|21. Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is placed prone and under fluoroscopic guidance; the needle is placed into the SI joint with a mixture of 20 mg of Celestone and Marcaine for pain relief. Code the procedure(s).
A. 27096, 77003-26 B. 20610
C. 27096, 73542-26 D. 27096
22. Patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF procedure was performed, which included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. Which are the correct ICD-9-CM and CPT® codes assignment?
A. 24579, 29065-51, 812.52 B. 24577, 812.42
C. 24579, 812.42 D. 24575, 812.52
23. 35-year-old female patient presents with acute onset of severe pain since October. Her workup has revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative findings were consistent with two large fragments of free disk fragments in the foramen at C5-C6 on the right side. After general anesthesia, the patient was placed on the operative table in the supine position. All pressure points were cushioned and a transverse skin incision was fashioned under fluoroscopic guidance over the C5-C6 disc space. Dissection through the platysma eventually allowed for exposure of the anterior entrance to the vertebral body of C5 and C6 and retractors were inserted to maintain adequate exposure. The operating microscope was brought into the field. Caspar posts were placed and slight distraction allowed exposure. A complete discectomy was performed at C5-C6 by using endplate curets pituitary rongeurs and Kerrison rongeurs. The posterior longitudinal ligament was resected and beneath the posterior longitudinal ligament, two significant sized disc fragments were noted in the foramen at C5-C6. These were removed using pituitary and Decker instruments. The endplates were then decorticated so that they were parallel to each other and a midline keel was performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody Kineflex-C device was placed under fluoroscopic guidance. Satisfied with the positioning of the device, the decision was made to close. What is the correct code for this procedure?
A. 63075 B. 63081
C. 22856 D. 22554
24. A 17-year-old male presents to the emergency department after being involved in a car accident. The patient’s primary physician calls the orthopedic surgeon to the emergency department. The orthopedist diagnoses a sprained knee ligament. He places a long leg walking cast and instructs the patient to return to his office for follow-up care. What are the procedure and diagnosis codes?
A. 29358, 844.8 B. 29355, 844.9
C. 27520-54, 844.0 D. 29345, 844.9
25. Patient complains of chronic/acute arm and shoulder pain following bilateral carpal tunnel surgery. Patient is followed by pain management for over a year. Physician finally diagnoses patient with reflex dystrophy syndrome (RSD). Physician performs six trigger point injections into four muscle groups. Code the procedure(s).
A. 20552 B. 20610 x 6
C. 20552 x 5 D. 20553
26. A Grade I, high velocity open right femur shaft fracture was incurred when a 15-year-old female pedestrian was hit by a car. She was taken to the operating room within four hours of her injury for thorough irrigation and debridement, including excision of devitalized bone. The patient was then reprepped, redraped, and repositioned. Intramedullary rodding was then carried out with proximal and distal locking screws. What are the correct codes for this diagnosis and procedure?
A. 27506, 11044-51, 821.11 B. 27506, 11012-51, 821.11
C. 27507, 11012-51, 821.01 D. 27507, 11044-51, 821.10
27. This 45-year-old male presents to the operating room with a painful mass of the right upper arm. General anesthesia was induced. Soft tissue dissection was carried down thru the proximal aspect of the teres minor muscle. Upon further dissection a large mass was noted just distal of the IGHL(inferior glenohumeral ligament), which appeared to be benign in nature. With blunt dissection and electrocautery, the 4.5 cm mass was removed en bloc and sent to pathology. The wound was irrigated, and repair of the teres minor with subcutaneous tissue was then closed with triple-0 Vicryl. Skin was closed with double-0 Prolene in a subcuticular fashion. What is the correct CPT® code for this service?
A. 23076 B. 23066
C. 23075 D. 23030
28. Postoperative Diagnosis: 1. Impingement syndrome left shoulder. 2. AC synovitis left shoulder Procedure: Arthroscopy with subacromial decompression and AC resection left shoulder. The patient was placed supine on the operating table prepped and draped in usual sterile fashion. The scope was introduced from a posterior portal and the joint was inspected. The rotator cuff looked in good condition. The articular surfaces looked good. The bicep also was in good condition. We went subacromially and there was a fair amount of bursal inflammation encountered. We did a thorough bursectomy. A ligament chisel was used to take down the coracoacromial ligament. A high-speed bur was used to do a subacromial decompression going from lateral to medial. We took off about 2 cm of bone anteriorly. Next we opened the AC joint through an anterosuperior portal. We ground off about 10 mm of distal clavicle because there was a large subchondral cyst and we wanted to get this totally ground out, which we did. Then the wounds were irrigated out, Nylon suture was placed in our portals. The patient was placed in a bulky dressing and an arm sling and sent to the recovery room in stable condition. Code the procedure.
A. 29826-LT, 29824-LT B. 29825-RT, 29824-RT
C. 23120-LT, 23130-LT D. 29826-LT, 29824-LT, 29825-LT
29. The patient presented for medial meniscal tear left knee. Arthroscopy with partial medial menisectomy left knee and arthroscopic picking (drilling pick holes) of the lateral femoral condyle left knee was performed. Code the procedure and diagnosis codes.
A. 29880-LT, 29879-LT, 836.0 B. 29881-LT, 29879-LT, 836.0
C. 29882-LT, 29885-LT, 836.1 D. 29881-RT, 29885-LT, 836.2
30. A 47-year-old patient was previously treated with external fixation for a Grade III left tibia fracture. There is now nonunion of the left proximal tibia and he is admitted for open reduction of tibia with bone grafting. Approximately 30 grams of cancellous bone was harvested from the iliac crest. The fracture site was exposed and the area of nonunion was osteotomized, cleaned, and repositioned. Intrafragmentary compression was applied and three screws and the harvested bone graft were packed into the fracture site. What are the correct codes for this diagnosis and procedure?
A. 27724, 733.82, 905.4 B. 27722, 733.82
C. 27722, 733.81, 905.4 D. 27724, 733.82
31 . A patient reports a history of right groin pain, which is worse with sitting and rising from a sitting position. Physical examination, x-rays, and CT scans confirm a cam lesion in the right femoral head-neck region and noted as the cause for loss of rotation. Dr. Curtis completed an arthroscopy of the right hip with debridement and a femoroplasty. How should Dr. Curtis report her procedure?
b. 29862-RT, 29914-59
c. 29861-RT, 29862, 29914
d. 29860-RT, 29862-59, 29914-59
32 . Dr. Reese completed a deep transfer of the anterior tibial and flexor digitorum tendons. Which code(s) should be used to report this procedure?
a. 27658 x 2
b. 27690, 27692-51
c. 27691, 27692
d. 27691, 27692 x 2
33. Which code(s) should you report for the following case?
Preoperative diagnosis: Procedures:
Left knee medial collateral ligament tear Exam under anesthesia
Anterior cruciate ligament tear Diagnostic arthroscopy of left knee
Possible meniscus tear Left knee arthroscopic repair of lateral meniscus
Postoperative diagnosis: Same
Tourniquet time: 2.5 hours
Procedure: The patient was taken to the operating room and positioned, and an epidural anesthetic was placed. Once the anesthetic had taken effect, the patient’s left leg was examined under anesthesia and noted to have increased valgus laxity with end point, a positive Lachman test, and positive pivot-shift test. The patient was prepped and draped in the normal fashion, exsanguinated, and the tourniquet applied to a 350 mmHg. The knee was then insufflated and irrigated with fluid. Using the arthroscopic sheath, visualization of the knee joint began. Attention was turned to the lateral meniscus where the tear was debrided. Using the arthroscope, the lateral meniscus was sutured with two mattress-type sutures of non-absorbable 2-0 material. The sutures were then tied and visualized with arthroscopy to reveal the meniscus to be in excellent shape and stable position. The 3.5-cm wound was thoroughly irrigated and closed with intermediate subcutaneous sutures. A sterile compression dressing was applied. The patient was placed in a TED hose and Watco brace, setting the brace between 40º and 60º of free motion. He was then taken to the recovery room in stable condition. The instrument, sponge, and needle counts were correct.
a. 29882, 29877-52, 29870-51
b. 29866, 29868
c. 29870, 29882, 12032
34 . Two weeks ago, Sam underwent an open repair of his lower femur due to a traumatic fracture suffered while snow skiing. His leg is healing as expected, and no new treatment is required to the femur. Today, he returns as planned for an application of a new long leg cast. The cast application is completed by the same physician who performed the surgery. How should today’s services be reported?
a. 29345-58, V53.7, V54.16
b. 99024, V53.7, V54.16
c. 29345, 29700-59, 99024, V53.7, V54.29
d. 29345-76, 821.22, V53.7, V54.16
35. What type of soft tissue tumor resection is commonly used for malignant tumors or very aggressive
a. Manipulative soft tissue resection
b. Radical soft tissue resection
c. Residual soft tissue resection
d. Manageable soft tissue resection
36 . A patient was stabbed in the right arm. A surgeon took the patient to an operating suite and completed wound exploration. The surgeon widened the wound to achieve proper visualization and completed subcutaneous debridement and ligation of minor subcutaneous blood vessels. No further procedures were required for this wound exploration. The arm wound was closed and dressed in the usual fashion. The patient tolerated the procedure well and was returned to the recovery room in good condition. How would you report this procedure?
a. 20103, 11011-51
c. 20103, 11011-59
d. 11043, 12036-59, 20103-51
37. A patient underwent an anterior interbody arthrodesis with discectomy, osteophytectomy, fusion, and decompression of nerve roots at level C3, C4, and C5. The fusion was explored and then stabilized with application of anterior instrumentation placed from C3 to C5. Which codes would you use to report this procedure?
a. 22551, 22585 x 2, 22845-51, 22830-59
b. 22554, 22585 x 2, 22845, 22830-51
c. 22600, 22614, 22842, 22830-59
d. 22551, 22552 x 2, 22845, 22830-51
38. Which code(s) would you report for an aspiration and injection of a ganglion cyst to the bone of the left great toe?
d. 20600, 20612-59
39. A patient suffering from a nonhealing knee tendon underwent a platelet-rich plasma injection under imaging guidance. How should you report this procedure?
c. 20551, 77002
d. 0232T, 20551, 77002
40. Dr. Bender completed a therapeutic manipulation of the temporomandibular joint. An anesthesiologist placed this healthy 54-year-old patient under general anesthesia and monitored the patient during the procedure. The intraservice time was noted as one hour. The patient tolerated the procedure well and was returned to the recovery room in good condition. How would Dr. Bender’s services be reported?
a. 21073, 99144, 99145 x 2
d. 21480, 99149, 99150 x 2