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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?
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?
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.
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.