Ch.11 CPT Surgery – Flashcards
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The physcian reported a bronchoscopy to assess the pt's lung anatomy prior to performing a lobectomy, report 32480 (removal of lung,single lobe). Do you report a code for the bronchoscopy?
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no cause its a scout endoscopy, part of establishing the surgical approach (identifying anatomic landmarks)
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T/F if an endoscopy is performed initially to diagnose the pt on the same day as the open procedure the endoscopy is seperately coded and reported
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True modifier 58 is added to indicate staged procedure
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T/F If endoscopic procedures are performd on distinct seperate areas during the same session seperately report each procedure
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True (except for brief bronchoscopy for procedure laryngoscopy)
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what is included in the surgical package?
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topical anesthesia, one related e/m service following decision 4 surgery, postoperative care, eval of pt in post anesthesia recovery area
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How to determine the global period for major surgeries?
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count the day before the day of surgery, the day of surgery, & the 90 days following
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What is the global period for minor surgery?
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0-10 days
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The 10 day global period includes
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the day of surgery and the 10 days after
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When a pt receives treatment for an unrelated condition during the global period, what mod is added?
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add -24 to e/m service & -79 to surfical service
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T/F The CMS global surgical package does not include initial consulatation or eval services by the surgeon to determine need for surgery
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true
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A pt underwent ventral hernia repair performed by a general surgeon, when the pt is seen by the general surgeon for follow up care related to the ventral hernia repair and such care is provided within the global period, what do u report?
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payment for such follow up care is bundled in the CPT code for the ventral hernia surgery
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An excision of a malignant lesion on the left arm is performed in the office on May 10. The postop global for code 11606 is 10 days. the pt return to office on May 15 and is treated for conjunctivitis. Report e/m code and add?
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modifier 24 (unrelated e/m service by same doc)
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when an e/m service provided is for the purpose of deciding to perform a major surgical procedure, what mod is added?
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add -57 (decision for surgery)
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according to cpt, follow up care for diagnostic procedures includes only?
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that care related to recovery from the diagnostic procedure itself
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T/F When a physician treats the pt's condition for which the diagnostic procedure was performed after the diagnostic procedure, a separate code should be reported?
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True
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What 5 codes for services provided should be reported (seperately) when a physician treats the following during the postop global for therapeutic procedures?
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1.complications, 2.exacerbations,3. recurrence ie cancer, 4.presence of other diseases,5. injuries
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What is the code reported separately for when physician provides supplies & materials over & beyond the supplies usually included with the procedure rendered?
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99070
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Medicare will no longer reimburse the physician for what code?
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99070
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add on codes are exempt from which mod?
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-51
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when do you report the separate procedure code in addition to codes for other procedures? & what mod is added?
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for a different session, separate incision/excision, separate injury; add -59 (distinct procedure)
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what can be used as a special report?
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operative report
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what code is used for experimental procedures?
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42999
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Integumentary procedures are often performed as?
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staged procedures
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what is a procedure that establish a drainage pathwat for fluid that forms at sites of infection?
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Incision & Drainage
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t/f report a code for the Incision & drainage, when a procedure to excise a lesion results in drainage of an area, either as a part of the procedure or as a way to gain access to the lesion, if the excision or another is performed during the same time
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false, do not report a code for I&D
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can the original surgery code be reported with the procedure to treat the complication?
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no report code for surgical complication only! (the NCCI edits will deny reimbursement for the procedure performed to treat complication)
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1 elliptical excision was made to remove 2 nevi from the patients left arm. Lesion A was 3cm in diameter, and lesion B was 2cm in diameter. skin margins were 4mm at each end of the ellipse and 2 mm btwn the 2 lesions. simple closure was performed what is the size for the lesions?
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lesion a is 3.5; lesion b is 2.5 (the narrowest margin for each end is 4 mm=.4cm) (narrowest margin btwn each leasions is 2mm=.2cm)
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if an operative report describes the diameter of a lesion as having multiple sites, what do u calculate?
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select the largest size as the diameter ie (2cm x 3cm x 5cm) is 5cm
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T/F a benign or malignant lesion is excised & complex closure is performed during the same operative session 2 codes are reported
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true
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t/f when a scar is excised followed by complex closure, report the complex repair code only
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true
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t/f when a malignant excison is excised and the pt returns for further excision to ensure that the malignancy has been completely resected, do not report a code for excision again
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false, do report excision of a malignant lesion even if report documents no residual malignancy
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when drugs are injected directly into the lesion it is appropriate to report?
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level 2 national codes for meds administered
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are cpt codes 11900-01 reported determined by the # of lesions treated or by the # of injections
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by the # of lesions treated
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with coding wound repairs what is 1 of the deeper layers of subcutaneous tissue & fascia involved
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intermediate
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with coding wound repairs which requires more than 1 layered closure ie debridement, revision?
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complex
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with coding wound repairs which is a single layer heavily contaminated & requires extensive cleaning ?
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intermediate
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when a physician documents layered closure dont assume an intermediate repair code is to be reported; locate documentation of?
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closure of subcutaneous tissue or (more than 1 layer beneath the dermi) &/or extensive cleaning or removal of foreign matter from heavil contaminated wound that is closed with a single layer
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you cant add multiple wound lengths together t/f?
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false you can add together by same category
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what do you report as 1st listed procedure for wound repairs ?
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the most complicated service
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t/f do not separately report codes for the repair of nerves, blood vessels & tendons (from the specific body system involved?
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false
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patient underwent excision of nasal scar. an advancement flap from the cheek was used to repair scar removal defect . a full thickness skin graft was used to close the 4 x 2cm flap donor site, cheek defect, what do you report & why?
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code for advancement flap from cheek & code for the full thickness graft (14060 & 15240-51) ; why?when a procedure is performed to repair a secondary defect (ie site of donor advancement flap) report an addtl procedure code for the repair (ie full thickness skin graft)
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free skin grafts are also known as?
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full thickness skin grafts
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what are grafts typically used to repair edematous, infected, or large wounds (ie result of burns)?
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split thickness grafts
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what are grafts often harvested from inguinal folds, supraclavicular region, abdomen, thigh, & postauricular skin?
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full thickness skin graft
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t/f free skin grafts dont include repair of the donor site with skin grafts or local flaps
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true, they include simple debridement but u have to report addtl codes when the donor site is repaired
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when assigning codes for skin grafts identify what?
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type of graft (ie perm. or temp.), recipient site (anatomic location), surface area of the recipient calcuated in cm
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code descriptions for skin substitute & dermal substitute refer to?
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nonpermanent grafts
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when multiple anatomic locations require different grafts, what mod. is added?
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-59 to the codes to indicate different sites underwent grating
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when a beningn/malignant lesion is excised & surgical preparation & free skin grafting are performed, what codes are reported?
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excision lesion code, skin graft code
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t/f when a benign/malignant lesion is excised with flap closure just the excision lesion code is reported
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false, the flap closure code is reported
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the removal of sutures by a physician other than the surgeon who initially placed the sutures in, is usually reported with?
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an e/m code
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to assign codes for the treatment of burns review the medical record to identify what?
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% of body surface, severity of burn, & extent (rule of 9s)
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during destruction,excision,incision,removal,repair,or closure procedures, do u report separate code for debridement?
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no the debridement is considered a necessary part of the total procedure
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what modifier is usually used for Moh's micrographic surgery?
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-58 staged or related procedure is attached to the diagnostic biopsy & moh's surgery
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t/f if a diagnosis is not established & the decision to perform th excision or mastectomy is dependent on the results of the biopsy, the biopsy is separately reported
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true add -58
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what are biopsies that are hand-operated needle & stereotactic localization?
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needle core biopsy
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what are biopsies that are excisional & incisional?
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open biopsy
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for a stereotactic localizaion, do you report addtl code for radiographic imaging?
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yes report from radiology section for stereotactic & codee for needle core biopsy from surgery section
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which biopsy removes the lump or suspicious area in its entirety?
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excisional biopsy
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which removes a portion of the lesion by slicing into it or incising it , usually performed on large tumors?
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incisional biopsy
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if the operative report indicates that the biopsy was incisional & the pathology report indicates that the entire lesion was removed, do you report it as an excision or incision?
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excisional biopsy
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what is the difference btwn total & radical mastectomy?
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a total mastectomy is removal of the entire breast and a sampling of axillary lymph nodes; a radical mastectomy includes the breast & nipple, pectoralis muscles, axillary nodes & internal mammary lymph nodes
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t/f if the breast excision is performed to obtain tissue to determine pathologic diagnosis of malignancy prior to proceeding to a mastectomy, the excision is not separately coded
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false, it is separately coded & reported with the mastectomy code & mod 58 is added to the codes
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t/f need to biopsy lymph nodes or remove muscle tissue in conjunction with mastectomies are included in cpt coding for mastectomy
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true
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t/f when a breast lesion is identified & treated & medical necessity indicates that biopsy of other nodes should be done, report the biopsy or lymph node dissection codes too
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true add an modifier like -lt or -rt
