AAPC - Chapter 9 Practical Applications

Case 1: Video-Assisted Thoracoscopy

• Diagnosis: Recurrent pleural effusion, stage IV right lung cancer.
• Procedure: Video-assisted thoracoscopy with adhesion lysis and talc pleurodesis.
• 700 ml of fluid was evacuated from the pleural space.
• Talc (8 grams) was introduced for pleurodesis under direct vision.
• Reported Codes: CPT 32650-RT, ICD-10-CM J90, C34.91.

Case 2: Tracheostomy

• Diagnosis: Malignant neoplasm of the glottis.
• Procedure: Tracheostomy performed with an incision made low in the neck.
• A tracheostomy tube was inserted and secured.
• Reported Codes: CPT 31600, ICD-10-CM C32.0.

Case 3: Bronchoscopy and Wedge Resection

• Diagnosis: Pneumothorax following MVA (Motor Vehicle Accident).
• Procedures: Bronchoscopy and left Video-Assisted Thoracoscopic Surgery (VATS) with wedge resection performed.
• Identified a large bleb at the apex of the left lung.
• Reported Codes: CPT 32666-LT, 31622-51, ICD-10-CM S27.0XXA, V03.90XA.

Case 4: Bilateral Sinus Surgery

• Diagnoses: Chronic hyperplastic rhinosinusitis, intranasal and sinus polyps.
• Complex bilateral sinus surgery performed including multiple endoscopic procedures.
• Specimens sent for routine and fungal cultures.
• Reported Codes: CPT 31259-50, 31267-50-51, ICD-10-CM J33.0, J33.8, J32.9.

Case 5: Mediastinotomy

• Diagnoses: Sarcoid of lymph nodes, new onset paratracheal adenopathy.
• Procedure: Mediastinotomy performed under general anesthesia.
• Major lymph node biopsied.
• Reported Codes: CPT 39000, ICD-10-CM D86.1, R59.0.

Case 6: Thoracentesis Attempt

• Diagnosis: Loculated left pleural effusion, chronic.
• Attempted ultrasound-guided thoracentesis; thick fibrous pleura inhibited fluid aspiration.
• Reported Codes: CPT 32555-LT, ICD-10-CM J90.

Case 7: Direct Laryngoscopy

• Diagnosis: Left vocal cord tumor.
• Procedure: Direct laryngoscopy with microscope for tumor removal.
• Specimen sent to pathology, minimal bleeding reported.
• Reported Codes: CPT 31541, ICD-10-CM D49.1.

Case 8: Right Upper Lobectomy

• Diagnosis: Carcinoma of the right upper lobe.
• Procedure: Video-Assisted Thoracoscopic Surgery (VATS) right superior lobectomy.
• Two small incisions for camera access; tumor excised and sent for pathology.
• Reported Codes: CPT 32663-RT, ICD-10-CM C34.11.

Case 9: Laparoscopic Bilateral Pelvic Lymphadenectomy

• Diagnosis: Grade 3 squamous cell carcinoma of the penis with inguinal lymphatic metastasis.
• Procedure: Laparoscopic bilateral pelvic lymphadenectomy performed.
• Comprehensive dissection of lymphatics completed under visible landmarks.
• Reported Codes: CPT 38574, ICD-10-CM C77.4, C60.9.

Case 10: Bronchoscopy for Carcinoma

• Diagnosis: Carcinoma of the right lung and bronchus intermedius.
• Procedure: Fiberoptic bronchoscopy, multiple washings, brushings, and biopsies taken for analysis.
• Extrinsic compression of the right upper lobe and a submucosal tumor identified.
• Reported Codes: CPT 31625-RT, 32623-51-RT, ICD-10-CM C34.81.