• Document: 2014 Final with Answers
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2014 Final with Answers 10000 Series 1. The patient is seen in follow-up for excision of the basal cell carcinoma of his nose. I examined his nose noting the wound has healed well. His pathology showed the margins were clear. He has a mass on his forehead; he says it is from a piece of sheet metal from an injury to his forehead. He has an X-ray showing a foreign body, we have offered to remove it. After obtaining consent we proceeded. The area was infiltrated with local anesthetic. I had drawn for him how I would incise over the foreign body. He observed this in the mirror so he could understand the surgery and agree on the location. I incised a thin ellipse over the mass to give better access to it, the mass was removed. There was a capsule around this, containing what appeared to be a black-colored piece of stained metal; I felt it could potentially cause a permanent black mark on his forehead. I offered to excise the metal, he wanted me to, so I went ahead and removed the capsule with the stain and removed all the black stain. I consider this to be a complicated procedure. Hemostasis was achieved with light pressure. The wound was closed in layers using 4-0 Monocryl and 6-0 Prolene. What CPT® and ICD-9-CM codes are reported? a. 10121, 709.4, V90.10 c. 10121, 729.6, V90.10 b. 11010, 873.52, V90.10 d. 11010, 729.6, V90.10 ANS: C Rationale: In CPT® index, see Integumentary System/Removal/Foreign Body, you are directed to code range 10120-10121. The surgeon indicated in the note they considered this incision and removal of foreign body to be complicated leading us to code 10121. In the ICD-9-CM Index to Diseases, see Foreign body/retained/fragments/subcutaneous tissue, you are directed to 729.6. There is no mention of granuloma of the skin making 709.4 incorrect. The patient did not have an acute laceration with a foreign body in an open wound, code 872.52 is not reported. In the Tabular List, instructions for 729.6 state to use an additional code from V90.01-V90.9 to identify the foreign body. V90.10 indicates a retained metal fragment. PTS: 1 DIF: Difficult 2. The patient is here because the cyst in her chest has come to a head and is still painful even though she has been on antibiotics for a week. I offered to drain it for her. After obtaining consent, we infiltrated the area with 1 cc of 1% lidocaine with epinephrine, prepped the area with Betadine and incised opened the cyst in the relaxed skin tension lines of her chest, and removed the cystic material. There was no obvious purulence. We are going to have her clean this with a Q-tip. We will let it heal on its own and eventually excise it. I will have her come back a week from Tuesday to reschedule surgery. What CPT® and ICD- 9-CM codes are reported? a. 10140, 706.1 c. 10061, 706.2 b. 10060, 706.2 d. 10160, 786.6 ANS: B Rationale: The physician performed an incision and drainage (I & D) of a cyst on the chest. To find the code, see the CPT® Index for Incision and Incision and Drainage/Cyst/Skin, you are directed to code choices 10040, 10600-10061. 10040 is for acne surgery. 10060-10061 are for I & D of a cyst. Only one cyst was drained making 10060 the correct code. In the ICD-9-CM Index to Diseases, look for Cyst/skin, code 706.2 is indicated. Verification in the Tabular List confirms code selection. PTS: 1 DIF: Difficult 3. Patient has returned to the operating room to aspirate a seroma that has developed from a surgical procedure that was performed two days ago. A 16-gauge needle is used to aspirate 600 cc of non-cloudy serosanguinous fluid. What codes are reported? a. 10160-78, 998.13 c. 10140-78, 906.3 b. 10180-58, 998.12 d. 10140-58, 729.91 ANS: A Rationale: The provider performed a puncture aspiration of a seroma (clear body fluid built up where tissue has been removed by surgery). In the CPT® Index, look for Cyst/Skin/Puncture Aspiration. Code 10160 is the correct code for the puncture aspiration. Even though it does not specifically state “seroma” it is the code to report. This is not a staged return to the operative suite for the puncture aspiration of the seroma. Modifier 78 is used because the patient is returning to the operative suite with a complication in the global period. The diagnosis is reported as a post-operative complication. In the ICD-9-CM Index to Diseases, Seroma indexes to 998.13. Verification in the Tabular List confirms code selection. PTS: 1 DIF: Difficult 4. Operative Report PREOPERATIVE DIAGNOSIS: Squamous cell carcinoma, scalp. POSTOPERATIVE DIAGNOSIS: Squamous carcinoma, scalp. PROCEDURE PERFORMED: Excision of Squamous cell carcinoma, scalp with Yin-Yang flap

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