question

What is the surgery section?

answer

The largest section of CPT which contains codes and code descriptions for surgical procedures performed by physicians

question

Why does the surgery section contain multiple codes that describe similar procedures?

answer

Because procedures can be performed in a variety of methods and different combinations

question

What guides the physician to do one or multiple procedures?

answer

The patient's physical status

question

What guides the selection of the appropriate code for reimbursement?

answer

The documented op report and other patient documentation

question

Overview of Surgery Section

answer

...

question

The subsections in the surgery section are organized _________.

answer

Anatomically

question

Anatomically

answer

body area or organ system

question

Categories and subcategories are organized within subsections according to _____________.

answer

type of procedure

question

What does selection of the appropriate surgery code require?

answer

careful review of the patient record to determine the procedure and services provided

question

What should you do before looking in the index for the appropriate code?

answer

review the op report to determine the body system, site, surgical approach, and type of procedure performed, and if multiple procedures were performed

question

Example: Excision of cervical stump

answer

was it performed through the abdominal approach or the vaginal approach?

question

Example: Removal of malignant lesion

answer

was it performed via excision or destruction?

question

What does CPT coding descriptions include

answer

the procedure performed

question

CPT coding descriptions do NOT include

answer

numerous activities integral to the procedure

question

True or False: It would be impractical to list every event common to all procedures of similar nature in the codes narrative description.

answer

True

question

True or False: Many common activities represent the principles of the medical and surgical care but are not coded separately.

answer

True

question

True or False: Some activities are only integral to certain groups of procedures.

answer

True

question

List some standard services that are integral to the med/surgical section:

answer

-Cleaning, shaving, and prepping -Draping and positioning -Inserting intravenous access for medicines -Administering sedatives -Administering local, topical, regional anesthesia -Est. the surgical approach -Performing lysis on simple adhesions -Isolating neurovascular ,muscular, or bony structures that limit access to surgical field -taking surgical cultures -irrigating wounds -inserting or removing drains, suction devices, dressings, and pumps -closing the surgical incision -applying, managing, and removing postop dressings including analgesic devices -documenting reports -identifying surgical supplies

question

Organization of Surgery Section

answer

...

question

The guidelines located at the beginning of the surgery section apply to ________

answer

all codes in the section

question

Notes located throughout the surgery section apply to _________

answer

a specific subsection, heading, or subheading based on type and site of procedure

question

What subsections are included in the Surgery Section?

answer

-General -Integumentary -Musculoskeletal -Respiratory -Cardiovascular -Hemic and Lymphatic -Mediastinum and Diaphragm -Digestive -Urinary -Male Genital -Female Genital -Reproductive -Intersex -Endocrine -Nervous -Eye and Ocular Adnexa -Auditory -Operating Microscope

question

Incision

answer

cut made into body tissue during surgery using a knife, electrosurical unit, or a laser

question

I & D

answer

Cutting open a lesion and draining its contents

question

Excision

answer

Removing a portion or all of an organ or another tissue using a scalpel or another surgical instrument

question

Introduction

answer

Injecting, inserting, or puncturing body tissue or scoping an organ

question

Removal

answer

Eliminating tissue or taking something out

question

Endoscopy

answer

Visualizing a body cavity using an instrument that can be inserted into the body through a small incision or a natural opening

question

Endoscope is also used as a ______

answer

Surgical approach for performing other procedures

question

Repair

answer

Improving improperly functioning body parts

question

2 Types of Repairs

answer

grafts and sutures

question

Grafts

answer

moving healthy tissue from one site to another to replace diseased or defective tissue

question

Suture

answer

Closing a wound using catgut, glue, silk thread, wire, or other materials

question

Revision

answer

Modifying a previous procedure

question

Reconstruction

answer

Rebuilding a body part, such as the breast

question

Destruction

answer

ablation or removal of benign, pre-malignant, or malignant tissue

question

Types of destruction

answer

-chemo-surgery -cryosurgery -electrosurgery -LASER -Surgical curettment

question

Chemosurgery

answer

Using chemicals to destroy diseased tissue, such as for skin cancer

question

Cryosurgery

answer

Applying extreme cold, such as liquid nitrogen, to destroy abnormal tissue cells, such as warts or small lesions

question

Electrosurgery

answer

Using an electrical device, such as electrocautery , to destroy abnoral tissue

question

LASER stands for

answer

light amplification by stimulated emission of radiation

question

LASER

answer

using a device that if filled with a gas, liquid, or solid substance that is stimulated to emit light to a specific wavelength to burn, cut, or dissolve tissue.

question

Other procedures

answer

Unrelated procedures, which include arthrodesis, Mohs micrographic surgery, manipulation, splinting, or casting

question

How are procedures categorized in the surgery section?

answer

therapeutic or diagnostic

question

Diagnostic procedures

answer

performed to evaluate the patients complaints or symptoms to establish the dx (biopsy, arthroscopy, endoscopy)

question

Therapeutic Surgical Procedure

answer

performed to treat specific conditions or injuries which includes the procedure itself and normal uncomplicated follow up care (repair or removal)

question

Terms like incision, repair, removal, revision, etc are all types of __________

answer

subheadings in the surgery section

question

Surgery Guidelines

answer

...

question

What do guidelines located at the beginning of the CPT surgery section do?

answer

ckarify the assignment of codes and explain terms

question

Surgery Guidelines include:

answer

-Services -CPT surgical package definition -Follow up care for diagnostic procedures -Follow up care for therapeutic procedures -Supplied material -Reporting more than 1 procedure/service -Separate procedures -Subsection information -Unlisted service or procedure -Special report -Surgical destruction

question

Services

answer

...

question

What is located in the E/M section of CPT?

answer

codes for physician services that are provided in the office, patient's home, hospital, and other health care facilities and codes for consults and other medical services

question

Where are codes for special services and reports located?

answer

in the CPT Medicine Section

question

CPT Surgical Package Definition

answer

...

question

Services included in the CPT surgical package are

answer

-local infiltration. metacarpal/tarsal, or topical -One related E/M service following the decision for surgery -Immediate postoperative care -Documentation of Postop physician orders -Evaluation of the patient in the post anesthesia recovery area -Typical postop follow up care

question

What does immediate postoperative care include?

answer

dictating the operative report and taking with the family and other physicians or qualified health care professionals

question

What does decision for surgery include?

answer

history and physical on the date of surgery or immediately prior to performance of surgery

question

What did CMS do in 1992?

answer

Established a national global definition for global surgical package that differs from CPT's surgical package definition

question

Why did CMS come up with a definition of global surgical package?

answer

to make sure payments are made consistently for the same services across Medicare administrative contractor jurisdictions

question

The Global Surgical Package definition prevents

answer

Medicare payments for services that are more or less comprehensive than intended

question

What does the CMS global surgical package include?

answer

the surgical procedure and a standard package if preoperative , intraoperative, and postoperative services

question

CMS categorizes surgeries as ____ or_____

answer

major or minor

question

CMS established a postoperative ______ period

answer

global (0, 10, or 90 days)

question

The global period for major surgeries is _____

answer

90 days

question

The global period begins the day _____ surgery

answer

following

question

The global period includes a ____ preoperative period

answer

one day

question

When reporting a CPT surgery code, ______ are included in that code and not separately coded

answer

surgical package services

question

To determine the global period for major surgeries:

answer

count the day before the day of surgery, the day of surgery, and the 90 immediately following the day of surgery (Examples pg. 506)

question

To determine the zero-day global period for minor surgeries:

answer

count the day of surgery only (Examples pg. 506)

question

To determine the 10-day global period:

answer

count the day of surgery and the appropriate number of days immediately following (Examples pg.506)

question

Where does CMS publish a list of the global periods for each CPT code?

answer

The Federal Registar (also includes some alphabetical codes in the global period)

question

MMM

answer

Global period policy does not apply; describes services furnished in uncomplicated maternity cases, including antepartum care, delivery, and postpartum care

question

XXX

answer

Global period policy does not apply

question

YYY

answer

Global period established by each MAC

question

ZZZ

answer

COT code is related to another service provided, which is always included in the global period of the other service

question

What do instructions for the global surgical package describe?

answer

the components of a global surgical package and payment rules for minor surgeries, endoscopies, and global surgical packages that are split between physicians

question

What items does the CMS global surgical package include?

answer

-Preoperative services -The day before surgery -The day of surgery -Intraoperative services -TX of complications -Postoperative visits -Post surgical pain management -Miscellaneous services

question

What does the CMS global surgical package NOT include?

answer

-Initial consult or evaluation services -Visits unrelated -Services provided by other physicians except when physicians agree on transfers -DX tests and procedures -clearly distinct surgical procedures -tx for postoperative complications that require a return trip to operating room -a requires more extensive procedure when a less extensive fails

question

The procedure being performed determines the ____

answer

global follow up care (NOT the condition being treated)

question

The global surgical package deals with the procedures performed during the global period by the _______

answer

operating surgeon only

question

True or False: E/M services provided as follow up to a surgical procedure are included in the reimbursement amount for the surgery , and codes for the follow up E/M services are not reported separately..

answer

True

question

When the patient receives the E/M service for an unrelated condition, make sure you report an ____ to receive reimbursement

answer

E/M code

question

When an E/M service provided is for the purpose of deciding surgery, the E/M code is considered a significant _____ service

answer

Separately identifiable

question

MACs use software that contains _____ to detect the separate billing of services included in the global package

answer

prepayment edits

question

What happens when an E/M code is provided for services provided during a global period and a modifier is not used?

answer

Claim is denied

question

Local Infiltration, Metacarpal/Metatarsal/Digital Block, or Topical Anesthesia

answer

...

question

True or False: Local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia, when provided by the physician performing the procedure, is considered part of the procedure.

answer

True (when provided by the surgeon, add modifier -47)

question

When a physician other then the surgeon provides general anesthesia, regional anesthesia, or monitored anesthesia care, the other physician reports an _______ code for services provided

answer

anesthesia

question

Moderate (conscious) Sedation

answer

moderate sedation or analgesia that results in a drug-induced depression of consciousness

question

True of False: CPT established a package concept for conscious sedation and a bulls eye located next to the code number identifies the conscious sedation as an inherent part of providing specific procedures.

answer

True (it would be inappropriate to report both the procedure and a separate conscious sedation code)

question

True or False: The management of postoperative pain by the surgeon, including epidural drug administration, is included in the global package with the operative procedure.

answer

True

question

Follow-up Care for Therapeutic Surgical Procedures

answer

...

question

__________ are performed to evaluate a patient's condition, to determine the nature of the condition, and to distinguish between one disease and another

answer

Diagnostic Procedures

question

What does CPT say follow up care for dx procedures includes?

answer

only that care directly related to recovery from the diagnostic procedure itself

question

Which codes should be provided for follow up care for dx procedures?

answer

- the patient's condition for which the dx procedure was performed -other conditions that are not related to the reason for performing the dx procedure

question

True or False: When a patient receives services from the physician who performed the diagnostic procedure and those services are in follow up to the procedure performed, do not report a code for services provided.

answer

True

question

Follow up Care for Therapeutic Surgical Procedures

answer

...

question

________are performed for the definitive treatment of a disease or condition rather than for dx or investigational purposes

answer

Therapeutic

question

What does follow up care for therapeutic procedures include?

answer

only the care that is typically considered part of the surgical service

question

True or False: The physician generally sees the patient several times as part of normal, uncomplicated follow up care.

answer

True (included in global package)

question

True or False: Normal follow up care is a necessary component of the surgical process.

answer

True

question

When should codes be provided during therapeutic follow up care?

answer

-complications -exacerbation -recurrence -presence of other diseases -injuries

question

Supplied Materials

answer

...

question

Supplies commonly included in the surgical package are not _____

answer

coded separately

question

Only those supplies and materials provided by the physician over and above the supplies usually included with the procedure rendered are _____

answer

coded separately

question

True or False: The CPT surgery section does not identify procedure codes for which it is inappropriate to report supply items separately.

answer

True

question

__________ is a specific reimbursement issue which varies from one payer to another.

answer

Reimbursement of supplies and materials required to perform the procedure

question

True or False: CMS created specific instructions regarding the separate reporting of supply items

answer

True

question

What happened with the full implementation of the practice expense component of the Medicare Fee Schedule?

answer

all supplies are now included in the payment for the procedure, Medicare no longer reimburse the physician for this code (some non Medicare payers will allow this though or the code for supplies above and beyond the usual)

question

Reporting More than One Procedure/Service

answer

...

question

What applies when a physician performs one or more procedure or service on the same date, during the same op session, or during a postop period?

answer

The surgical package concept of reporting one or more CPT modifiers to receive reimbursement consideration from third party payers

question

Add-On Codes

answer

...

question

Plus sign

answer

next to add on codes that describe a service that can be reported only in addition to a primary procedure

question

How else may an add on code be identified other than a plus sign?

answer

By specific language in the code description such as each additional or list separately in addition to

question

True or False: Add on codes are never stand alone

answer

True (they are integral part of another procedure and would not be performed without the primary procedure)

question

______ allow physicians to separately report procedures and services performed in addition to the primary procedure

answer

Add on codes

question

What is the key to identifying add on codes?

answer

Determining whether the code always has to be reported with another code

question

Add on codes are exempt from the

answer

multiple procedures concept (-51)

question

Separate Procedure

answer

...

question

CPT codes that contain the term separate procedure in parenthesis are commonly performed as an _____ component of a total service

answer

integral

question

When the total procedure or service is performed, do not report ad an additional procedure the code that contains the term ________in its code description

answer

separate procedure

question

When a separate procedure is performed during the same op session as a more comprehensive procedure,____________

answer

do not code the separate procedure in addition to the more comprehensive procedure

question

What do you do when a service that contains the separate procedure in its code description is performed distinctly?

answer

report the separate procedure code in addition to codes for other procedures (or services)

question

Reporting separate procedures may be necessary to classify:

answer

-Procedure performed during a different session, surgery, site, or organ system -Procedure performed through a separate incision or excision -Separate lesion excised during the same operative session as removal of another lesion -Tx of separate injury

question

Add modifier ___ to the separate procedure code to indicate that the procedure is not considered a component of another procedure but is distinct

answer

-59

question

Subsection Information

answer

...

question

Many of the surgery subsections contain unique instructions called

answer

notes

question

Where are notes located?

answer

Just below the title of the subsection

question

Where are parenthetical notes located?

answer

below codes (they apply to just that code)

question

Unlisted Service or Procedure

answer

...

question

When are CPT unlisted procedure codes assigned?

answer

when no specific code accurately describes the procedure performed

question

What must you include when reporting an unlisted procedure code on an insurance claim?

answer

written report that describes the procedure performed

question

Special Report

answer

...

question

Special report describes

answer

the procedure performed in an unlisted code submission

question

Special reports may be required for procedures and services _____ provided or they are _______

answer

rarely provided or unusual

question

Special reports establish ________

answer

medical necessity

question

As a minimum, to document a special report, include the following:

answer

-adequate description of the nature, extent, and need -time, effort, and equipment necessary to provide the procedure or service -complexity of symptoms -concurrent problems -dx and therapeutic procedures -final diagnosis -follow up care -pertinent physical findings

question

Surgical Destruction

answer

...

question

Surgical destruction is considered part of a __________procedure

answer

surgical

question

Different methods of destruction are not reported separately unless

answer

the technique substantially differs from the standard management of a problem or condition (CPT codes are available for exceptions due to special circumstances)

question

Surgical destruction

answer

the ablation (or removal) of tissues by any method, including chemical tx, cryosurgery, electrosurgery, or laser

question

General Subsection

answer

...

question

How many codes does the general subsection have?

answer

Just 2 -10021 (fine needle aspiration without imaging) -10022 (fine needle aspiration with imaging)

question

FNA

answer

Fine needle aspiration

question

Fine needle aspiration defined

answer

the removal of fluid from a cyst or cells from a solid mass to be examined cytologically

question

FNA is a ___________ procedure

answer

per-cutaneous

question

What happens if a cyst is not palpable on physical exam?

answer

the FNA is typically performed under imaging guidance using fluroscopy, ultrasound, or computed tomography

question

10021

answer

fine needle aspiration without imaging

question

10022

answer

FNA with imaging

question

T or F The parenthetical notes below the General subsection applies to both codes in the section

answer

True

question

What do the notes under the General subsection tell you?

answer

To also report the code for the imaging if applicable such as fluoroscopic guidance

question

Integumentary System Subsection

answer

...

question

What is included under the integumentary subsection?

answer

dermatological procedures, plastic surgery, and components of multiple surgical procedures (closure, flaps. and grafts)

question

Integumentary procedures are often performed as ____ procedures

answer

staged

question

Name some integumentary procedures

answer

-incision -biopsy -removing -paring/curettement shaving -destruction -excision -repair -adjacent tissue rearrangement -grafts -flaps

question

Adjacent tissue transfer/rearrangement

answer

closure of defects by relocating a flap of adjacent normal, healthy tissue from a donor sire to an near by (adjacent) defect such as a traumatic skin wound or the site of excised lesion; a portion of the flap remains intact to provide blood supply to the grafted site

question

Biopsy

answer

Removal and examination of tissue to establish a dx, confirm a dx, or determine the extent of a disease

question

Flap

answer

Relocation of a mass of tissue (usually skin) that has been partially removed from one part of the body so that it retains its own blood supply

question

Graft

answer

Any tissue or organ used for implantation or transplant

question

Mohs microsurgery

answer

technique of excising skin tumors by removing tumor tissue layer by layer, examining the removed portion microscopically for malignant cells, and repeating the procedure until the entire tumor is removed

question

Paring and curettement

answer

Removal of growths or other material from the wall of a cavity or another surface, a s with a curette; paring of lesions (e.g., corns and calluses) seldom, if ever, require local anesthesia.

question

Shaving

answer

Horizontal slicing to remove epidermal and dermal lesions (e.g., without a full thickness dermal excision); removal includes scissoring or any sharp method

question

Do not add _____ to skin, subcutaneous and accessory structures; nails pilonidal cyst; introduction; repair or destruction headings

answer

directional modifiers (lt and rt)

question

The skin is not a ____ organ

answer

paired

question

Skin, Subcutaneous and Accessory Structures

answer

...

question

What is included under the skin, subcutaneous and accessory structures headings?

answer

-I and D -Debridement -Paring or cutting -biopsy removal of skin tags -shaving of lesions -excisions of lesions

question

Incision and Drainage

answer

...

question

I&D Section

answer

contains procedures that establish a drainage pathway for fluid that forms at sites of infection

question

What does CPT I&D procedures include

answer

-cutaneous and subcutaneous drainage of cysts -fluid collections -infections -hematomas -pustules -seromas

question

Do not report an I&D code if

answer

a procedure to excise a lesion results in drainage of an area either as part of the procedure or as a way to gain access to the lesion during the same op session

question

Is it appropriate to report the I&D of a hematoma if it is performed during the same operative session as a excision,r repair, destruction, removal, and so on?

answer

NO

question

CPT does not define type of excision in terms: simple, extensive, or complex. ______ is responsible for this

answer

provider

question

There are different codes used if a cyst is over 2cm, is recurrent, or requires layered closure.

answer

True

question

There is a different code used if plastic repair will be required in the future.

answer

True

question

Extensive Cellulitis

answer

acute inflammation of skin's connective tissue that is caused by infection with bacteria

question

What happens if simple I&D of a pilonidal cyst can not be performed because of extensive cellulitis?

answer

An antibiotic is prescribed and a code for complicated I&D of the pilonidal cyst is used. If the patient returns for an excision of the pilonidial cyst one week after the antibiotic surgery, then another code for the excision is also coded.

question

T or F CPT describes procedures necessary to address complications

answer

True

question

Complications are not reported with ______

answer

codes for the original surgery that resulted in the complication

question

What happens if the original surgery procedure code is reported with procedure to treat the complication.

answer

NCCI will deny reimbursement for the procedure performed to treat the complication

question

Lesion Removal

answer

...

question

Skin lesion

answer

pathological change in tissue

question

What do you look at to accurately code a removal of a skin lesion?

answer

-method -status (benign or malignant) -size of the lesion -Site or body part lesion located -Type of wound closure/repair

question

To calculate the size of a lesion refer to _________noted located in the CPT surgery

answer

excised diameter

question

Excised diameter

answer

includes the size of the lesion plus its margins

question

What should documentation of the excised diameter include?

answer

dimensions for the greatest size of the lesion as well as for the margin around the lesion

question

When multiple lesions are removed, do not ______

answer

add together the greatest size of each separate lesions even when excised in one ellipse

question

Margin

answer

the amount of surrounding tissue that must be removed to adequately excise the lesion

question

The margin is calculated as the ______ from the lesion to the edge of the skin ellipse

answer

shortest distance

question

An ellipse resembles an

answer

oval

question

The _________ amount of tissue removed from the end of each ellipse is measured and uses to determine the excised diameter

answer

narrowest

question

T or F When multiple lesions are excised using one ellipse, the narrowest margin between lesions is measured and used in addition to measurements of each end of the ellipse to calculate the diameter.

answer

T

question

Benign lesions include

answer

-neoplasms -fibrous cysts -other inflammatory cystic lesions

question

Malignant lesions include

answer

-melanoma -BCC -SCC

question

Excised diameter includes the ____ plus its ____

answer

lesion plus its margins

question

T or F Do NOT refer to the pathology report for the diameter because placing a lesion in formalin, the formaldehyde solution used to preserve organic specimens, can result in shrinkage.

answer

T

question

Bulla

answer

Large Blister

question

Large Blister

answer

same as vesicle onlly greater than 10 mm

question

Vesicle

answer

Small Blister

question

Small Blister

answer

Accumulation of fluid between the upper layers of the skin; elevated mass containing serous fluid; less than 10 mm

question

Macule

answer

localized changes in the skin color of less than 1 cm in diameter

question

Freckle is a

answer

macule

question

2nd degree burn is a

answer

large blister

question

herpes and chickenpox is a

answer

small blister

question

Nodule

answer

solid and elevated; however, they extend deeper than papules into the dermis or subcutaneous tissues, greater than 10mm

question

Cyst or wart is a

answer

nodule

question

Papule

answer

solid, elevated lesion less than 1 cm in diameter

question

Nevi is a

answer

papule

question

Pustule

answer

vesicles or bllae that become filled with pus, usually described as less that 0.5cm in diameter

question

Acne, furuncles,carbuncles, and impetigo are

answer

pustles

question

Ulcer

answer

a depressed lesion of the epidermis and upper papillary layer of the dermis

question

Stage 2 pressure ulser is a

answer

ulcer

question

Tumor

answer

the same as nodule only greater than 2cm

question

Basal Cell Carcinoma tumor is a

answer

tumor

question

Urticaria

answer

Hives

question

Hives

answer

localized edema in the epidermis causing irregular elevation that may be red or pale, may be itchy

question

Insect bite and wheals are

answer

hives

question

Lesions are measured in ____

answer

centimeters

question

Just one type of ______ is reported for each lesion

answer

removal

question

Types of removal

answer

-destruction -debridement -paring -currettement -shaving -excision

question

Types of destruction

answer

-laser -freezing

question

What do you do when multiple methods are used on a lesion removal?

answer

report only the destruction method

question

What do you do when multiple distinct lesions are removed?

answer

report code for each lesion removed and attach modifier -59 to each code and be sure the provider has documented

question

What does the biopsy of a lesion involve?

answer

the partial removal of a lesion usually performed at the same time as the removal of the entire lesion to obtain a pathological specimen

question

When a lesion biopsy is performed as part of a removal then it is ______

answer

one procedure (report only the removal)

question

Lesion removal may be require_____, ______ or _______ closure and a tissue transfer may be performed

answer

-simple -intermediate -complex

question

T or F When the lesion removal requires bandaging, strip closing, or simple closure, the closure is included and not reported separately

answer

t

question

Simple repair

answer

-one layer closure, non layer closure, single layer closure -involves the use of staples, sutures, and or tissue adhesives to repair superficial wounds involving epidermis, dermis, and or subcutaneous tissue

question

Simple repair are _____ to a procedure

answer

integral

question

Intermediate and complex repair when necessary are coded ________

answer

separately

question

When a benign or malignant lesion is excised and complex closure is performed during the same op session, _______ is reported

answer

2 codes (excision and complex closure)

question

When a scar is excised followed by complex closure, report ______ only

answer

the complex repair

question

When multiple lesions are excised during the same op session, report a code for the excision of______

answer

each lesion

question

When a malignant lesion is excised and the patient returns for further excision to ensure complete resection, report ______

answer

excision of malignant lesion even of no residual malignancy

question

If a lesion has multiple sides, select _____ as the diameter

answer

the largest size

question

When intermediate or complex repair is performed on multiple lesions, you should ________

answer

group according to site

question

Nails

answer

...

question

Most nail surgery is performed using ____ or ____

answer

local or digital block anesthetic

question

Nail surgery is typically done on ________

answer

toe nails

question

Nondystrophic nails

answer

normal nails with no abnormal development or changes due to aging, injury, or disease.

question

Nail Debridement

answer

generally done to treat hypertrophic dystrophic nails and mycotic (fungal) nails

question

How is nail debridement performed?

answer

mechanically bu using instruments such as a nail splitter, a nail elevator, and an electrical burr (sander)

question

What must be done for lacerations to the nail bed where the wound extends under the proximal nail fold?

answer

a portion or all of the nail plate must be removed in order to visualize the laceration

question

Report modifiers __ through ___ for procedures performed on a fingernail or toenail

answer

-FA through -F9

question

Pilonidal Cyst

answer

...

question

Pilonidal cyst defined

answer

contains a tuft of hair that developed as a result of repeated friction, which caused hairs to penetrate the skin occurring primarily in the sacro area

question

Introduction

answer

...

question

Codes in the introduction heading include

answer

-tattooing -injection -insertion -removal -replacement (contraceptive capsules, tissue expanders, hormone implantation, non biodegradable drug implants, filling material such as collagen)

question

T or F There are codes for intralesional injections for one or more lesions

answer

T

question

The use of anesthesia is ______

answer

integral

question

Do not report lesion injection codes with _______ codes unless separate lesions are injected with different agents

answer

intralesional chemo codes

question

Attach modifier ___ to intralesional codes if multiple are performed during op session

answer

-59

question

Defect

answer

wound that is the result of surgical intervention or trauma

question

Donor site

answer

anatomic sire from which healthy skin is removed

question

Primary Defect

answer

wound resulting from initial surgical intervention or trauma

question

Recipient site

answer

anatomic site to which healthy skin is attached

question

Secondary defect

answer

wound resulting from removal of tissue to create flaps or crafts

question

Stroma

answer

Supporting tissue (matrix) of an organ

question

Tissue approximation

answer

method of replacing sutures with material or substance which facilitates enhanced cosmetic results and faster healing of defects

question

Undermining

answer

process of suing a surgical instrument to separate skin and mucosa from its underlying stroma so that the tissue can be stretched and moved to overlay a defect

question

Repair (closure)

answer

...

question

The repair section requires additional _____

answer

medical knowledge

question

Simple< Intermediate, Complex Repairs

answer

...

question

Simple

answer

superficial only simple one layer primary suturing required

question

Intermediate

answer

One of the deeper layers of subcutaneous tissue and fascia are involved

question

Complex

answer

Requiring more than one layered closure

question

Single closure is coded as intermediate when

answer

the wound is heavily contaminated

question

Layered does not always mean intermediate

answer

True

question

Wound closures utilizing adhesive strips as the only repair material are reported with the appropriate _________

answer

E/M code

question

Wounds are reported in _______

answer

centimeters

question

Lengths of wounds should be _____

answer

added

question

Modifier 51

answer

...

question

Adhesive strips is a ______ code

answer

supply

question

Coding Wound Repair

answer

...

question

You should calculate the size of the wound in ___

answer

centi.

question

______ together all the wounds and report one code for same site wounds

answer

add

question

_____ should come first

answer

most complicated

question

When a physician locates a foreign body and removes it then report _

answer

code for removal only

question

Simple ligation of vessels is ___

answer

integral to wound repair

question

Simple exploration is _____

answer

integral to repair

question

Wound codes are based on ___

answer

lengths

question

Code 13160 is a code for

answer

secondary closure because the first failed

question

Wound repairs usually require _____

answer

local anesthesia

question

Anesthesia is ______

answer

integral

question

When closure can not be done through simple, intermediate, or complex then ________ or _________ is used

answer

-adjacent tissue transfer or rearrangement -Skin replacement

question

Adjacent Tissue Transfer or Rearrangement

answer

...

question

To calculate adjacent tissue transfer size

answer

combine the defect area with the defect area created by tissue transfer (in centimeters)

question

When a procedure is done to repair a secondary defect then

answer

report an additional code

question

Advancement flap

answer

movement of tissue in straight line from donor to defect site using a sliding process, once movement is achieved, the flap is sutured in place; advancement flaps are not rotated or moved sideways

question

Double Pedicle Flap

answer

Maintains blood supply from both ends of the flap incision made to create a curvillnear flap contiguous with the defect; flap is pivoted and sutured in place over the defect

question

Free Flap

answer

Island flap that is detached from donor site and reattached at recipient site via micro-vascular anastomasis

question

Islamd Flap

answer

Flap consisting of skin and subcutaneous tissue with a pedicle comprised only of nutrient vessels; also called island pedicle flap

question

Myococutaneous flap

answer

autologous graft consisting of both skin and muscle tissue from the donor site

question

Random pattern flap

answer

Mycocutaneous flap with random pattern of arteries

question

Rhomboid flap

answer

Random pattern flap that can be raised on any or all corners of a parallelogram configuration, typically 120 and 60 degrees; also called a limberg flap

question

Rotation flap

answer

Incision made to create a curvillinear flap contagious with the defect; flap is dissected, freed. pivoted, and sutured in place over the defect

question

Tissue Management

answer

Defined by anatomic site and size of defect; includes excision of the defect of lesion; terms used to describe transfer or rearrangement include Z-pasty, W-plasty, V-Y-plasty, rotation flap, advancement flap, and double pedicle flap

question

V-Y Plasty

answer

After creation of a V-shaped incision, the edges of the incision are drawn together and sutured, converting the incision to a Y shape

question

W-plasty

answer

Both edges of the wound or defect are trimmed into the shape of a W or multiple Ws

question

Z-Plasty

answer

Involves making an incision along with two additional incisions, one above and another below, creating a z formation

question

Skin replacement surgery and skin substitutes, Flaps, and other flaps and grafts

answer

...

question

autograph

answer

Xplantation of tissue from same individ.

question

Tissue cultured autografts

answer

supplied by labs

question

What modifier should be used with tissue cultured autografts

answer

58

question

Why use modifier 58 with tissue cultured autographs

answer

Bc labs can grow a limited amount of tissue so they are staged procedures

question

Acellular dermal replacement

answer

Bioengineered artificial skin

question

Allograft

answer

Xplantation of tissue from someone of the same species

question

xenograft

answer

Xplant from a different species (pig, cow, etc)

question

2 types of skin grafts

answer

Free skin graft Pedicle graft

question

2 classifications of free skin grafts

answer

Full thickness Split thickness

question

Free skin grafts

answer

Completely separated from donor site

question

Full thickness skin graft

answer

Includes epidermis and dermis

question

Split thickness skin graft

answer

Entire epidermis and portion of dermis

question

Where are full thickness skin grafts oftern harvested?

answer

From inguinal folds, supraclavicular region, abdomen, thigh, and postauricular skin bc of the availability of excess skin in those regions

question

When are split thickness grafts used?

answer

To repair edematous, infected, or large wounds (such as burns)

question

Before coding a skin graft the area over the graft should be free of infection or other disease, if it requires the recipient area to be cleansed what should also be reported with the skin graft code?

answer

A surgical preparation code

question

Do codes include simple debridement when coding grafts?

answer

Yes for the recipient area only, if the donor site requires debridement it must be coded additionally

question

Example: If a patient needed a graft for the nose and this was accomplished by using the cheek; however, the cheek needed to be repaired as well and this was done using the thigh. What is the donor site you would code?

answer

The cheek bc it was a donor site that required a graft for repair

question

Pedicle skin grafts

answer

Not immediately separated from donor site, a portion is xferred to the recipient site and the remaining portion (base) is attached to the donor site so that there is a vasculature and nerve supple to recipient area. After the recipient area's blood flow is good the base is then grafted.

question

What is the delay technique

answer

Used to improve blood supply to the base of a flap, by temp. obstructing blood supply to the flap to allow a relatively long flap to be xferred onto a narrow pedicle

question

When you assign skin grafts what should you identify

answer

1. Type of graft 2. Recipient site 3. Surface area of recipient site by cm.

question

t/f only one type of skin graft is usually applied to an anatomical locationt/f only one type of skin graft is usually applied to an anatomical location

answer

true

question

if multiple anatomic locations require different grafts what modifier should you use

answer

59 to reported as a different site

question

If a benign/malignant lesion is excised and the surgical prep and free skin graft are performed how many codes should be reported?

answer

2 (one for the excision of the lesion and another for the graft)

question

How many codes are reported if a lesion is excised with a flap closure?

answer

1 just the flap closure

question

t/f generally, debridement of nonintact skin in anticipation of a skin graft is necessary prior to the application of the skin graft and is included in the skin graft?

answer

true

question

If skin is intact when is the graft performed?

answer

After excisional prep of intact skin, so an excisional preparation are separately reported.

question

If multiple tissue rearrangements and skin grafts procedures are required during the same operative session you must make sure you _______

answer

Report each one separately and do not add together the total sq. cm for repair of different defects

question

An adjacent tissue xfer or rearrangement requires hwo many codes

answer

1

question

How many codes required for a free skin graft?

answer

2 or more (graft, surgical prep, repair of donor site if needed)

question

How many codes needed for a flap (skin and or deep tissue)

answer

1 or more (flap and repair of donor site if needed)

question

Other flaps and grafts require how many codes?

answer

1 or more (flap/graft and the repair of site)

question

Dermabrasion

answer

Performed for conditions such as acne scarring, wrinkles, rhytids, and keratosis. Uses a rotary devise to sand down the raised lesions or thick skin

question

-What codes should be used for tattoo removal? Why

answer

15780-15782 bc tattoo removal usually involves the dermis

question

Is microdermabrasion classified in cpt

answer

No, which means unlisted code 17999 is used

question

Microdermabrasion

answer

Skin freshening technique used to repair facial skin that is damaged by the sun or aging. Uses a sandblaster device used to spray tiny crystals across the face

question

chemical peel

answer

Involves the use of chemical agents to remove wrinkles and abnorm. Pigmentation

question

Actinic keratosis (AK)

answer

Common sun induced lesion of the epidermis with potential to become skin cancer.

question

AK is usually treated by what procedures

answer

Cryosurgery with liquid nitrogen, topical drugs, and curettage.

question

Blepharoplasty

answer

Any surgical repair of the eyelid

question

What does a blepharoplatry do?

answer

Remove the orbicularis muscle, orbital fat, and excess eyelid around the orbit

question

What is a blepharoptosis repair?

answer

Performed on the levator muscle of the eyelid

question

Should you use a modifier with a blepharoplasty code?

answer

Yes, to indicate which eyelid

question

Rhytidectomy

answer

Excising a section of the skin to eliminate wrinkles and can be done to reduce glabellar frown lines

question

Glabellar frown lines

answer

Vertical furrows in the forehead and btw the eyebrows

question

Graft procedures for facial nerve paralysis involves what

answer

The removal of connective tissue from the body, the graft is then xplanted to the face to reanimate previously paralyzed areas

question

Abdominal panniculectomy aka

answer

Abdominoplasty

question

What is an abdominoplasty

answer

Performed to remove fatty tissue and excess skin from the lower to middle portions of the abdomen

question

When is an abdominoplasty normally performed

answer

On individs who have lost considerable weight

question

lipectomy

answer

Removal of localized subcut fat deposits by suction curettage or blunt cannulization

question

When a physician does a suction-assited lipectomy what is done

answer

A liposuction cannula is inserted through the fat to remove excess deposits

question

Is it appropriate to report a separate code for each area of liposuction to the trunk?

answer

yes

question

Pressure Ulcers (Decubitus Ulcers)

answer

...

question

Pressure ulcer aka

answer

1. Decubitus ulcer 2. Bedsore

question

Pressure ulcer

answer

Ulceration of the skin and underlying tissue

question

Pressure ulcers result in

answer

Inflammation, swelling, necrosis, ulceration, and infection

question

Does the primary excisional procedure of a staged process include the flap/graft procedures?

answer

No they are reported separately

question

If a muscle or myocutaneous flap is planned for a subsequent session prospectively what should be reported

answer

The appropriate flap code and modifier 58

question

Burns, Local Tx

answer

...

question

Is the application of material such as biobrane included in burn txs?

answer

yes

question

What should be identified when coding burn txs

answer

1. Percent of body surface 2. Severity of burn

question

What is the severity of burn classified into

answer

1. Partial thickness (first and second degree) 2. Full thickness (third degree)

question

What do you use to determine the extent of body surface involved in the burn

answer

The rules of nine

question

Rules of nine

answer

Divides the body into 9 segments by percentage, this differs by the patients age

question

Rules of Nine

answer

1. Head = 4 ½ 2. Arms 4 ½ ea 3. Legs 9 ea 4. Trunk 18 5. Genital 1

question

Destruction

answer

...

question

Destruction

answer

The ablation of tissue by any method

question

Should you report a separate code for debridement when the intended procedure is performed during the same session as the debridement?

answer

No, its integral

question

Destruction of benign or premalignant lesions and destruction of malignant lesions, any method

answer

...

question

Each lesion treated is report as

answer

a separate code

question

Mohs micrographic surgery

answer

...

question

What is mohs micrographic surgery

answer

An advanced tx proceure used to treat basal cell carinome and squamous cell carcinoma skin cancers

question

Dermatologists trained in mohs surgery serve as ___, ___, and ___

answer

Surgeon, pathologist, and reconstructive surgeon

question

How is mohs surgery performed?

answer

By using a microscope to trace and ensure the removal of skin cancer to its root

question

t/f reporting both mohs surgery codes and surgical pathology codes together is inappropriate

answer

true

question

if a mohs surgeon performs a diagnostic biopsy to make sure the decision to perform the procedure is appropriate what codes are reported?

answer

The biopsy code is reported separately with a modifier 58

question

breast

answer

...

question

What may be used to detect breast cancer

answer

1. Mammo 2. Ultrasound 3. Mri 4. Fna 5. Core biopsy 6. Surgical biopsy

question

What tx plans may be used to treat breast cancer

answer

1. Mastectomy 2. Radiation 3. Breast reconstruction 4. Etc

question

What may not be reported separately at the time of a lesion excision of the breast when there is an ESTABLISHED dx

answer

Fna biopsies, core biopsies, open incision/excision biopsies, and related procedure (unless performed on a different lesion or on the other breast)

question

If there is not an established dx and the decision to perform surgery is dependent on the biopsy, can the biopsy code be reported separately

answer

Yes, with modifier 58

question

Breast biopsies are performed in what 3 ways

answer

1. Fine needle aspiration 2. Needle core 3. Open

question

Needle core biopsy is classified in what 2 ways

answer

1. Hand operated 2. Sterotactic localization

question

What 2 ways is open biopsy classified

answer

1. Excisional 2. Incisional

question

Fine needle aspiration

answer

...

question

Fna of the breast is reported depending on ______

answer

Whether imaging guidance was used during the procedure

question

Describe an fna

answer

Uses a thin needle to insert through the mass several times. Suction is applied as the needle is withdrawn to obtain stands of single cells from ctologic dx

question

If an fna is performed using imaging guidance or sterotactic localization what other code should be reported

answer

77031

question

Needle core biopsy

answer

...

question

Describe needle core biopsy

answer

After tissue is obtained it is fixed for routine pathologic section

question

Sterotactic localization

answer

Indicated for nonpalpable lesions bc it uses specialized 3d imaging to target the lesion

question

What is used to obtain a needle core biopsy

answer

The breast is placed in fixed position and a biopsy gun is used

question

Should you use an additional code with a needle core biopsy

answer

Yes, such as one for sterotactic localization or mammo guidance

question

t/f a biopsy code is assigned for each biopsied site when done by needle core?

answer

True, example if 3 needle core biopsies sites are performed then you will have 3 codes

question

Open biopsy

answer

...

question

Open biopsy

answer

Incision/excisional depending on the amount of the lesion removed'

question

Excisional biopsy

answer

Removes the lump or suspicious area in it entirety

question

Incisional biopsy

answer

Removes a portion of the lesion by slicing into it and is usually performed on large tumors

question

What does excisional breast surgery include

answer

1. Certain biopsy procedures (precut or open) 2. Removal of cysts or other lesions 3. Surgical tx of the breast and chest wall malignancies

question

An excisional biopsy is not a ______

answer

Lumpectomy

question

What is a lumpectomy

answer

A partial mastectomy

question

Should you report modifiers indicating which breast when a breast procedure is performed?

answer

yes

question

When more than one lumpectomy is performed in different areas of the breast what modifier should be used

answer

51

question

mastectomy

answer

...

question

What does partial mastectomy procedures describe

answer

Open excisions of breast tissue with specific attention to adequate surgical margins.

question

partial mastectomy

answer

Making an incision the skin and fascia over the breast tumor and clamping lymphatic and blood vessels, then excision of the tumor mass along with a section of the breast tissue is done

question

Partial mastectomy aka

answer

1. Lumpectomy 2. Quadrant ectomy 3. Segmental mastectomy 4. Tylectomy

question

Total mastectomy procedures include

answer

Complete mastectomy, modified radical mastectomy, simple mastectomy, and subcut mastectomy

question

Define total mastectomy

answer

Surgical removal of the entire breast, including the pectoral fascia and a sampling of axillary lymph nodes

question

Define radical mastectomy

answer

Total mastectomy that includes removal of the breast and nipple, pectoral muscles, axillary lymph nodes, and internal mammy lymph nodes

question

Define modified radical mastectomy

answer

Total mastectomy that includes removal of the breast and nipple, axillary lymph nodes, and pectoral minor muscle

question

Breast repair and reconstruction

answer

...

question

What elements are included in the breast reconstruction codes

answer

1. Elevation and xfer of the flap 2. Closure of the donor site 3. Breast contouring 4. Insertion of breast implant or prosthesis, when performed

question

Breast reconstruction with TRAM flap refers to

answer

A single pedicle that includes closure of the donor site

question

Tram

answer

Transverse rectus abdominis myocutaneous flap

question

Tram flaps include what

answer

1. Creation of breast pocket 2. Elevation of ab flap 3. Muscle dissection 4. Flap xfer 5. Fascial closure (donor site) 6. Ab closure 7. Breast contouring

question

Are the excisions of lesions during the same op session as a mastectomy reported separately

answer

No, unless performed to est. the malignat dx before proceeding to the mastectomy (use modifier 58 if this happens)

question

What other types of codes are generally integral with mastectomy codes

answer

1. Other integumentary codes for incision and closure 2. Biopsy lymph nodes 3. Removal of muscle tissue 4. Ipsilateral lymph node dissection

question

If a breast lesion is identified and treated and medical necessity indicates that biopsy of the other breast is needed can you report a separate code

answer

Yes, be sure to use a modifier to indicate which breast

question

t/f breast reconstruction codes also include the insertion of a prosthetic implant and they are not reported with cpt code that describe the insertion of breast prosthesis only

answer

true

question

if breast procedures are performed on both breast what modifier should be used

answer

50

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