|20. Indication: Patient has a hypertrophic scar on the posterior side of the left leg at the level of the knee. This has begun to restrict his mobility. Physical therapy trial was unsuccessful. Procedure: After the proper induction of anesthesia, the subcutaneous tissue of the patient’s left leg beneath the scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was then excised down to viable dermis. Hemostasis was obtained with epinephrine soaked pads. Skin was harvested from the patient’s thigh in a split thickness fashion and was used to cover the 90 sq cm defect created by the surgery. The graft was secured with skin staples and then dressed with fine mesh gauze followed by medication-soaked gauze. The donor site was dressed with mesh followed by Adaptic, followed by a dry dressing and an Ace wrap.
A. 15110-52, 15002 B. 15100, 11406
C. 15100, 15002 D. 15110, 15002
21. The physician is called in to perform repairs for a 17-year-old girl involved in a motor vehicle accident. She sustained an 8.6 cm laceration to her forehead, a 5.5 cm laceration to her right cheek, a 4 cm laceration to her left cheek, a 4 cm laceration across her chin, and a 12.5 cm laceration to her chest. The wound on her chin required a layered closure. All other wounds required complex closure.
|A. 13132, 13133 x 4, 13101, 12052
|B. 13132, 13133 x 3, 13133-52, 13101, 13102, 12052
|C. 13132, 13133 x 3, 13101, 13102, 12052
|D. 13131, 13132, 13133 x 3, 13101, 13102, 12052
22. A 36-year-old male presents to have multiple lesions destroyed. Three benign lesions on his face are destroyed and five actinic keratoses on his left arm are destroyed. Code for the procedures.
A. 17000, 17003 B. 17000, 17003 x 4, 17110
C. 17110 D. 17280 x 5, 17000, 17003
23. A 15-year-old boy was burned in a fire and assessed to have received burns to 75 percent of his total body surface area. He was transferred to a burn center for definitive treatment. Once stable, he was brought to the OR. Procedure: Due to extent of the patient’s burns and lack of sufficient donor sites, his full-thickness burns will be excised and covered with porcine grafts, and a split-thickness skin biopsy will be harvested for preparation of autologous grafts to be applied in the coming weeks, when available. After induction of anesthesia, extensive debridement of the full-thickness burns was undertaken. Attention was first directed to the patient’s face, neck, and scalp. A total of 500 sq cm in this area received full-thickness burns. The eschar involving this area was excised down to viable tissue. Hemostasis was achieved using electrocautery. Attention was then turned to the trunk. A total of 950 sq cm in this area received full-thickness burns. The eschar involving this area was excised down to viable tissue. Hemostasis was achieved. Attention was then turned to the arms and legs. A total of 725 sq cm received full-thickness burns. The eschar involving this area was excised down to viable tissue. Hemostasis was achieved. Attention was then turned to the hands and feet. A total of 300 sq cm in this area received full-thickness burns. The eschar involving this area was excised down to viable tissue. All involved areas were then covered with porcine graft. Finally a split thickness skin graft of 0.015 inches in depth was harvested using a dermatome from a separate donor site. A total of 85 sq cm was recovered. What procedures codes would be reported service?
|A. 15300, 15301 x 10, 15320, 15321 x 10, 15004, 15005, 15002, 15003
|B. 15420, 15421 x 7, 15400, 15401 x 16, 15004, 15005 x 16, 15002, 15003 x 7
|C. 15420, 15421 x 7, 15400, 15401 x 16, 15004, 15005 x 7, 15002, 15003 x 16, 15040
|D. 15420, 15421 x 7, 15400, 15401 x 16, 15004, 15005 x 7, 15002, 15003 x 16
24. The left breast was prepped and draped in a sterile fashion. An incision from the 3 around to the 9 o’clock position on the areolar border on its inferior aspect was made in the skin and extended to the subcutaneous tissue. The breast mass was excised by sharp dissection. The mass was found to be approximately 1.5 – 2 cm in maximum dimension. Frozen section revealed clear margins. Hemostasis was made adequate using electrocautery and the Argon beam coagulator. After this was accomplished, the skin margins were reapproximated with running inverted 3-0 Vicryl subcuticular suture. Select the procedure and diagnosis codes.
A. 19120, 611.72 B. 19301, 611.72
C. 19125, 217 D. 19101, 611.79
25. This 37-year-old paraplegic has developed a sacral decubitus ulcer. He is brought to the OR today for debridement of the pressure ulcer with a split-thickness skin graft to cover the defect. The patient was placed prone on the operative table after induction of adequate endotracheal anesthesia. The sacral area was prepped and draped sterilely, and the ulcer is inspected. The area is debrided extensively to healthy tissue. Involved bone, including part of the coccyx, was also removed. Once the area was clear of necrotic tissue, the site was prepared for a skin graft. A split-thickness skin graft was harvested from the thigh with a dermatome. Total graft size was 25 sq. cm. The graft was sutured in place using 6-0 Vicryl. The harvest site was closed primarily with skin staples. Dressings were applied. Needle counts were correct x 2. The patient tolerated the procedure well. Code the procedure(s).
A. 15002, 15100-51 B. 15937, 15100-51
C. 15937 D. 15937, 15100-51, 15002
26. The patient is a 32-year-old female who was discovered to have breast cancer on the right side. She was treated with mastectomy followed by chemotherapy and radiation therapy. She now elects to proceed with reconstruction by TRAM flap. Code for the reconstruction.
A. 19364 B. 19361
C. 19316 D. 19367
27. A 55-year-old male presents in the office with an ingrown toenail on the right and left foot. The procedure was discussed in detail and the patient elected to have it performed. The right foot was prepped and draped in sterile fashion. The right great toe was anesthetized with 50/50 solution of 2 percent lidocaine and .05 percent Marcaine. A mini-tourniquet was placed around the toe for hemostasis. The lateral border was incised and excised in total. Phenol was then applied, the toe was then flushed. Tourniquet was released and dressing applied. At this time the patient elected to only have one performed and will return in two weeks for the left foot. Code the procedure.
A. 11765 B. 11750
C. 11752 D. 11740
28. Pre-Procedure Diagnosis: Basal cell carcinoma, left chin. Procedure: Wide local excision of 3.0 cm with 0.3 cm margin basal cell carcinoma of the left chin with a 4 cm closure. Procedure: The patient’s left chin was examined. The site of intended excision was marked out. The site was then prepped. The patient was then prepped and draped in the usual fashion. A 15 blade scalpel was then used to make an incision in the previously marked site. It was carried down to the subcuticular fat. The lesion was then sharply dissected off underlying tissue bed using a 15-blade scalpel. It was tagged for pathologic orientation. The hyfrecator was used for hemostasis. The wound edges were then undermined. The wound was then closed by advancing the tissue surrounding the lesion and closing in layers with 3-0 Vicryl for the deep layer, followed by 5-0 Prolene for the skin. The skin closure was in a running subcuticular fashion. Steri-Strips were then applied. What are the procedure and diagnosis codes?
A. 11644, 12052-51, 173.3 B. 11643, 12013-51, 173.3
C. 11444, 12052-51, 239.2 D. 11443, 12013-51, 239.2
29. The physician removes a tumor from the patient’s neck using the Mohs micrographic surgery technique. During the first stage, the physician takes four tissue blocks and reviews them under a microscope. The exam of the tissue blocks reveals a second stage is necessary to remove areas where the tumor is still present. The physician removes two additional tissue blocks. What are the appropriate CPT® codes for reporting the procedure?
A. 17311, 17312, 17315 B. 17313, 17315
C. 17313, 17314, 17315 D. 17311, 17312
30. Using ultrasound guidance, the physician performed a percutaneous needle core biopsy on a suspicious lump on the patient’s right breast. This procedure was performed in the physician’s office. Code this encounter.
A. 10022-RT B. 19101-RT, 76942
C. 19102-RT, 76942 D. 19102-RT
31. Dr. Smith performed a cryosurgery to destroy three premalignant lesions for a patient. Which code(s) shouldyou report for this procedure?
c. 17003 x 3
d. 17000, 17003 x 2
32. Which codes should be reported for the following case?
Preoperative diagnosis: Lesion, left hand
Confirmed by pathology postoperative diagnosis: Primary malignant carcinoma, left hand
Procedure performed: Excision of malignant carcinoma, left hand
Anesthesia: General; 40 ml of lidocaine was infiltrated into the wound prior to making the incision
Procedure: The patient was brought to the operative suite where the left hand was prepped and dressed. A circular incision was made to include the 1-cm lesion with narrowest margins of 0.6 cm with dissection down to subcutaneous tissue. Homeostasis was obtained; the wound was closed with simple mattress sutures. The patient tolerated the procedure well and was returned to the recovery room in good condition with sterile dressing in place.
a. 11603, 173.6
b. 11622, 173.6
c. 11423, 198.2
d. 11403, 198.2
33. Nancy underwent a fine needle aspiration with imaging guidance for a lesion in the right breast. During the aspiration procedure, a percutaneous metallic clip was placed in the right breast. Which codes describe this procedure?
a. 10022-RT, 19295-RT
b. 10021-RT, 19295-RT
c. 19290-RT, 19297-59
d. 19295-59, 10021-RT
34. Which of the following procedures could be coded with a breast reconstruction with free flap?
a. Harvesting of the flap
b. Microvascular transfer
c. Closure of the donor site and inset shaping the flap into a breast
d. None of the above
35. Barry underwent a complex incision and drainage due to a postoperative wound infection, which required an extensive secondary closure of the surgical site. Which codes describe this procedure?
a. 13160, 10081-59
b. 10121, 12020-51
c. 13160, 10180-51
d. 10061, 12021-59
36. Stephanie discovered a lesion on her trunk and was referred to Dr. Ralph, a trained Mohs surgeon, for treatment. Stephanie had no prior pathology of this lesion; therefore, Dr. Ralph completed a diagnostic skin biopsy with frozen section prior to the surgery. After reviewing the biopsy results, Dr. Ralph took the patient to the procedure suite and performed a Mohs surgery that same day. Dr. Ralph’s final report indicated the procedure required three stages, including five tissue blocks in each stage. He had to take an additional four blocks in stage two to verify margins and cell structure. Which codes should Dr. Ralph report for this entire encounter?
a. 17313, 17314 x 2, 17315 x 4, 11100-59, 88331-59
b. 17313, 17314 x 2, 17315-59
c. 17311, 17312 x 2, 17315
d. 17311, 17312 x 4, 17315-59, 11101-51, 88331-51
37. Mark cut his hand and arm while working on his car. Dr. Bill applied sutures to both the arm and hand wounds. An intermediate closure of 16 cm was placed in the arm and a simple closure of 3.6 cm was placed in the hand. Which codes should Dr. Bill report?
a. 12004, 12035-59
b. 12035, 12042-59
c. 12035, 12002-51
d. 13132, 12036-51
38. A patient underwent an excision of a 2.1-cm diameter malignant lesion on her nose. An 11.2-sq-cm
adjacent tissue transfer was required to repair the primary and secondary defect sites. How should you
code this procedure?
a. 11643, 14061-59
c. 11646, 13152-51, 13153-51
d. 11443, 12054-59
39. Glen required a replacement of his nonbiodegradable drug delivery implant system. Glen was taken into the procedure suite where he was prepped. Dr. Roberts injected a local anesthetic and made a 3.2-cm incision in the skin for removal of the previous cylinder. He then replaced the cylinder and sutured the new device in place with a single running stitch. The 3.2-cm trunk wound was closed with simple sutures. The device was tested, with excellent results. The patient tolerated the procedure well and was released from care with a sterile dressing in place. How should this procedure be coded?
a. 11983, 12032-51
b. 11977, 12032-59
c. 11981, 11982-51, 11983-51, 12002-59
d. 11983, 12002-51
40. Two malignant lesions on the scalp measuring 1.1 cm and 2.0 cm, and one malignant lesion on the neck measuring 2.2 cm were destroyed. Electrocautery was used for the first two lesions and laser was used for the third lesion.The procedures should be coded as:
B. 17273, 17272
C. 17273, 17272, 17272
D. 17274, 17273
41. OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Possible basal cell carcinoma.
POSTOPERATIVE DIAGNOSIS: Basal cell carcinoma.
PROCEDURE PERFORMED: Excision lesion 4.3 cm x 2 cm Left thigh
FTSG from calf to thigh
ANESTHESIA: General by LMA.
DESCRIPTION OF PROCEDURE: After undergoing adequate general anesthesia and after DuraPrep prepping the left thigh and draping with cloth towels and drapes, 0.25 percent Marcaine with epinephrine, total of 30 cc, was used to anesthetize the skin.
A lesion slightly over 4 cm was observed on the patient’s left thigh. A small portion was removed and sent for frozen section analysis. This returned Basal Cell carcinoma. Per prior consent, we removed the remaining lesion with a .75 surrounding margin. Due to size and location of this lesion the decision was made to harvest a full thickness skin graft from his left lower leg.
Lower leg was prepped and draped and 0.25 percent Marcaine was given. Excision of 5 cm x 5cm full thickness graft was obtained and placed on back table for prep. We returned to the thigh area. All edges were trimmed and the graft was placed into the defect and sewn with a
running #3-0 Vicryl, the skin edges were approximated with a running subcuticular #4-0 Vicryl and further sealed with Dermabond. Hemostasis was well controlled. The wound was irrigated with normal saline.
What are the correct procedure code(s)?
A. 11406, 15770, 12032
B. 11606, 15220, 15221
C. 11402, 15220
D. 11602, 15220, 15221
42. Preoperative Diagnosis: Left axillary hidradenitis.
Postoperative Diagnosis: Left axillary hidradenitis.
Operation: Excision of hidradenitis.
Indications: The patient is a 62-year-old female with chronically infected left axillary hidradenitis.
Description of Operation: With the patient in supine position and under general anesthesia, the left axilla was prepped and draped in the usual sterile fashion. An elliptical skin incision was made in the axilla to excise most of the hidradenitis tracts. The incision was carried down through subcutaneous tissue. The underlying subcutaneous tissue was excised. Bleeding points were controlled by means of electrocautery. The wound was then irrigated with a dilute antibiotic solution. The subcutaneous tissues were closed with a continuous suture of 2-0 Vicryl. The skin edges were stapled together a dry dressing was applied. The patient tolerated the procedure satisfactorily. Sponge and needle counts were correct.
The correct CPT® code for this procedure:
43. OPERATIVE REPORT
FIRST SURGICAL ASSISTANT: W. P., M.D
ANESTHESIA: Monitored anesthesia care with local anesthetic
PREOPERATIVE DIAGNOSIS (ES): Left chest wall mass
POSTOPERATIVE DIAGNOSIS (ES): Left chest wall mass
NAME OF OPERATION: Left chest wall mass excision
INDICATIONS FOR PROCEDURE: Mr. C is a 63-year-old gentleman who presented to the outpatient clinic with a palpable left chest wall mass. Clinical characteristics suggested a benign lipoma. However, because of the very large size of the mass and the fact that it had increased in size rapidly I recommended a complete excision for definitive diagnosis. He presents today for that purpose.
OPERATIVE FINDINGS: The patient had a left chest wall mass excised without difficulty. The mass measured approximately 7 centimeters and had the benign appearance of a lipoma.
DESCRIPTION OF PROCEDURE: Mr. C was brought to the operating room and placed supine on the operating room table. Because this was a sedation case, no sequential compression devices were applied. However, a single dose of Ancef 1 gram was administered intravenously 10 minutes prior to the incision time. Sedation was then initiated with propofol and Fentanyl and the patient was prepped and draped in the standard surgical fashion. The left chest wall mass was palpated and an incision directly over it along the Langer’s line was planned. This was infiltrated with a mixture of 1 percent plain lidocaine and 0.5 percent plain Marcaine. The incision was then made and carried down through the dermis with electrocautery. We then opened the subcutaneous tissue of the skin and immediately encountered an organized mass that has a benign appearance of a lipoma. Using careful blunt and sharp dissection, we were able to completely excise this mass around its entire circumference leaving the capsule intact. Once we had the mass largely excised from the anterior, superior, inferior, lateral, and medial approaches the mass was everted from the chest wall. The mass was then removed from its posterior attachments using electrocautery. The mass was then passed off the field. Attention was then turned to the wound. Aggressive hemostasis was obtained with electrocautery. The wound was irrigated with copious amounts of sterile saline. A deep 3-0 Vicryl stitch was then placed to reapproximate the pectoralis fascia. The deep dermal layer was then reapproximated with interrupted 3-0 Vicryl stitches. The skin was reapproximated with a running subcuticular using 4-0 Monocryl. Dermabond dressing was applied. The patient tolerated the procedure well, was awakened, and transferred to the recovery room.
The specimens removed include the left chest wall mass, which measured 7 centimeters. Estimated blood loss was minimal. Intravenous fluids were 700 milliliters of crystalloid. Sponge, instrument, and needle counts were correct at the end of the case. The condition of the patient on discharge from the operating room was stable.
SPECIMENS REMOVED: Left chest wall mass measuring 7 cm
What is the correct CPT® code?