Reference no: EM133137032

Question: Use codes from the surgery section of CPT to code for the following procedures. Use modifiers where appropriate and remember to sequence the most complex procedure first.

Integumentary System:

1. Removal of 20 skin tags.

2. Closed reduction of closed fracture, clavicle, with manipulation

3. Suture of superficial wounds of neck (3cm) and layer (intermediate) closure of wound of right shoulder (8cm)

4. Manual debridement of 3 toenails

5. Excision of 3 lesions:
benign lesion of shoulder, 4.2 cm benign lesion of hand, 5.1cm malignant lesion on face, 4.4 cm

6. Adjacent tissue transfer of chin defect; 9 sq.cm.

7. Destruction of .4 cm malignant lesion of the neck.

8. Nipple reconstruction.

9. Patient is seen in the E.R. after an accident. A 3.0 cm wound of the upper arm required a layered closure and a 1.0 cm superficial laceration of the left cheek was repaired.

10. Operative Note:
This 59 year-old male developed a sebaceous cyst on his right upper back. After ensuring a comfortable position, the skin surrounding the cyst was infiltrated with 1/2% Xylocaine with epinephrine to achieve local anesthesia. An elliptical incision surrounding the cyst was made; total excised diameter of 5.0 cm. The cyst wall was dissected free from the surrounding tissues. Hemostatis was obtained and the wound was irrigated. The wound was closed with 3-0 Vicryl, figure-of-eight stitches.
What type of lesion was removed? benign or malignant? How was it removed?
What is the excised diameter of the lesion? Was this a layered closure?
CPT code:

11. Operative Note: Excision of epidermal benign lesion on dorsum hand measuring 1.9 cm X 0.5 cm x 0.8 cm.
The hand was prepped and draped in the usual fashion after obtaining satisfactory analgesia with infiltration of local anesthesia. An elliptical skin incision was made surrounding the lesion. The skin lesion was completely excised and closed with interrupted

4-0 Dexon for the subcutaneous tissue and skin with 4-0 Dexon. Neosporin ointment was applied.
CPT code for procedure would be:

Musculoskeletal System:

1. Closed treatment of three vertebral process fractures requiring a cast.

2. Under general anesthesia, manipulation of a right shoulder joint with external fixation.

3. Lengthening of four tendons of the elbow.

4. Open treatment of a carpal scaphoid fracture with internal fixation applied.

5. Arthroplasty of two metacarpophalangeal joints.

6. Amputation, lower arm, using Krukenberg procedure

7. Replantation of right arm, including the neck of the humerus through the elbow joint, following a complete traumatic amputation.

8. A patient is diagnosed with osteochondroma of the scapula. The surgeon excises the tumor.
What is an osteochondroma?
What is the CPT code for this procedure?

9. Operative Report
Preoperative Diagnosis: Internal derangement left knee Postoperative Diagnosis: Tear of lateral meniscus
Operative Procedure: Left knee arthroscopy, partial meniscectomy

The arthroscope was inserted through the routine superolateral portal as well as an inferomedial portal for insertion of scope and instruments. The knee joint was then examined in routine manner, the medial meniscus was intact. The lateral meniscus was partially detached and this portion was removed. No other defects were noted. The knee was irrigated well using normal saline. The instruments were removed from the knee. Wound closed with #4-0 nylon and dressed. Estimated blood loss 0. Intravenous fluids 1000 cc. Specimen: meniscus
What is the CPT procedure code:

Respiratory System:

1. A unilateral, total lung lavage.

2. Resection of apical lung tumor with chest wall resection and reconstruction.

3. Removal of a crayon lodged inside nasal passage.

4. Surgical nasal endoscopy with polypectomy.

5. Direct, operative laryngoscopy for removal of button lodged in 2-year-old child's larynx.

6. Surgical sinus endoscopy with sphenoidotomy.

7. James Wilson has been having difficulty breathing and has had continual sinusitis. Dr. Adams takes James to the operating room to perform a sinus endoscopy with anterior and posterior ethmoidectomy and removal of polyps.

8. The patient is seen in the E.R. for epistaxis. The physician performs an anterior packing of the left nasal passage.

9. The surgeon performs a thoracentesis by placing a needle through the chest wall into the pleura to withdraw fluid.

10. Operative Report Case:
Preoperative Diagnosis: Chronic laryngitis with polypoid disease Postoperative Diagnosis: Same
Procedure: Direct laryngoscopy and removal of polyps from both cords

Procedure Detail: After adequate premedication, the patient was taken to the operating room and placed in supine position. The Jako laryngoscope was inserted. There were noted to be large polyps on both vocal cords, essentially obstructing the glottic airway. Using the straight-cup forceps, the polyps were removed from the left cord first. They were removed up to the anterior third, but the anterior tip was not removed on the left side.

Thepolyps were removed from the right cord up to the anterior commissure. there was minimal bleeding noted. The patient was extubated and sent to recovery in good condition.

Attachment:- surgery section.rar