CPC 2 series (Musculoskeletal System)

  1. 1 : Preoperative Diagnosis: Gunshot wound with foreign body in the flank. Postoperative Diagnosis: Gunshot wound with foreign body in the flank. Operation: 1. Debridement of gunshot wound of the flank 2. Removal of foreign body from the flank. Anesthesia: General Complications: None Blood Loss: Minimal Drains: N/A Indications: This well-developed, well-nourished 19-year-old female was shot this evening in a drive-by shooting. According to police she was mistaken for a gang member. She was brought by ambulance to the emergency room where she was stabilized, then brought to the operating room for surgery to access and repair the damage and to remove the bullets or bullet fragments. A police officer was present throughout the surgery to gather evidence and for chain of custody. Informed Consent: The risks and benefits of the procedure were explained to the parent. The parent elected to proceed with the procedures. Approach and Surgical Procedure: The patient was placed supine on the operating table, and general anesthesia was induced. The patient was then placed in the right lateral decubitus position with the left side up. The patient was secured in position using beanbags. After that, cushions were applied to the axillary area and to the area beneath the knees and ankles. Next, the flankwas prepped and draped in the usual sterile fashion. An elliptical incision was made around the wound, and devitalized tissue was debrided. The wound was extended to explore the wound and to determine if any foreign bodies were present. The subcutaneous cavity was also debrided, and hemostasis was achieved using electrocautery and clamps. After achieving hemostasis, the cavity was packed with Betadine dressings, then sterile dressings were applied over the wound. What codes would be reported?

  1. 2 : Patient complains of chronic/acute pain following tenodesis surgery performed on right shoulder and forearm. Patient is followed by pain management for over a year. Physician finally diagnoses patient with reflex dystrophy syndrome (RSD). Physician performs three trigger point injections into extensor and flexor of carpi radialis and deltoid muscle. Code the procedure(s).

  1. 3 : Sangeetha a 56-year old female suffering from Rheumatoid arthritis on her Knee encountered for joint injection today. After administering a local anesthetic, the physician inserts a needle through the skin and into a joint or bursa. A fluid sample was removed from the joint for examination and injected with NSAID with Computer tomography guidance. The needle is then withdrawn and pressure is applied to stop any bleeding. What CPT codes should be reported?

  1. 4 : Siva a 29- Year old male sustained a tibial fracture for which a spatial frame was placed 4 months ago and today he encountered for adjustment of the device. Dr. Vetrimaran an orthopedic physician checked the patient and he decided to go with exchange of the spatial frame. Under general anesthesia he removed the Old device and placed new spatial frame with computer assistance. What CPT codes should be reported for this procedure?

  1. 5 : Julie a 52-year-old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. Biopy was performed and found to be sarcoma during a previous encounter. She is brought to the Operating Room today for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated sarcoma approximately 4 centimetres. This was excised primarily bluntly with a few attachments divided with electro cautery. What CPT should be reported for today’s service?

  1. 6 : A 60 year old osteoporotic fracture patient came for kyphoplasty surgery on T3 & L4 vertebral segments. A 5 mm to 7 mm incision is made and small cannulae are inserted into the vertebral body from one or both sides. Balloon catheters, called "tamps," are inserted into the vertebra and inflated. Tamps create a void in the soft trabecular bone and restore vertebral alignment. Balloons are then deflated and high viscosity cement under direct image control is injected into the void previously created by bone tamps on both T3 & L4. What codes should be reported.

  1. 7 : . PREOPERATIVE DIAGNOSIS: Lateral meniscus tear, Plica syndrome in left knee. POSTOPERATIVE DIAGNOSIS: Lateral meniscus tear, Plica syndrome in left knee. TITLE OF PROCEDURE: Operative arthroscopy, partial medial menisectomy and Debridement, leftt knee the patient was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The left knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the lateral patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging lateral synovial plica was debrided. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The lateral compartment was inspected. An up-biting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The medial compartment was then inspected. The medial meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT codes should be reported?

  1. 8 : Pre-Op Diagnosis: Left Femoral neck fracture. Post-Op Diagnosis: Left Femoral neck fracture. Procedure Performed: ORIF Femoral neck fracture. The physician directly exposes the femoral fracture for treatment. The patient is placed in a supine position or slightly rolled up onto the other side. A 15 cm incision is made over the left lateral hip. The fascia lata is split and the vastus lateralis muscle is detached from the femur. The physician exposes the femoral neck and head. A small periosteal elevator or Kirschner wire is used to reduce (reposition) the fracture. The physician places guide pins through the bone and across the fracture. The guide pins help determine correct screw length. The physician suspect’s risk of subsequent non-union or avascular necrosis, hence he decided to replace the femoral head with a femoral prosthesis. The femoral canal is reamed out. A prosthesis of the proper size and length is selected and inserted into the femoral canal. The physician reduces the prosthesis into the acetabulum. The incision is repaired in layers with sutures, staples, and/or Steri-strips. What CPT codes should be reported?

  1. 9 : A 13 year old scoliosis patient planned for osteotomy today. Spinal osteotomy is performed to correct severe spinal deformity. Using a posterior or posterolateral approach, the surgeon excises all posterior elements at the site of the correction, including the pedicles and the adjacent facet joints (inferior and superior). The physician then removes a posterior wedge of cancellous bone from the vertebral body to achieve the desired correction. The entire posterior and lateral vertebral body walls were also removed. Area operated was T3–T7 The osteotomy was closed by extending the patient's position on the operative frame or through instrumentation compression.Code the procedure

  1. 10 : Pre-Op Diagnosis: Multiple rib fracture. Post-Op Diagnosis: Multiple rib fracture. Procedure performed: ORIF of left ribs 4,5,6, 7 and right ribs 4 and 5 with thoracoscopy. Description: When the patient is appropriately prepped and anesthetized, the provider makes an incision in the skin over the chest and inserted a scope inside and visualizes the fractured rib. He the extended the incision dissects through the tissue and down to the affected ribs on left side. He reduces the fractured ribs 4,5,6,7 back into position using plate to stabilize the fractured ribs. The provider then irrigated the area and closed the incision. Same procedure was done for right ribs 4, 5 and patient was transferred for post-operative care. How would you report this procedure?

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