An established patient has a simple removal of sutures performed by the nurse. The sutures were put in by an emergency room physician. The physician briefly looked at wound and ordered removal. CPT Code: ______. ICD-10-CM Code: ________ 2. Mastopexy, right side female breast, for ptosis. CPT CODE: __, ICD-10-CM Code: ___ 3. Secondary scar revision of amputation site lower right arm (ulna and radius) performed 9 months status post amputation due to chronic staph infections. CPT Code: __. ICD-10-CM Codes: ______, __________ 4. Closed treatment of right hip dislocation, complication of hip arthroplasty, due to joint prosthesis, without anesthesia. CPT Code: _____ ICD-10-CM Codes: _______, _______, ____¬¬¬¬¬_ 5. This is a 15-year-old girl, never seen at this clinic. During a problem focused history, she states that she noticed a lump on the back of her right wrist yesterday. P/E: There is a 2-cm freely movable, rubbery, round swelling on the dorsal surface of the right wrist. Distal neurovascular and tendon exam intact. This is not painful to palpitation. (The MDM was of straightforward complexity.) Diagnosis: Ganglion cyst, right wrist Treatment: Refer to Dr. Andrews for treatment CPT Code: ______________. ICD-10-CM Code: ______________ 6. A surgeon performed a repair of a vaginal enterocele using an abdominal approach and reported the service with 57270. The patient was a morbidly obese with a BMI of 42, and due to this circumstance, the procedure took a significant amount of additional time (45 minutes) to perform. Code and Modifier: ___________, ___ ICD-10-CM Codes: ________, ____________, _____ 7. What is the largest third-party payer? ¬__________________ 8. What are the two general and most important considerations when assigning a gastrointestinal code? _______________, __________________ 9. A __________is defined as an objective evidence of disease that can be observed by the physician. A) Sign B) Symptom C) Complication D) Complexity 10. Initial office visit for dysphagia. First Listed Diagnosis: ___________, ICD-10-CM-Code: _____
The Correct Answer and Explanation is :
Here are the correct CPT and ICD-10-CM codes for the scenarios provided, along with an explanation for each:
- Simple Removal of Sutures by Nurse
- CPT Code: 15850
- ICD-10-CM Code: Z48.02 (Encounter for removal of sutures) Explanation: The CPT code 15850 is for the removal of sutures performed by a professional, in this case, the nurse. The ICD-10 code Z48.02 is used when the patient is being seen for the removal of sutures, and the condition for which the sutures were originally placed is no longer relevant.
- Mastopexy for Ptosis (Right Side)
- CPT Code: 19316
- ICD-10-CM Code: Q13.0 (Congenital ptosis of eyelid) Explanation: CPT code 19316 is for breast surgery to lift and reshape the breast, commonly called mastopexy. ICD-10 code Q13.0 is used to describe congenital ptosis of the eyelid, which relates to the condition that requires the mastopexy, as it involves a lifting procedure for sagging breasts.
- Secondary Scar Revision (Amputation Site)
- CPT Code: 14040
- ICD-10-CM Codes: S58.209A (Unspecified injury of right forearm, initial encounter), L08.9 (Infection of skin and subcutaneous tissue, unspecified) Explanation: CPT code 14040 is used for secondary revision of a scar, particularly for a situation involving amputation. The ICD-10 codes S58.209A and L08.9 address the initial encounter of injury and infection at the amputation site.
- Closed Treatment of Right Hip Dislocation (Post Hip Arthroplasty)
- CPT Code: 27230
- ICD-10-CM Codes: T84.02XA (Dislocation of hip prosthesis, initial encounter), M16.11 (Unilateral primary osteoarthritis, right hip), Z96.641 (Presence of right hip joint prosthesis) Explanation: CPT code 27230 is for the closed treatment of hip dislocation. The ICD-10 codes address the complications from the joint prosthesis (T84.02XA) and the osteoarthritis (M16.11) that may have caused the dislocation. Z96.641 represents the presence of a hip prosthesis.
- Ganglion Cyst, Right Wrist
- CPT Code: 25075
- ICD-10-CM Code: M67.431 (Ganglion cyst of right wrist) Explanation: CPT code 25075 is for the excision of a ganglion cyst from the wrist, while M67.431 specifically identifies a ganglion cyst of the right wrist, a fluid-filled lump that occurs on the joints or tendons.
- Repair of Vaginal Enterocele Using Abdominal Approach
- CPT Code: 57270
- Modifier: 22 (Increased procedural services)
- ICD-10-CM Codes: N81.9 (Female pelvic organ prolapse, unspecified), E66.01 (Morbid obesity due to excess calories), Z68.42 (Body mass index 42.0-42.9, morbid obesity) Explanation: The CPT code 57270 is for the repair of a vaginal enterocele. The modifier 22 is used to reflect the increased procedural time due to the patient’s obesity (BMI 42). The ICD-10 codes represent the condition of prolapsed pelvic organs, morbid obesity, and the BMI factor.
- Largest Third-Party Payer
- Answer: Medicare Explanation: Medicare is the largest third-party payer, covering individuals aged 65 or older, people with disabilities, and those with end-stage renal disease.
- Important Considerations When Assigning a Gastrointestinal Code
- Answer: Anatomical Site, Condition Being Treated Explanation: When assigning a gastrointestinal code, it’s crucial to know the anatomical site of the procedure or condition, as well as the specific condition being treated. These factors help determine the correct coding.
- Objective Evidence of Disease
- Answer: A) Sign Explanation: A “sign” is defined as an objective piece of evidence of disease that can be observed by a healthcare provider, such as a rash or elevated blood pressure, whereas symptoms are subjective experiences reported by the patient.
- Initial Office Visit for Dysphagia
- First Listed Diagnosis: Dysphagia
- ICD-10-CM Code: R13.10 (Dysphagia, unspecified)
These codes and explanations cover the appropriate procedures and diagnoses based on the provided scenarios, ensuring accurate billing and medical documentation.