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1. What are the common modifiers used?
2. What are upcoding, unbundling, and exploding?
3. Review the new E/M codes briefly.
4. Is post-op care included in a code?
5. If you list three CPT codes, which one goes
first? Why?
6. You perform an excision of a 1-cm basal cell
cancer with a 2-cm ellipse. Frozen sections are positive, so a further
1 cm is resected. Do you code separately for each excision?
Do you code separately for closure? What if you skin graft the defect?
What if it is a melanoma and you take 3-cm margins?
7. In the emergency room you close a 1-cm forehead
laceration... a) with a one-layer closure of 6.0 nylon, b) with vicryl
and a 6.0 nylon, c) after debriding the irregular edges, or d) by
wide undermining and two-layer closure. Code for each of these cases.
Also, does insurance pay a plastic surgeon more than an ER doctor because
of their special training?
Answer...
8. In the burn unit, you tangentially excise
one arm and dress it with allograft. The other arm is scraped of
granulation tissue and skin grafted with 800 sq.cm of allograft.
What are the dimensions of a carrier board? Do you code for expanded
or nonexpanded skin?
Answer...
9. You treat a facial fracture with arch bars,
intramaxillary fixation, plating of the LeFort III level fracture, wiring
of the NOE complex, obliteration of the frontal sinus with bone and plating
of the anterior wall of the frontal sinus, a bone graft to the nose, and
Medpor in both orbits. Code this.
Answer...
10. You debride a sternum and do a pectoralis
flap. Then you debride a pressure sore, do an ostectomy and close
with a V-Y hamstring flap. Are debridements billed separately?
11. You resect a large melanoma of the scalp
leaving a 13 x 15 cm defect. You harvest a lat dorsi, do a free flap
with two vein grafts, close the donor site, and skin graft the muscle with
300 sq.cm of skin graft. Code this.
12. You excise a large scalp basal cell cancer
and undermine from ear to ear to get it closed primarily. You bill
for an advancement flap because your senior partner told you that this
was correct. Is it?
13. Your patient wants an abdominoplasty.
Her general surgeon calls you and says, by the way, she has a small umbilical
hernia, can you fix that while you are there? On physical exam, you
do indeed feel an umbilical hernia. How do you bill the insurance
company?
14. You do a bilateral TRAM: supercharged on
one side, pedicled on the other side with mesh placed in the abdomen.
Code this.
15. Your intern excises a 1-cm lipoma in minor
surgery while you do a case in the main OR. Code this.
16. A tissue expander is inserted in the forehead
with 8 injections at subsequent office visits. In a second operation,
you excise a 2.5-cm lesion from the nasal tip, do a forehead flap with
the expanded skin, and remove the expander. At stage three, you divide
that forehead flap and inset the flap. Code these.
17. Do you code for excision of a basal cell
cancer if you use a 1400 series code? What about a 1500 series code?
18. Your patient cannot breathe secondary to
a deviated septum but wants his nose to look better too. You do a
septoplasty, infracture, resection of lower laterals, and alar excisions.
Code this.
19. You do a Dupyutren's with a palmar fasciotomy
and release of the middle finger and small fingers. A capsulectomy
is performed on the PIP of the ring finger. You accidentally cut
the ring digital nerve and repair it after bringing in the microscope.
Code and bill this.