40000 Series (10Q) - Try Free Quiz
1. Mr. Johnson, a 46-year-old male, has smoked cigars for the last 20 years of his life. He has a suspicious lesion on his lower lip and is being seen for treatment. The physician suspects that it may be malignant. The physician performed a shave biopsy of the patient’s lower lip. What is the correct code for this procedure?
A. 40490 B. 40500 C. 11100 D. 11600
2. What is the correct code for the plastic repair of cleft lip with nasal deformity when utilizing an Abbe- Estlander cross-lip pedicle flap?
A. 40527 B. 40761 C. 42200 D. 40700
3. The physician performed a needle biopsy of salivary gland and sent the aspirate out to pathology for study. What is the correct CPT code for the physician to report?
A. 42400 B. 10021 C. 42400, 88172 D. 42405, 88173
4. PROCEDURAL NOTE
PATIENT: Ortiz, Pamela
AGE: 13 DATE: 01/19/2016
PREOPERATIVE DIAGNOSIS: Oropharyngeal Hemorrhage s/p Tonsillectomy POSTOPERATIVE DIAGNOSIS: Same PROCEDURE: Control of oropharyngeal hemorrhage The patient was seen in the emergency room one day after tonsillectomy due to uncontrolled oropharyngeal hemorrhage. The patient was admitted to the hospital for control of nasal hemorrhage and observation. The suture site from tonsillectomy was visualized and the pharynx was packed with gauze to control any additional bleeding. The patient remained in hospital for an additional 24 hours under observation and to control any additional hemorrhaging. The physician recommended the patient schedule a follow-up appointment in two days to check the sutures. How should you code this procedure?
A. 42960 B. 42961 C. 42962 D. 42971
5. A physician performed a thoracoabdominal diaphragmatic hernia repair on 45-year-old male patient with the implantation of prosthetic mesh for support. What is the correct code for this procedure?
A. 39531 B. 39530 C. 43336 D. 43337
6. The physician performed a partial Nissen Fundoplasty via a lower thoracic incision. What is the correct code for this procedure?
A. 43327 B. 43328 C. 43325 D. 43331
7. A 5-year-old patient received a gastric intubation from physician after ingesting approximately 5 tablespoons of carpet cleaning detergent. The gastric tube was orally inserted through the esophagus and into the stomach and lavage was performed to evacuate the stomach contents. What is the correct CPT code?
A. 43753 B. 43752 C. 43754 D. 43755
8. A physician performed a revision of a gastrojejunostomy with intestine resection and vagotomy. What is the correct code for this procedure?
A. 43850 B. 43855 C. 43860 D. 43865
9. Where are codes for the pancreas located in the CPT manual?
A. Within the endocrine section (60000 to 60699)
B. Within the digestive system section (40490 to 49999)
C. Within the urinary system section (50010 to 53899)
D. There are no codes for the pancreas in the CPT manual
10. A 7-year-old boy fell from a treehouse, cutting open his upper lip across the upper vermilion border. Due to the vermilion border being involved, repair of the lip was performed by plastic surgery. What CPT code should be used for repair of the lip over the vermilion border?
A. 40650 B. 40652 C. 40654 D. 40700
40,000 SERIES (10 QUESTIONS) – ANSWER KEY & RATIONALE
1. Answer: A - Code 40490 (Biopsy of Lip) is the correct code for this procedure. Code 40500 (Vermilionectomy (Lip Shave), with Mucosal Advancement) is not correct because it is a more extensive procedure than what was performed at the visit, which was just a biopsy. Code 11100 (Biopsy of Skin) is also not correct because the code 40490 is used for the lip, which is more specific.
2. Answer: A - The correct code for the plastic repair of cleft lip with nasal deformity when utilizing an Abbe-Estlander cross-lip pedicle flap is 40527 (Excision of Lip; Full Thickness, Reconstruction with Cross-Lip Flap (Abbe-Estlander)). In parenthesis under code 40761 for plastic repair of cleft lip/nasal deformity, it notes that if using the Abbe-Estlander type repair, use the 40527 code. Code 42200 is only used for the repair of a cleft palate.
3. Answer: A - The correct CPT code for the physician to report is 42400 (Biopsy of Salivary Gland; Needle). Code 42405 is not correct because it allows for an incisional biopsy of the salivary gland, whereas this procedure was done via needle. It is also not correct to code for the pathology service using codes 88172 or 88173 because the physician sent the sample out to the lab. The lab should code for the pathology service not the physician.
4. Answer: B - You should code this procedure using code 42961 (Control Oropharyngeal Hemorrhage, Primary or Secondary (e.g. Post-Tonsillectomy); Complicated, Requiring Hospitalization). The notes indicate that the patient was admitted to the hospital for observation, so the code 42960 (Simple Control) is not appropriate. In addition, code 42962 refers to a secondary surgical intervention, but in this case, no other surgical interventions were noted.
5. Answer: D - The correct code for this procedure is 43337 (Repair, Paraesophageal Hiatal Hernia, via Thoracoabdominal Incision, Except Neonatal; with Implantation of Mesh or Other Prosthesis). Code 39531 was deleted and replaced with code 43337, as indicated by the notes within the mediastinum and diaphragm section. Code 43336 is inappropriate because it does not take into account the implantation of mesh, while code 43337 does.
6. Answer: B - The correct code for this procedure is 43328 (Esophagogastric Fundoplasty; Thoracotomy). The code 43327 is correct because it is used for the same procedure, but it refers to a laparotomy and the note states that the procedure was performed using a lower thoracic incision. Code 43325 is also correct because it includes a fundic patch. In this case, the notes did mention a fundic patch.
7. Answer: A-The correct CPT code is 43753 (Gastric Intubation and Aspiration(s) Therapeutic, Necessitating Physician’s Skill, including Lavage if Performed). Code 43752 is only for the placement of a naso- or oro-gastric tube and does not include lavage and evacuation of the stomach contents. Code 43754 includes the placement of the gastric tube and aspiration of stomach contents, but for diagnostic purposes not for treatment of a poisoining.
8. Answer: D - The correct code for this procedure is 43865 (Revision of Gastrojejunal Anastomosis (Gastrojejunostomy) with Reconstruction, With or Without Gastrectomy or Intestine Resection; With Vagotomy). Code 43860 is used for the same procedure, but without the vagotomy. In this case, a vagotomy was performed, making code 43865 the more appropriate code. Codes 43850 and 43855 are used for a gastroduodenostomy not a gastrojejunostomy.
9. Answer: B - Codes for the pancreas are listed in the digestive system section of the CPT manual (40490 to 49999). Although there is a subheading within the endocrine section titled “Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body,” there are no codes for the pancreas within that section. There is subsection, code range (48000 to 48999), within the digestive system that is designed specifically for the pancreas.
10. Answer: A - 40650 is the only code specific to the vermilion border repair of the lip. Code 40652 is incorrect because it is for a lip repair, up to half of the vertical height. Code 40654 is incorrect because the repair did not involve more than one half of the vertical height and was not listed as complex. Code 40700 is incorrect because there was no mention of cleft lip repair.