Questions and Answers
What are the CPT® and ICD-10-CM codes reported for Case 1?
60220, E04.1
What are the CPT® and ICD-10-CM codes reported for Case 2?
60225, C73
What are the CPT® and ICD-10-CM codes reported for Case 3?
60252, C73
What are the CPT® and ICD-10-CM codes reported for the primary surgeon in Case 4?
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What are the CPT® and ICD-10-CM codes reported for Case 5?
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What are the preoperative diagnoses for Case 6?
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What is the CPT® code for the bilateral paravertebral facet joint injection of steroids at the L3-L4 and L4-L5?
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What is the ICD-10-CM code reported for the bilateral paravertebral facet joint injection?
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What is the CPT® code for the right-sided decompressive hemicraniectomy with duraplasty?
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What is the ICD-10-CM code reported for the right-sided decompressive hemicraniectomy?
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What is the CPT® code for the replacement of the dorsal column stimulator generator?
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What is the ICD-10-CM code reported for the dorsal column stimulator generator replacement?
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What is the CPT® code for the right L4-5 laminotomy with bilateral decompression of the lateral recess?
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What is the ICD-10-CM code reported for the right L4-5 laminotomy?
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What is the CPT® code for the left L5-S1 hemilaminectomy with left foraminotomy?
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What are the ICD-10-CM codes reported for the left L5-S1 hemilaminectomy?
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Study Notes
Case 1: Right Thyroid Lobectomy
- Preoperative diagnosis: Right thyroid follicular lesion; postoperative diagnosis confirmed the same.
- Operative procedure: Right thyroid lobectomy, planned and performed.
- Findings: A large thyroid mass identified, with intact right recurrent laryngeal nerve and normal vocal cord movement post-surgery.
- Surgical procedure included a 2 cm incision, meticulous dissection, and complete removal of the right thyroid lobe.
- CPT® code: 60220, ICD-10-CM code: E04.1.
Case 2: Near Total Thyroidectomy
- Preoperative diagnosis: Papillary thyroid cancer; confirmed in postoperative diagnosis.
- Operative procedure: Near total thyroidectomy.
- Anesthesia used: General endotracheal.
- Findings: Nodular right thyroid and visualized parathyroids with an estimated blood loss of 100 cc.
- Surgical technique involved removal of right lobe and two-thirds of the left lobe while sparing parathyroids.
- CPT® code: 60225, ICD-10-CM code: C73.
Case 3: Approximately 85% Thyroidectomy
- Preoperative diagnosis: Papillary carcinoma of thyroid.
- Postoperative findings included papillary carcinoma of the left thyroid and lymph nodes showing metastasis.
- Procedure performed: Approximately 85% thyroidectomy (subtotal).
- Surgical approach involved meticulous dissection and removal of the left lobe along with several large lymph nodes.
- Estimated blood loss: 80 cc with overall successful hemostasis.
- CPT® code: 60252, ICD-10-CM code: C73.
Case 4: Ventriculoperitoneal Shunt Insertion
- Preoperative diagnosis: Post-hemorrhagic hydrocephalus.
- Operation performed: Insertion of left frontal ventriculoperitoneal shunt and removal of external ventricular drain (no documentation supporting removal).
- Patient history included trauma with intraventricular hemorrhage and failed clamp trial.
- Surgical procedure involved burr hole creation and catheter placement, followed by extensive wound closure.
- CPT® code: 62223, ICD-10-CM code: G91.3.
Case 5: Left Craniotomy for Epidural Hematoma
- Preoperative diagnosis: Acute epidural hematoma resulting from a motor vehicle accident.
- Operative procedure: Emergent left craniotomy for evacuation of hematoma.
- Findings included a well-formed clot and a bleeding point in the middle meningeal artery.
- Surgical approach was via a curvilinear incision and involved meticulous hemostasis and closure.
- Estimated blood loss: 100 cc with stable postoperative condition.
- CPT® code: 61312, ICD-10-CM codes: S06.4X0A, V89.2XXA.
Case 6: Bilateral Paravertebral Facet Joint Injection
- Preoperative diagnoses: Low back pain and degenerative lumbar disc.
- Procedure performed: Bilateral paravertebral facet joint steroid injections at L3-L4 and L4-L5 with fluoroscopic guidance.
- Patient was placed prone, in a sterile environment, and local anesthetics were administered.
- Injection of a mixture of Marcaine and methylprednisolone was conducted with proper needle placement confirmed via lateral x-ray.
- CPT® codes: 64493-50, 64494-50, ICD-10-CM code: M51.36.
Case 7: Right-Sided Decompressive Hemicraniectomy
- Procedure performed: Right-sided decompressive hemicraniectomy with duraplasty.
- Anesthesia administered: General endotracheal, with estimated blood loss of approximately 400 ml.
- Patient history included significant ischemic infarct to the right MCA territory that converted to hemorrhagic transformation.
- Surgical intervention was deemed life-saving after discussions with family regarding risks and possible outcomes.### Case 8
- Preoperative and postoperative diagnosis: Dorsal column stimulator generator malfunction.
- Procedure: Replacement of dorsal column stimulator generator.
- Anesthesia type: Monitored anesthetic coverage with local anesthesia.
- Estimated blood loss: Less than 5 ml.
- Complications: None reported during the procedure.
- Implant used: Medtronic's prime advanced nonreconstructable generator.
- Reason for surgery: Previous device malfunctioned and declining effectiveness noticed over a month.
- Procedural details include preoperative counseling, skin incision, entry into the generator pouch, and safe connection of leads to the new generator.
- Closure involved layered sutures and sterile dressing application.
Case 9
- Preoperative and postoperative diagnosis: Spinal stenosis at L4-L5.
- Procedure performed: Right L4-5 laminotomy and foraminotomy with bilateral decompression of the lateral recess.
- Type of anesthesia: General endotracheal tube anesthesia.
- Estimated blood loss: Minimal.
- Patient symptoms: Lower extremity pain and numbness predominantly on the right side, diagnosed via MRI.
- Surgical approach included midline incision, muscle retraction, and careful resection of soft tissue and ligaments.
- Postoperative care included irrigation and layered closure of the wound with Vicryl sutures.
Case 10
- Preoperative and postoperative diagnosis: Left L5 radiculopathy and left L5-S1 neural foraminal stenosis.
- Procedure performed: L5-S1 hemilaminectomy with left foraminotomy using a microsurgical technique.
- Anesthesia type: General endotracheal anesthesia.
- Estimated blood loss: 25 ml.
- Patient background: Prior lumbar surgery, presenting symptoms of left lower extremity L5 radicular pain.
- MRI findings indicated significant foraminal narrowing due to facet arthropathy, prompting surgery.
- Procedure involved meticulous surgical techniques, including laminotomy, visualization with a microscope, and decompression of the thecal sac.
- Closure techniques included layered sutures and sterile dressing application.
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Description
This quiz covers practical applications from AAPC Chapter 14, focusing on the diagnosis and operative procedures related to thyroid lesions. It tests knowledge on preoperative and postoperative diagnoses and the findings during thyroid surgeries. Ideal for those studying medical coding and terminology.
