AAPC Chapter 14 Practical Applications
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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?

<p>62223, G91.3</p> Signup and view all the answers

What are the CPT® and ICD-10-CM codes reported for Case 5?

<p>61312, S06.4X0A, V89.2XXA</p> Signup and view all the answers

What are the preoperative diagnoses for Case 6?

<p>Low back pain, Degenerative lumbar disc</p> Signup and view all the answers

What is the CPT® code for the bilateral paravertebral facet joint injection of steroids at the L3-L4 and L4-L5?

<p>64493-50, 64494-50</p> Signup and view all the answers

What is the ICD-10-CM code reported for the bilateral paravertebral facet joint injection?

<p>M51.36</p> Signup and view all the answers

What is the CPT® code for the right-sided decompressive hemicraniectomy with duraplasty?

<p>61322</p> Signup and view all the answers

What is the ICD-10-CM code reported for the right-sided decompressive hemicraniectomy?

<p>I61.9</p> Signup and view all the answers

What is the CPT® code for the replacement of the dorsal column stimulator generator?

<p>63685</p> Signup and view all the answers

What is the ICD-10-CM code reported for the dorsal column stimulator generator replacement?

<p>T85.113A</p> Signup and view all the answers

What is the CPT® code for the right L4-5 laminotomy with bilateral decompression of the lateral recess?

<p>63030-50</p> Signup and view all the answers

What is the ICD-10-CM code reported for the right L4-5 laminotomy?

<p>M48.061</p> Signup and view all the answers

What is the CPT® code for the left L5-S1 hemilaminectomy with left foraminotomy?

<p>63042-LT</p> Signup and view all the answers

What are the ICD-10-CM codes reported for the left L5-S1 hemilaminectomy?

<p>M54.16, M48.07</p> Signup and view all the answers

Flashcards

Right Thyroid Lobectomy

Removal of the entire right thyroid lobe, typically performed for a benign or cancerous lesion.

Near Total Thyroidectomy

Surgical removal of the majority of the thyroid gland, typically for thyroid cancer.

Approximately 85% Thyroidectomy (Subtotal)

Removal of about 85% of the thyroid gland, typically for thyroid cancer.

Ventriculoperitoneal Shunt Insertion

Surgical procedure used to treat hydrocephalus, involving a shunt placement to drain excess fluid from the brain into the abdomen.

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Left Craniotomy for Epidural Hematoma

A surgical technique used to evacuate a blood clot in the space between the skull bone and the brain membrane.

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Bilateral Paravertebral Facet Joint Injection

A procedure that involves injecting steroid medication into the facet joints of the lower back to relieve pain and inflammation.

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Right-Sided Decompressive Hemicraniectomy

Removal of a portion of the skull bone to relieve pressure on the brain due to swelling.

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Dorsal Column Stimulator Generator Replacement

Replacement of a malfunctioning spinal stimulator generator, a device used to treat chronic pain.

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Right L4-5 Laminotomy and Foraminotomy

A surgical procedure to remove part of the bone and ligaments in the spine to relieve pressure on the nerves.

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L5-S1 Hemilaminectomy with Left Foraminotomy

A surgical procedure to enlarge the opening in the spine through which a nerve exits, aiming to relieve nerve pressure.

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Thyroidectomy

A surgical procedure to remove a portion of the thyroid gland, typically for thyroid cancer.

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Laminectomy

A surgical procedure involving the removal of a portion of the spine to relieve pressure on the spinal cord or nerves.

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Epidural Hematoma Evacuation

The removal of a blood clot from the space between the skull bone and the brain membrane.

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Craniotomy

A surgical procedure to remove a portion of the skull bone to relieve pressure on the brain due to swelling.

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Foraminotomy

A surgical procedure aimed at relieving pressure on the spinal nerves by widening the spaces in the spinal column.

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Decompression

A surgical procedure to enlarge the opening in the spine through which a nerve exits, aiming to relieve nerve pressure.

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Evacuate Epidural Hematoma

Surgical procedure to relieve pressure on the brain caused by a large blood clot between the skull bone and the brain membrane.

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Paravertebral Facet Joint Injection

Injection of steroid medication into the facet joints of the lower back to alleviate pain and inflammation.

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Decompressive Hemicraniectomy

Removal of a portion of the skull bone to relieve pressure on the brain due to swelling, often caused by a stroke.

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Laminotomy and Foraminotomy

A surgical procedure to remove part of the bone and ligaments in the spine, relieving pressure on the nerves.

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Hemilaminectomy with Foraminotomy

A procedure to enlarge the opening in the spine where a nerve exits, relieving pressure on the nerve.

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Subtotal Thyroidectomy

Surgical removal of approximately 85% of the thyroid gland, usually carried out to treat thyroid cancer.

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Craniotomy for Epidural Hematoma

A surgical procedure to open the skull (craniotomy) to access and remove a blood clot (hematoma) pressing on the brain, often performed for injuries such as head trauma.

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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.

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