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3 series (Respiratory & Cardiovascular System)
1 : Pre-op Diagnosis : Hypertrophy of nasal turbinates. Post-op Diagnosis : Hypertrophy of nasal turbinates. Planned Procedure: Excision of nasal turbinates. The physician removes a part of the superior nasal turbinate located on the lateral wall of the nose. The turbinate is primarily removed in cases of hypertrophy that obstruct the nasal airway. The physician places topical vasoconstrictive drugs on the turbinate to shrink the blood vessels. A mucosal incision is made around the base of the turbinate. The physician fractures the bony turbinate from the lateral nasal wall with a chisel or drill. The turbinate is excised. Electrocautery may control bleeding. The nasal mucosa is sutured in single layers. The nasal cavity may be packed with gauze. What CPT code should be reported?
2 : A 23–year-old patient with facial pain, nasal congestion and frequent cough came to Outpatient setting for maxillary sinus evaluation. Topical vasoconstrictive agents are applied to the nasal mucosa and nerve blocks with local anesthesia are performed. The endoscope is placed into the nose and a thorough inspection of the internal nasal structures is accomplished. A trocar puncture is made directly into the inferior meatus area of the nose. The endoscope is placed into the maxillary sinus for evaluation. The intraoral mucosa may be closed in a single layer. What CPT code should be reported?
3 : Pre-op Diagnosis : Benign lesions in Vocal cord. Post-op Diagnosis : Benign lesions in Vocal cord. Procedure Performed : Direct Laryngoscopy with Vocal cord lesion removal. Description : A topical anesthetic is administered to the oral cavity, pharynx, and larynx and the laryngoscope is inserted into the patient's mouth. The interior of the larynx is examined, Since the lesions are of smaller size microscope was utilized to visualize and the lesion on the right side was excised first and the one on left was excised after both the excised lesion were sent to pathology. What CPT codes should be reported.
B) 31541, 31541-59
D) 31545, 69990
4 : Ranjani 65-year-old female came to diagnose 3 lesions on her lung. She was taken to Endoscopy suite and Bronchoscope was introduced through mouth and all lesions found to be is Left lower lobe. All the 3 lesions were biopsied and sent to pathology for cancer positivity. How would you report this service?
A) 31628, 31632 x 2
C) 31625, 31632 x 2
5 : Gajini 36-year old business man admitted to hospital for treatment of his multiple tumor on left lung. A small incision is made in the skin of the chest and the lesion is accessed by inserting an ablation probe connected to a radiofrequency generator between the ribs. Under ultrasound guidance, the ablation probe is advanced into the lesion of the lung. Treatment with the heat probe lasts for several minutes and the incision is closed with sutures. This process is repeated for all 4 lesions within the left lung. What codes should be reported?
A) 32998 - LT x 4
B) 32503 - LT
C) 32998 - LT
D) 32503 - LT x 4
6 : A 68-year-old patient with chronic emphysema has surgery to remove two lobes of the right lung and part of bronchus was resected with anastomosis. How would you report this scenario?
A) 32482, 32486
C) 32440, 32486
7 : A 56-year-old male was brought in to the operating room for placement of multi-chamber pacemaker placement. Patient was prepped and draped in usual sterile technique and general anaesthesia has been administered by anaesthesiologist. A time-out was called in and the physician made an incision using 7-blade instrument and made a sharp dissection on the midline of chest. The thorax is opened, and physician inserted the electrodes on RT atrium, RT ventricle and LT ventricle through epicardial approach. Physician created a pocket subcutaneously in the sub clavicular region for the insertion of pacemaker pulse generator and the generator is inserted into the pocket. The pocket is closed using 3-0 vicryl sutures. All the epicardial leads are inserted into the pacemaker pulse generator and physician rechecks the electrodes are correctly placed. What CPT code best describes the service?
A) 33202, 33221
B) 33208, 33225
C) 33208, 33221
D) 33202, 33221-51
8 : Pre-Op Dx – End life of pacemaker battery Post-Op Dx – End life of pacemaker battery Procedure – Replacement of Pacemaker pulse generator and transvenous Dual chamber electrodes. Procedure Description: A 69-year-old female patient is taken to operating room for the replacement of pacemaker pulse generator. Patient is administered with general anaesthesia via Endotracheal tube and time out was called. The patient is then prepped and draped in usual sterile fashion and the we made an incision on the skin pocket to remove the previously placed pacemaker pulse generator and identified that the skin pocket is infected with bacterial invasion. We thoroughly irrigated the area with betadine and did an extensive irrigation. we then removed the battery using a blunt dissection and placed a new pulse generator in the skin pocket. Physician also checked the electrodes on the Rt atrium and Rt ventricle and found to be defective, so we removed the electrodes through transvenous approach and replaced with 2 new electrodes using the same approach. Patient tolerated the procedure well and brought to the PACU. What is/are the appropriate CPT code(s) for the scenario?
B) 33228, 33217
C) 33208, 33233, 33235
D) 33233, 33235, 33217, 33213
9 : Post-Op Dx – Tumour of Rt Atrium. Procedure – Resection of cardiac tumour in Rt Atrial chamber. Procedure Description – The patient was brought in to Operating room after sterile dressing and anaesthesia has been administered through ET tube. Cardiopulmonary bypass is employed. Venous tubes are placed in both caval veins. The part of the Rt Atrium is opened where the tumour is located. Every effort is made to avoid making an incision in any ventricular wall. After the heart is opened, the tumour is resected with a margin of normal heart tissue. While excising the tumour we found a dark thrombus on the posterior apex of Rt atrium. we tried to remove the thrombus through the initial incision but failed because of the risk to damage to the adjacent wall. So, we decided to make a small incision on the posterior apex of Rt atrium and removed the thrombus. All holes in the heart are closed. Cardiopulmonary bypass is stopped when heart function returns. Patient tolerated the procedure well. Choose the correct Code sequence for the scenario
A) 33120, 33310-59
C) 33120, 33315-51
D) 33120, 33315-59
10 : A 65-year-old high risk patient with symptomatic aortic stenosis was brought to OR for Transcatheter aortic valve replacement(TAVR). The axillary vessels are cannulated through guidewire under fluoroscopic guidance for cardiopulmonary bypass support and cardioplegia is successfully obtained. A guidewire is placed in the femoral artery in the groin and manipulated into the left ventricle. A catheter is inserted following the guidewire to the aortic valve. A balloon is inflated to compress the native valve. A porcine valve attached to an expandable stent is deployed over the compressed native valve. The catheter and guidewires are removed. A temporary single chamber pacemaker catheter has been placed to regulate the heart rhythm. Code the case with appropriate CPT code(s).
A) 33361, 33368, 33210-51
B) 33361, 33368
C) 33362, 33368, 33210
D) 33361, 33368, 33210-59
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