Question Paper: Billing and Coding Applications with Simulations

Topics: Knee, Orthopedic surgery, Anterior cruciate ligament Pages: 17 (4071 words) Published: September 5, 2012
User| Kristin Maze|
Course| BC3030X: Billing and Coding Applications with Simulations (5-21-2012) Section 5| Test| Week 1 - Coding Applications Test|
Started| 5/27/12 1:52 PM|
Submitted| 5/28/12 9:46 PM|
Status| Completed|
Time Elapsed| 59 minutes out of 1 hour.|
Instructions| |
* Question 1
0 out of 4.5 points
| |
 | LOCATION:| Outpatient, Hospital|
 PATIENT:| Larry Frost|
 SURGEON:| Mohomad Almaz, MD|
 |  |
DIAGNOSIS:    Localized degenerative arthritis, left distal clavicle, with persistence of arthritic symptoms

OPERATIVE PROCEDURE: Removal of distal 1 cm (centimeter) left clavicle After satisfactory level of general anesthesia was reached and patient was in the supine position, he was further placed in a beach chair position. A longitudinal incision was created over the region of the left AC joint. At this time, sharp dissection was conducted down to the fascial plane. The fascial plane was then further incised, reflecting both the deltoid and the trapezial fascia and the distal aspect of the clavicle undermining the clavicle; at this time we simply proceeded excising the distal 1 cm of the clavicle with use of a reciprocal saw. With completion of this element of the procedure, the margins of the bone were otherwise unremarkable in gross appearance. It was also significant to note at this time the acromial end of the articulation was unremarkable. The wound was irrigated, followed by controlling of punctate bleeding with use of electrocautery, followed by the closure of the deltotrapezial fascia. At this time I further imbricated sutures for stable repair, followed by repair of subcutaneous and dermal planes. A simple dressing was applied. The patient tolerated the procedure well and was transported to the recovery room in a stable manner.

CPT SERVICE CODE(S): ___________________________________________________ ICD-9-CM DX CODE(S): _______________________________________________Answer| | | | | Selected Answer:|  |
 | |
Response Feedback:|   Professional Services: 23120-LT (Claviculectomy, Partial) ICD-9-CM DX: 715.31 (Osteoarthrosis, localized, shoulder)

The key to correctly reporting this service is to be able to translate the removal of a portion of the left clavicle into a claviculectomy. Once this is done the code can be located in the index of the CPT manual and reported with 23120 with modifier -LT to indicate the left side. The diagnosis is stated in the Diagnosis section of the report to be degenerative arthritis and reported with 715.31 to indicate a localized osteoarthrosis of the shoulder.|

| | | |
* Question 2
4 out of 4.5 points
| |
 | LOCATION: Outpatient, Hospital

PATIENT: Cathy Downs

SURGEON: Mohamad Almaz, MD

PREOPERATIVE DIAGNOSIS: Torn left medial meniscus, old

POSTOPERATIVE DIAGNOSIS: Torn left medial meniscus, old

PROCEDURE PERFORMED: Arthroscopy of the left knee with partial medial meniscectomy.

FINDINGS: The patient was found to have a horizontal tear involving the posterior one half of the medial meniscus. She had a previous partial meniscectomy in this area, but she seemed to have a horizontal tear in this area. This was in the location of her pain that she had preoperatively. The remainder of the knee looked very good. The articular surfaces throughout the knees were in excellent condition, and the anterior cruciate ligament was intact. The lateral meniscus was intact.

PROCEDURE: While under a general anesthetic, the patient's left knee was examined. No effusion was noted. She had three well-healed arthroscopy incisions. The collateral ligaments were intact. Lachman test was negative, as was the pivot shift. The McMurray's test was questionably positive medially with some crepitus. We then prepped the patient's left leg with Betadine and draped in a sterile fashion. An Esmarch bandage was used to exsanguinate the leg, and a tourniquet on the thigh was inflated to 300...
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