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Question 1
A 28-year-old patient taken to the same-day surgery unit with a histo
Question 1
A 28-year-old patient taken to the same-day surgery unit with a history of abdominal surgery and is experiencing sharp pains in the pelvic area. Diagnostic workup has presented no etiology. An exploratory laparoscopy was performed and revealed adhesions around the fallopian tubes and ovaries. The adhesions were taken down during the procedure
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Question 2
A patient with a lung mass in the left lower lobe that was discovered on prior x-ray presents to the outpatient surgery area for a diagnostic bronchoscopy. Following anesthetic to the airway, a fiber optic bronchoscope is introduced into the bronchial tree. A needle is advanced through a channel in the scope, and tissue is aspirated from the lung mass for pathologic evaluation under fluoroscopic guidance.
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Question 3
An 81-year-old male patient was taken to the special procedure unit for cystoscopy after developing gross hematuria. The cystoscopy revealed a 2.5 cm. tumor in the trigone and a 2.1 cm. tumor of the posterior wall. Both tumors were fulgurated. The patient was diagnosed with urothelial cell carcinoma.
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Question 4
A 19-year-old patient with an abnormal blood test underwent a bone marrow aspiration from the sternum. The area was cleaned with antiseptic solution, and a local anesthetic was injected. The needle was inserted beneath the skin and rotated into the cortex and the sample taken. The needle was repositioned slightly, and a new syringe attached, and a second sample was obtained. These were then sent to the lab for analysis. The results showed ALL.
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Question 5
An ambulatory surgery operative report for a 72-year-old male patient states the patient received a full-thickness graft of the cheek following lesion removal of a basal cell carcinoma. The lesion plus margins are documented to be 3.2 cm. in diameter. A 10-sq-cm. graft is applied with donor skin from his thigh, closed by suture.
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Question 6
A 34-year-old male was taken to the outpatient surgery unit for a laparoscopic cholecystectomy. Due to the previous abdominal surgery, adhesions were encountered. During the course of the laparoscopic cholecystectomy procedure, the adhesions were lysed, but this did not prolong the procedure.
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Question 7
A 48-year-old female presents to the outpatient surgery unit of the hospital with a complaint of neck swelling. The physician noted diffuse swelling of the neck with enlargement of the thyroid gland. The patient exhibits no clinical signs of hyperthyroidism. The physician suspects lymphoma, and a biopsy is performed. A large, hollow core needle is passed through the skin into the thyroid using ultrasound guidance. Tissue is sent for histopathology. A diagnosis of thyroid gland follicular lymphoma is confirmed, and chemotherapy is planned.
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Question 8
A 54-year-old female patient came into the Emergency Department (ED) because of passing melanotic stools. The ED physician initially saw her. The gastroenterologist was called into consultation. Because of the massive amounts of bleeding, it was decided to proceed with endoscopy. The endoscope was passed into the esophagus, stomach and duodenum. Blood and clots were noted. This patient could possibly have a duodenal ulcer, but because of the amount of blood, it was difficult to delineate an ulcer crater. Code the CPT code for the procedure only. Do not code any E/M codes.
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Question 9
A 62-year-old male patient is being assessed for possible colon cancer and treated in the special procedure unit of the hospital. He undergoes a colonoscopy into the ascending colon with biopsy of a suspicious area in the transverse colon using the cold biopsy forceps. In addition, a colon ultrasound of the area is performed, with transmural biopsy of an area of the mesentery adjacent to the transverse colon.
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Question 10
A 40-year-old female patient with multiple suspicious breast lesions had percutaneous biopsies of the left breast using stereotactic guidance on two lesions and ultrasound guidance on one lesion
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Question 11
A 51-year-old male was brought to the same-day surgery area for treatment of the open fracture of the distal phalanx of his index finger on the left hand. The patient had open treatment performed to remove the fracture fragments without any internal or external fixation hardware used.
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Question 12
A patient is diagnosed with a recurrent thyroglossal duct cyst. The surgeon locates the cyst using palpation, and an incision is created. The cyst is then excised.
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Question 13
A patient was hit in the face by a baseball on the neighborhood baseball field. They sustained a 2.3-cm. superficial laceration to the right medial cheek. X-rays revealed a nasal fracture that required stabilization. The Emergency Department physician stabilized the fracture with a splint and tape and repaired the laceration with a simple suture of the skin.
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Question 14
A 40-year-old patient under local anesthesia and ultrasound guidance, underwent radiofrequency ablation of an incompetent greater saphenous vein in the right lower extremity.
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Question 15
A patient presents to the hospital outpatient department for chemotherapy treatment. She is a 15-year-old female with acute lymphoblastic leukemia. The chemotherapy agent is listed as an injection of lyophilized cyclophosphamide, 200 mg. IV push. Code both the CPT code and HCPCS code for this scenario.
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Question 16
A 77-year-old patient was admitted to the special procedures room for an endoscopic-directed percutaneous endoscopic gastrostomy tube placement because of moderate malnutrition.
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Question 17
A 40-year-old male patient was taken to the same-day surgery suite to have a colonoscopy. During the procedure, it showed diverticulitis of the descending colon that was bleeding, which was controlled with the laser.
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Question 18
A 43-year-old female patient presents for wide excision of a 2.0 cm. malignant melanoma of the left thigh. The area excised resulted in a 4.3 cm. x 2.5 cm. defect requiring rotational advancement flap closure. The pathology report shows clear margins.
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Question 19
A 48-year-old female had recent surgery for melanoma of the left arm, documented as Clark level IV. She has no obvious signs of metastasis or adenopathy, but staging needs to be done. In the nuclear medicine suite, the skin surrounding the lesion was injected with Tc-99 sulfur colloid. The patient was subsequently taken to the OR three hours later. Under general anesthesia, the skin was injected with 4mL of isosulfan blue dye. The gamma probe was used to identify the location of the hot spot in the nodal basin. An incision was made, and a blue node was identified. This deep axillary sentinel node was excised in its entirety and sent for frozen section, which proved to be positive for melanoma.
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Question 20
A patient with advanced renal cell carcinoma of the right kidney is admitted to the interventional radiology department to undergo percutaneous radiofrequency ablation of four tumors of the right kidney. This was accomplished under CT guidance.
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Question 21
HCPCS Level II code(s) for advanced life support defibrillation supplies
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Question 22
HCPCS Level II code(s) for routine disposable supplies used during a basic life support transport
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Question 23
HCPCS Level II code(s) for a CPAP device
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Question 24
HCPCS Level II code(s) for diabetes self-management training, group session, per 30 minutes
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Question 25
HCPCS Level II code(s) for a sacroiliac joint injection for arthrography
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Question 26
HCPCS Level II code(s) for a blood tubing, venous, for hemodialysis
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Question 27
HCPCS Level II code(s) for an injection of dilaudid, 4 mg.
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Question 28
HCPCS Level II code(s) for an injection of Botox, two units
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Question 29
HCPCS Level II code(s) for a skin protection wheelchair seat cushion, adjustable, 28 inches in width
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Question 30
HCPCS Level II code(s) for a portable whirlpool
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Question 31
Explain the imperative of upholding high personal and professional ethical standards and obligations as a coder. As you explain, offer examples of how you believe ethical conduct and standards can help advance your career and the coding and/or health care professions as a whole.
Your response must be at least 300 words in length.
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