Unit 7 - Seminar

A 2 x 2 cm lesion was excised from Mrs. Smith’s right arm. The lesion and 1mm margins all around the lesion were excised.

What is the excised diameter of this excision?

What is the difference between simple closure and intermediate closure of a wound?

Practice Exercises

Exercise 11.5 – Lesion Removal

Assign the CPT code(s) and any appropriate modifier(s) to each statement

1. A physician excises a 1 cm lesion of the left forearm, and the defect is closed with a simple repair.

2. Punch biopsy of a skin lesion on the back and another one on the arm.

3. Excision of a 2.1 cm malignant lesion of the nose and two malignant lesions, including margins, of the chest, each 1.5 cm diameter, including margins.

4. Four warts were removed by paring.

5. A physician excised a 2 cm benign lesion from the face.

Exercise 11.6 - Nails

Assign the CPT code(s) and any appropriate modifier(s) to each statement.

1. A diabetic patient was seen by a podiatrist for trimming of nondystrophic nails, which are unaffected by abnormal development or changes in structure or appearance. Following cleansing and drying of all toenails of both feet, clippers are used to cut each nail straight across so that it is in line with the edge of the end of the toe.

2. Reconstruction of nailbed, second toe on left foot, with graft.

3. Avulsion of nail plate, simple, 5 nails, right foot.

4. The physician evacuated blood from a hematoma located beneath a patient’s fingernail, second digit, left hand. The physician used an electrocautery needle to pierce the nail plate so the hematoma can drain. Pressure was applied to the nailbed to force the blood from beneath the nail plate. A loose dressing was applied so the area can continue to drain.

5. Wedge excision of skin of nail fold for ingrown toenail, third digit, right foot.

Exercise 11.7 – Pilonidal Cyst

Assign the CPT code(s) and any appropriate modifier(s) to each statement.

1. Excision of complicated pilonidal cyst.

2. Pilonidal sinus excision, simple.

3. Excision of extensive pilonidal cyst.

4. The physician shaved hair adjacent to a pilonidal cyst and made an incision to allow drainage of cystic fluid.

5. The patient presented with an infected pilonidal cyst (complicated). The cyst was incised and drained.

Exercise 11.11 – Breast

Assign the CPT code(s) and any appropriate modifier(s) to each statement

1. Excision of two lesions, right breast, identified by the placement of radiological markers for each.

2. A transverse rectus abdominis myocutaneous flap procedure for right breast reconstruction is performed using a single rectus adbominis muscle to transfer the necessary tissue to form a breast mound.

3. Lumpectomy, left breast.

4. Physician performed a partial mastectomy of the right breast with right axillary lymphadenectomy and biopsy of the right sentinel node.

5. Patient’s left breast lesion was localized for needle biopsy. Mammographic images were obtained to verify needle placement with regard to the lesion. After verifying the position, the biopsy was obtained and postbiopsy targeted mammographic imaging was performed. A metallic clip marker was placed through the same instrument at the site of tissue removal, using the same guidance. A mammogram after the procedure confirms the location of the clip in the breast for future reference.

Review – Multiple Choice

1. Which is a therapeutic surgical procedure?

a. Arthroscopy

b. Biopsy

c. Endoscopy

d. Repair

2. A patient undergoing a surgical procedure was draped and positioned. ….

Which service is assigned a separate code?

a. Administration of a sedative

b. None of the services are reported separately

c. Taking cultures

d. Transcription of the dictated report

3. Which modifier indicates a staged procedure or service?

a. -58

b. -59

c. -66

d. -76

4. When a patient receives treatment for an unrelated condition during the global period, which modifier is added to the CPT code?

a. -51b. -57c. -59d. -79

Chapter 12

Review

(pp. 502-504)

Chapter 12

Coding Cases

(pp. 504 – 506)