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Example 1: Medical Terminology
The term "Salping-Oophorectomy" refers to
a. The removal of the fallopian tubes and ovaries
b. The surgical sampling or removal of a fertilized egg
c. Cutting into the fallopian tubes and ovaries for surgical purposes
d. Cutting into a fertilized egg for surgical purposes
Rational
Answer: A
The term "salp" means tube, the term "ooph" refers to the ovary, and the suffix "ectomy" means to surgically remove. Some CPT books (like the professional edition put out by the AMA) contains pages with common medical terms like these in the beginning of the book (prior to the coding guidelines)
Example 2: Musculoskeletal
OPERATIVE NOTE
PREOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4-C5 and C5-C6.
POSTOPERATIVE DIAGNOSIS: myelopathy secondary to very large disc herniations at C4-C5 and C5-C6.
PROCEDURE PERFORMED:
1. Anterior discectomy, C5-C6
2. Arthrodesis, C5-C6
3. Partial corpectomy, C5
4. Machine bone allograft, C5-C6
5. Placement of anterior plate with a Zephyr C6
ANESTHESIA: General
ESTIMATED BLOOD LOSS: 60 mL
COMPLICATIONS: None
INDICATIONS: This is a patient who presents with progressive weakness in the left upper extremity as well as imbalance. He has a very large disc herniation that came behind the body at C5 as well and as well as a large disc herniation at C5-C6. Risks and benefits of the surgery including bleeding, infection, neurologic deficit, nonunion, progressive spondylosis, and lack of improvement were all discussed. He understood and wished to proceed.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed in the supine position. Preoperative antibiotics were given. The patient was placed in the supine position with all pressure points noted and well padded. The patient was prepped and draped in standard fashion. An incision was made approximately above the level of the cricoid. Blunt dissection was used to expose the anterior portion of the spine with carotid moved laterally and trachea and esophagus moved medially. I then placed needle into the disc spaces and was found to be at C5-C6. Distracting pins were placed in the body of C6. The disc was then completely removed at C5-C6. There was very significant compression of the cord. This was carefully removed to avoid any type of pressure on the cord. This was very severe and multiple free fragments noted. This was taken down to the level of ligamentum. Both foramen were then also opened. Part of the body of C5 was taken down to assure that all fragments were removed and that there was no additional constriction. The nerve root was then widely decompressed. Machine bone allograft was placed into C5-C6 and then a Zephyr plate was placed in the body C6 with a metal pin placed into the body at C5. Excellent purchase was obtained. Fluoroscopy showed good placement and meticulous hemostasis was obtained. Fascia was closed with 3-0 Vicryl, subcuticular 3-0 Dermabond for skin. The patient tolerated the procedure well and went to recovery in good condition.
a. 22554, 63081, 63082, 20931, 22845
b. 22551, 63081, 20931, 22840
c. 22551, 63081, 63082, 20931, 22845
d. 22554, 63081, 20931, 22840
Rational:
Answer: A
Per. Paul Cadorette and the American Medical Association article titles, "Coding Guidance for Anterior Cervical Arthrodesis", "When a spinal fusion (arthrodesis) is performed, the first thing a coder needs to recognize is the approach or technique that was utilized. With an anterior (front body approach)to cervical fusion the incision will be made in the patient's neck, so the key terms to look for are platysma, esophagus, carotid, and sternocleidomastoid. These structures will be divided and/or protected during dissection down the vertebral body. After dissection, the procedure can proceed on one of three ways:
1) When the interspace is prepared (minimal discectomy, perforation of endplates) then 22554 would be reported.
2) When a discectomy is performed to decompress the spinal cord and/or nerve root(s) report 22554 for the arthrodesis along with 63075 for the discectomy procedure.
3) When a partial corpectomy (vertebral body resection) is performed at C5 and C6 report CPT code 22554 for the arthrodesis with 63081 and 63082. Two codes are reported because the corpectomy procedure is performed on two vertebral segments (C5 and C6). CPT codes 63081-63091 include a discectomy above and/or below the vertebral segment, so code 63075 (discectomy) would not be reported if performed at the C5-C6 interspace.
Once the decompression procedure has been completed, a PEEK cage can be placed within the interspace or a structural bone graft can be fashioned to fit the vertebral defect created by the previous corpectomy. Insertion of the PEEK cage would be reported with a biomechanical device code 22851. This code is only reported one time per level even if two cages are placed at C5-C6. When a structural bone graft is used, determine whether it is an allograft (20931)) or an autograft (20938). The bone graft codes are only reported one time per procedure and not once for each level. Finally, the physician will place an anterior plate with screws (22845) across the C5-C6 interspace to stabilize the area fusion".
Some guidance on coding such procedures can also be located in the Spine (vertebral column) coding guidelines (above code 22010).
Example 3: ICD-9-CM
Jim was at a bonfire when he tripped and fell into the flames. Jim sustained multiple burns. He came to the emergency room via an ambulance and was treated for second and third degree burns of his face, second degree burn on his shoulders and forearms, and third degree burns on the fronts of his thighs.
a. 941.20, 841.30, 943.25, 943.21, 945.36, 948.42, E897
b. 941.30, 943.29, 945.36, 948.42, E897
c. 941.09, 943.09, 945.09, 948.64, E897
d. 941.30, 943.29, 945.36, 948.64, E897
Rational
Answer: B
Burn codes always have no less than three codes: A burn code, a total body surface area code (948.XX), and an E code. You can have more than three codes but never less. Burn codes have the following rules (which can be found at the beginning of the ICD-9 book under general guidelines), always code one location to the highest degree (Ex. 1st and 2nd degree burns on the arm, only code 2nd degree). When sequencing burn codes always list the highest degree first (Ex. 1st degree burns to the face and 3rd degree burns to the arm. List the arm burn first and then the face burn). Answer B is the answer because its codes describe the highest degree burn to each anatomical location, it sequences the burn codes in order of highest to lowest degree burns, the 948 (TBSA code) has the correct calculation, and the E code correctly describes the bonfire incident.
Example 4: Anesthesia
When does anesthesia time begin?
a. After the induction of anesthesia is complete
b. During the pre-operative exam prior to entering the OR
c. When the anesthesiologist begins preparing the patient for the induction of anesthesia
d. Once the supervising physician signs over the patient's care to the anesthesiologist
Rational
Answer: C
The answer to this question can be located in the anesthesia coding guidelines under the title "Time Reporting"
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- Answer Key, With Full Rationale
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Common Anatomy Terminology Handouts
Common Medical Terminology Prefix, Root Word, and Suffix Handouts - The Official AAPC Proctor-to-Examinee Instructions (read out loud on the day of the exam)
AAPC's CPC exam is 150 questions long. Questions range from true and false, to 1-2 sentences, to full page operative notes.
Questions on the CPC exam do not cover just specific medical codes. Questions can be very diverse, testing the examinees knowledge on:
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- Medical Terminology and Gross Anatomy
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