Question

Assign the correct CPT codes for each case study.

Case Study # 1:

Preoperative Diagnosis: Angina

Postoperative Diagnosis: Patent coronary arteries and grafts, ASHD present

Procedure: Right and left heart cath with coronary angiography

The patient was brought to the cath lab in a fasting state. The right going was prepped and draped in the usual sterile fashion. After local anesthesia was administered, sheaths were placed percutaneously into the right femoral artery and vein. IV heparin 3,000 units were given. Using a thermodilution catheter, right heart pressures were measured, and thermodilution cardiac outputs and AV oxygen differences were obtained. A pigtail catheter was inserted into the left ventricular cavity, and simultaneous left ventricular pressures were measured. A pullback was obtained across the aortic valve.

Using a 7R4 catheter, angiography was performed of the right coronary artery and both vein graft. A 7L4 was used for angiography of the left coronary artery. Additional attempts were made to image the vein graft to the right coronary artery with a right coronary artery bypass catheter. The pigtail catheter was reinserted, and left ventricular angiography and aortic root angiography were performed. The patient tolerated the procedure well and returned to the recovery room.

DX Codes: I25.10, I20.9, Z95.1

CPT Codes:

Case Study # 2

History and Indications: The patient is a 70 year old female who previously underwent a cholecystectomy but presents again with similar pain in the right upper quadrant in the presence of disturbed live function studies.

Procedure: ERCP sphinctereomty and stone extraction. The Olympus Vedeo side-viewing duodenoscoped was atraumatically introduced into the esophagus and advanced with slide-by technique into the stomach. The gastric mucosa was normal. The pyloric channel was normal and easily intubated. The first and second part of duodenum were visualized. The ampulla appeared normal. Initial cannulation was precurved catheter revealed a normal pancreatic duct. A single injection was made into the pancreas. Repositioning was accomplished with the assistance of a straight 0.035 guidewire, and free cannulation and injection of the papilla of Vater was accomplished. Full visualization of the common duct was obtained, revealing a large multifaceted free-floating stone within the proximal duct. The intrahepatic biliary system appeared normal . The extrahepatic biliary system appeared dilated. An exchange was made with the 20-millimiet shpincterotome and sphincterotomy was performed with perfect hemostasis. The duct was then swept with a 15 millimeter stone extraction balloon, and the stone was pulled into the duodenal lumen. The duct was “swept” two more times with negative results. Additional spot and overhead films were obtained to confirm clearance of all stone material. The procedure was terminated with the patient in satisfactory condition, and she was returned to the recovery area.

Assessment: Choledochlithiasis associated with obstruction

DX Codes: K80.51

CPT Codes:

Case Study # 3

The patient is a 77 year old female who has been in generally good health until last month, when she developed a crusty lesion inside the left naris. She initially treated it will Vicks ointment. When it failed to heal, she decided to seek medical attention. Her PCP biopsied this lesion, and the pathologic diagnosis was squamous cell carcinoma of the left internal nasal ala. She is posthysterectomy for endometrial carcinoma 10 years. She has smoked 1 ½ packs of cigarettes each day for the past 40 years.

The patient presented to the outpatient surgery center of the hospital for wide excision of the left internal nasal alar lesion, which is less than .5cm in diameter. This procedure included a full0thickness resection in the middle and posterior thirds of the lateral cartilage, along with vestibular skin and mucous membrane. Nasal reconstruction was required to provide an acceptable cosmetic appearance following excision. A flap graft composite reconstruction was utilized for primary course of the defect that was left following excision, using donor tissue from the right arm and requiring primary closure of a 2-cm graft.

DX Codes:C30.0, Z85.42, F17.210

CPT Codes:

Case Study # 4

Preoperative Diagnosis: Lesion, Right forehead

Postoperative Diagnosis: Basal cell carcinoma, right forehead

Procedure: Excision of 1.0 centimeter lesion involving the right forehead

Technique: The sin and subcutaneous tissue around the forehead lesion were infiltrated with 0.5% Marcaine with 1:100,000 epinephrine. A total of 1.5 cc was used. The patient was then prepped and draped in the usual sterile fashion.

Microscopic excision was carried out. A 2.0 mm margin of resection was planned around the lesion. Long suture was placed on the superior margin and a short suture was placed on the inferior margin. The tissue was excited and sent for frozen section, which returned with a diagnosis of basal cell carcinoma with clear margins. The site was closed with interrupted 5-0 plain gut. The patient was sent to the recovery area in good condition. No complications. Blood loss was 1cc.

DX Codes: C44.319

CPT Codes:

Answer 1

CPT codes used for surgical procedures. it is diffrent for every surgery procedures. it depends on size, type of surgery.

Case study 1. CPT for the right heart and left heart catheterization with coronary and bypass graft angiography is 93461. This measures both right and ventricular pressure in the heart and coronary arteries and graft in the coronary artery. Even though catheter are used separated, it measures the right coronary and left coronary artery and graft

Case study 2: CPT for the ERCP procedure with stone removal from the extra hepatic biliary system after sphincterostomy is 43264

CASE study 3: CPT code is a wide excision of internal alar lesion is 30125 which involves skin, mucous membrane and cartilage and CPT code for the reconstructive surgery is 30400. resconstrcutive surgery is done to appear for normal shape

Case study 4: 11641 IS Excision and resection of the lesions of the forehead. the tissue is excised and resected for biopsy and close the wound. the tissue is sent for surgical procedure.