using fluoroscopic guidance to negotiate the wire through the inner lumen of the ureteral stent tube rather than through side holes a diagnostic catheter is positioned over the wire into the renal pelvis, allowing opacification of the renal pelvis. The guide wire is repositioned into the renal pelvis and the diagnostic catheter removed. A new double-J ureteral stent tube is introduced and positioned. The guide, sheath and safety wire are removed after appropriate position is confirmed with fluoroscopy and a permanent image is obtained for the medical record.What code would be used to describe the exchange?

Codes:50385

10.

All third-party payers require the use of HCPCS codes in submissions for service provided to any patient.

False

11.

A 27-year-old triathelete is thrown from his bike on a steep downhill ride. He suffered a severely fractured vertebra at C5. An anterior approach is used to dissect out the bony fragments and strengthen the spine with titanium cages and arthrodesis. The surgeon places the patient supine on the OR table and proceeds with an anterior corpectomy at C5 with diskectomies above and below. Titanium cages are placed in the resulting defect and morselized allograft bone is placed in and around the cages. Anterior synthes plates are placed across C2-C3 and C3-C5, and C5-C6. What is the best way to code for this?

Codes: 63081, 22554-51, 22846, 22851, 20930

12.

A 45-year-old male with a previous biopsy positive for malignant melanoma, presents for definitive excision of the lesion. After induction of general anesthesia the patient is placed supine on the OR table, the left thigh was prepped and draped in the usual sterile fashion. IV antibiotics are given as patient had previous MRSA infection. The previous excisional biopsy site on the left knee had measured approximately 4 cm and was widely elipsed with a 1.5 cm margin.. The excision was taken down to the underlying patellar fascia. Hemostasis was achieved via electrocautery. The resulting defect was 11cm x 5cm. Wide advancement flaps were created inferiorly and superiorly using electrocautery. This allowed the skin edges to come together without tension. The wound was closed using interrupted 2-0 monocryl and 2 retention sutures were placed using #1 Prolene. Skin was closed with a stapler. Choose the correct code(s) for this note.

Codes: 14301

13.

PRE-OPERATIVE DIAGNOSIS: Esophageal reflux; dysphagia; epigastricpainPOST-OPERATIVE DIAGNOSIS: Acute gastritis; hiatal herniaOPERATION: EGD with biopsy using forceps.SPECIMEN: Biopsy from GE junctionGROSS FINDINGS: No evidence of esophageal strictures or narrowing or varicosities but there was some inflammation noted at the GE junction on the stomach side. Representative biopsies were performed. Remaining part of the stomach and duodenum were unremarkable. She had moderated hiatal hernia. OPERATIVE PROCEDURE: Once the patient was properly identified and consent reviewed, the patient was brought to the endoscopy suite. Patient was placed in the supine semi-seated position. Flexible endoscope was passed under direct visualization into the esophagus. Esophagus was insufflated. Scope was advanced. Esophagus and GE junction were normal appearing. Right at the GE junction just distal to it on the stomach side, there were inflammatory changes and area of inflammation. No evidence of active bleeding or ulceration. Representative biopsies were performed of this locale. Stomach was insufflated. Scope passed through the GE junction into the stomach. Stomach was insufflated. Scope was retroflexed. Cardia, fundus and antrum remaining parts were unremarkable. Scope was then advanced through the pylorus to the duodenum and passed duodenal sweep. Duodenum was unremarkable. What are the code(s) for this encounter? Codes: 43239, 535.00, 553.3

14.

Which HCPCS modifier indicates the great toe of the right foot?

Codes: T5

15.

Mrs. Mertz goes to the procedure room to have a permanent pacemaker implanted. She is given a mild sedative and the area just under the right clavicle is prepped and draped in a sterile manor. An incision is made to create a pocket for the pulse generator. A venogram is shot through an indwelling antecubital IV and a catheter is threaded from the pocket into the right subclavian vein. The catheter is then advanced into the right atrium under fluoroscopic guidance. Using the Seldinger technique the catheter is withdrawn over a guide wire and a 32 FR Medtronic pacing wire is threaded back over the guide wire and into the right atrium under fluoroscopy. The guide wire is removed and the pacing tip is screwed into the myocardium. Thresholds are tested for sensing and capture. The lead is then attached to the pulse generator and placed into the pocket. The pocket is closed with interrupted 4-0 Prolene. Choose the correct code(s).

Codes: 33206, 71090-26, 75820 - 26

16.

A 72-year-old male Medicare patient receives 30 minutes of individual diabetes outpatient self-management training session. The patient is a newly diagnosed type II diabetic.

Codes: G0108, 250.00

17.

Dr. Smith sees a patient referred by his partner who is also an orthopedic surgeon regarding the ongoing treatment of a tibial fracture that happened 3 weeks ago. The patient’s mom is concerned that it may not be healing. Dr. Smith reviews and updates the patient’s complete PFSH and performs a problem focused exam and makes no changes to the existing fracture care. What is the CPT code for this encounter?

Codes: 99024

18.

Date: 02/01/XXSurgeon:PRE-OPERATIVE DIAGNOSIS: MenorrhagiaPOST-OPERATIVE DIAGNOSIS: MenorrhagiaOPERATION: D&C; hysteroscopyANESTHESIA: IV sedationGROSS FINDINGS: Evaluation under anesthesia revealed a normal sized and shaped uterus. No adnexal masses were palpated. No cervical, vaginal or external genitalia lesions. Hysterscopic visualization of the endocervix revealed no lesions. Hysteroscopic visualization of the endometrial cavity revealed a normal sized and shaped cavity with a homogenous light yellow pinkish endometrium. There was an approximately 1 cm polyp in the left fundal area.OPERATIVE PROCEDURE: After adequate IV sedation, the patient was placed in the dorsal lithotomy position. The vaginal area was prepped with Betadine and aseptically draped. The anterior cervical lip was grasped with a Behr’s clamp. A hysteroscope was passed using normal saline to expand the cavity. The above findings were noted. The hysteroscope was removed. Endocervical curettage was performed with a small sharp curet. Tissue sent: laveledendocervicalcurettings. Cervical os was progressively dilated with #29 Pratt dilator. Sharp curettage of the endometrium was performed. Polyp forceps were passed. It appeared the polyp had been produced. The hysteroscope was reinserted and the cavity appeared empty. Tissue was sent labled endometrial curettings. Instruments were removed from the vagina. Good hemostatsis was noted. Estimated blood loss was 10cc. Patient to recovery room in satisfactory condition.

Codes:58558, 626.1

19.

A 52-year-old male has scheduled a colonoscopy due to a strong family history for colon CA. He is on the table and the physician finds multiple polyps in the transverse colon. The physician removes two of the polyps with a snare and a third with hot biopsy forceps. What are the correct CPT and ICD-9-CM codes for this encounter?

Codes: 45385, 45384-59; 211.3, V16.0

20.

OPERATIVE REPORTOPERATIVE PROCEDURE: Excision of back lesion.INDICATIONS FOR SURGERY: The patient has an enlarging lesion on the uppermidback.FINDINGS AT SURGERY: There was a 5-cm, upper midbacklesion.OPERATIVE PROCEDURE: With the patient prone, the back was prepped anddraped in the usual sterile fashion. The skin and underlying tissues wereanesthetized with 30 mL of 1% lidocaine with epinephrine.Through a 5-cm transverse skin incision, the lesion was excised. Hemostasis wasensured. The incision was closed using 3-0 Vicryl for the deep layers and running3-0 Prolenesubcuticular stitch with Steri-Strips for the skin.The patient was returned to the same-day surgery center in stable postoperativecondition. All sponge, needle, and instrument counts were correct. Estimatedblood loss is 0 mL.PATHOLOGY REPORT LATER INDICATED: Dermatofibroma, skin of back.Assign code(s) for the physician service only.

Codes: 11406, 12032, 216.5

21.

A patient sees Dr. Smith for a consult at the request of his PCP, Dr. L for an ongoing problem with allergies. The patient has failed Claritin and Alavert and feels his symptoms continue to worsen. Dr. Smith performs an expanded problem focused history and exam and discusses options with the patient on allergy management. The patient agrees that he would like to be tested to possibly have better control on his allergies and ongoing care for them. Dr. Smith sends a report back to Dr. L thanking him for the referral and the date the patient is set up for allergy testing along with his findings from the encounter. What is the E/M code?

Codes: 99242

22.

OPERATIVE REPORTPREOPERATIVE DIAGNOSIS: Open fracture, left humerus, with possible loss ofleft radial pulse.PROCEDURE PERFORMED: Open reduction internal fixation, left open humerusfracture.PROCEDURE: While under a general anesthetic, the patient's left arm wasprepped with Betadine and draped in sterile fashion. We then created alongitudinal incision over the anterolateral aspect of his left arm and carried thedissection through the subcutaneous tissue. We attempted to identify the lateralintermuscular septum and progressed to the fracture site, which was actuallyfairly easy to do because there was some significant tearing and rupturing of thebiceps and brachialis muscles. These were partial ruptures, but the bone wasrelatively easy to expose through this. We then identified the fracture site andthoroughlyirrigated it with several liters of saline. We also noted that the radialnerve was easily visible, crossing along the posterolateral aspect of the fracturesite. It was intact. We carefully detected it throughout the remainder of theprocedure. We then were able to strip the periosteum away from the lateral sideof the shaft of the humerus both proximally and distally from the fracture site. Wedid this just enough to apply a 6-hole plate, which we eventually held in place withsix cortical screws. We did attempt to compress the fracture site. Due to somecomminution, the fracture was not quite anatomically aligned, but certainly it wasfelt to be very acceptable.Once we had applied the plate, we then checked the radial pulse with a Doppler.We found that the radial pulse was present using the Doppler, but not withpalpation. We then applied Xeroform dressings to the wounds and the incision.After padding the arm thoroughly, we applied a long-arm splint with the elbowflexed about 75 degrees. He tolerated the procedure well, and the radial pulsewas again present on Doppler examination at the end of the procedure.