A patient is diagnosed with compression fractures of the C6, C7 and T1 vertebrae. The patient agrees to have vertebroplasty. Bone cement is injected in the vertebral space until each of the two whole vertebral body is filled. The procedure is performed bilaterally. What CPT coding is reported?
Correct Answer: B
1. Procedure Type and CPT Code Selection: The physician performed an injection into the wrist joint for degenerative osteoarthritis management using Synvisc (a viscosupplementation product). Code 20606 is the correct CPT code for an arthrocentesis, aspiration, and/or injection procedure in an intermediate joint, such as the wrist. This code specifically includes the use of ultrasound guidance, which is often standard in such injections. Code 20551 (injection of a single tendon origin) and 20526 (injection into a carpal tunnel) are incorrect here as they do not apply to intra-articular injections for joint osteoarthritis management. 2. Diagnosis Code Selection (ICD-10-CM): The diagnosis is degenerative osteoarthritis in the right wrist. ICD-10-CM Code M19.231 is used for primary osteoarthritis of the right wrist. This code directly reflects the diagnosis of primary osteoarthritis affecting this specific joint. M19.031 would represent primary osteoarthritis in the wrist but does not specify laterality; therefore, it is less accurate than M19.231, which denotes the right wrist. 3. Summary of Code Application: The correct CPT and ICD-10-CM codes are 20606 for the injection procedure and M19.231 for primary osteoarthritis of the right wrist. 4. AAPC and CPT Coding Guidelines: According to AAPC CPC guidelines, proper joint injection codes require specific identification of the joint location and guidance if used. Additionally, selecting the most specific ICD-10-CM code for laterality is essential for accuracy in musculoskeletal diagnoses. Thus, based on CPT and ICD-10-CM coding guidelines, the verified answer is B. 20606, M19.231.
CPC Exam Question 12
Where is a Warthin's tumor found?
Correct Answer: C
Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign tumor of the salivary glands, most commonly affecting the parotid gland. It typically presents as a painless, slow-growing mass near the angle of the jaw. ICD-10-CM, medical dictionaries, and oncology textbooks
CPC Exam Question 13
A 47-year-old male with a history of peripheral artery disease presents with worsening claudication of the left leg. A diagnostic angiography confirms stenosis in the left iliac artery. To restore blood flow to the left leg, the vascular surgeon plans to perform angioplasty, using a balloon to dilate the vessel lumen followed by placement of an expandable stent in the left iliac artery. What CPT coding is reported for the procedure?
Correct Answer: D
The clinical scenario involves a diagnostic angiography (not separately reportable in this case as the therapeutic intervention occurs in the same session and the diagnosis is already known) and a percutaneous transluminal angioplasty (PTA) with stent placement in the left iliac artery. To code this correctly: CPT Code 37267: Transluminal stent placement(s), includes angioplasty within the same vessel, when performed; iliac artery. This code includes the angioplasty if it is performed in the same vessel as the stent (which is true here - both procedures are done in the left iliac artery). Since angioplasty is inherent to the stenting (to open the narrowed vessel before stent placement), only the stent code is reported. No need to report angioplasty separately (e.g., 37263) when performed in the same vessel as the stent. Other options explained: A). 37267, 37263 - Incorrect. 37263 (angioplasty in the iliac artery) would only be reported if angioplasty was done in a separate iliac artery segment without stenting. Reporting both codes for the same vessel would be unbundling and against CPT/NCCI guidelines. B). 37258, 37254 - Incorrect. These codes relate to renal artery procedures, not iliac artery. C). 37258 - Also incorrect, as this refers to renal stent placement, not iliac. Official CPT Guideline Reference: In the CPT manual (Category I codes, 37220-37235), specific instructions state that angioplasty is included when performed in the same vessel as a stent and should not be reported separately.
CPC Exam Question 14
A patient with coronary artery disease due to lipid-rich plaque undergoes coronary artery bypass grafting. The surgeon performs a left internal mammary artery graft to the left anterior descending artery. Then performs saphenous vein grafts to the obtuse marginal artery, ramus intermedius, and posterior descending artery. An endoscopic saphenous vein harvest is performed. What CPT coding is reported for the surgical procedure?
Correct Answer: D
Procedure Coding (CPT): 33533 - CABG, arterial graft; single arterial graft (LIMA to LAD) Correct for left internal mammary artery # LAD 33519 - CABG, venous grafts; three coronary venous grafts Saphenous vein grafts placed to: Obtuse marginal Ramus intermedius Posterior descending artery Total = 3 venous grafts 33508 - Endoscopic harvest of saphenous vein Separately reportable only when endoscopic Add-on code (no modifier required) Why Other Options Are Incorrect: A / C - Incorrect arterial graft code (33536 = multiple arterial grafts) B - Incorrect venous graft count (33512 = two grafts) CPT Guideline Reference: CABG codes are selected based on: Type of conduit (arterial vs venous) Number of distal anastomoses Endoscopic harvest is add-on and separately reportable
CPC Exam Question 15
A patient presents to the pulmonologist's office for the first time with coughing and shortness of breath. The patient has a history of asthma. The physician performs a medically appropriate history and exam. The following labs are ordered: CBC, arterial blood gas, and sputum culture. The pulmonologist assesses the patient with a new diagnosis of COPD. The patient is given a prescription for the inhaler Breo Ellipta. What E/M code is reported?
