Code an arthrocentesis into the acromioclavicular joint of the left shoulder

Code an amputation of the right leg just above the knee.

Dexamethasone acetate, 16 mg was injected into the left shoulder joint for a frozen shoulder syndrome of an established patient in the provider’s office. Before the injection, on the same visit, AP and lateral shoulder x-rays were performed in the provider’s office and interpreted by the provider. Apply all the correct CPT and HCPCS codes.

Code an arthrocentesis into the acromioclavicular joint of the left shoulder

A surgeon performs a midfoot capsulotomy, medial tendon release and tendon lengthening, Select the appropriate code.

Select the appropriate code(s) for a patient undergoing a hammertoe operation that includes an interphalangeal fusion on the right great toe.

A patient presents to the operating room with contracture and tenosynovitis of the left long finger after sustaining the injury in an accident several months ago. The physician performs a tenolysis and capsulotomy on the flexor tendon in the interphalangeal joint. Provide the most appropriate CPT coding for the scenario.

A 78-year-old patient suffering from pain related to osteoporosis and subsequent vertebral compression fractures presents to an ASC for percutaneous vertebroplasty under CT guidance at the L1 level. Provide the appropriate procedure coding for the osteoplasty.

The physician performs arthroscopic meniscus repair with partial medial and lateral repairs. What code would you use?

How would you code an arthroscopic abrasion chondroplasty of the medial femoral condyle?

Joe was in a motorcycle accident and fractured his right femur. The surgeon placed an intramedullary locking implant (nail) through a buttock incision. How would you code the procedure?

Jeff is a 13-year-old boy who fractured his left radius and ulna while snowboarding. Three weeks after the physician placed a long arm cast on Jeff, he was skateboarding and crushed the cast (without further injury to the arm). The physician replaces the cast with a short-arm fibreglass cast. How would you code the services provided after the skateboard accident?

Mary has been having pain in her temporomandibular joint. Her doctor decides to manipulate the joint under general anesthesia, and schedules her for this procedure the next day. How would this procedure be coded?

The patient has developed plantar fasciitis, a painful condition in his heel and sole of his foot. He has tried using shoe inserts and over-the-counter pain relievers, but is still having pain. His physician plans an injection of the tendon sheath on the bottom of his foot. How would this injection be coded?

Julia tripped and fell down three stairs in her apartment. X-rays show a fracture of the metatarsal bone of her left great toe, and the physician treats this fracture with a special orthotic boot. How would you code the physician’s services?

Mrs.Williams has had a bunion on her right foot for many years and is scheduled for surgery to correct this condition. The doctor plans to do a double osteotomy of the metatarsal bone. How will he code this surgery?

Mrs. Smith underwent an arthrodesis of her spine for spinal deformity, posterior approach, segments L3-L5. How is this arthrodesis coded?

Operative report: Preoperative diagnosis: Open fracture, left humerus, with possible loss of left radial pulse.Procedure performed: Open reduction internal fixation, left open humerus fracture.Procedure: While under general anesthetic, the patient’s left arm was prepped with Betadine and draped in sterile fashion. We then created a longitudinal incision over the anterolateral aspect of his left arm and carried the dissection through the subcutaneous tissue. We attempted to identify the lateral intermuscular septum and progressed to the fracture site, which was actually fairly easily to do because there was some significant tearing and rupturing of the biceps and brachialis muscles. These were partial ruptures, but the bone was relatively easy to expose through this. We then identified the fracture site and thoroughly irrigated ut with several liters of saline. We also noted that the radial nerve was easily visible, crossing along the posterolateral aspect of the fracture site. It was intact. We carefully detected it throughout the remainder of the procedure. We then were able to strip the periosteum away from the lateral side of the shaft of the humerus both proximally and distally from the fracture site. We did this just enough to apply a 6-hole plate, which we eventually held in place with six cortical screws. We did attempt to compress the fracture site. Due to some communition, the fracture was not quite anatomically aligned, but certainly it was felt to be very acceptable. Once we had applied the plate, we then checked the radial pulse with a Doppler. We found that the radial pulse was present using the Doppler, but not with palpation. We then applied Xeroform dressings to the wounds and the incision. After padding the arm thoroughly, we applied a long-arm splint with the elbow flexed about 75 degrees. He tolerated the procedure well, and the radial pulse was again present on the Doppler examination at the end of the procedure.

Libby was thrown from a horse while riding in the ditch; a truck that honked the horn as it passed her startled her horse. The horse reared up, and Libby was thrown to the ground. Her left tibia was fractured and required insertion of multiple pins to stabilize the defect area. A unilateral multiplane external fixation system was then attached to the pins.

Mary tells her physician that she has been having pain in her left wrist for several weeks. The physician examines the area and palpates a ganglion cyst of the tendon sheath. He marks the injection sites, sterilizes the area, and injects corticosteroid into two areas.

The physician applies a Minerva-type fiber glass body cast from the hips to the shoulders and to the head. Before application, a stockinette is stretched over the patient’s torso, and further padding of the bony areas with felt padding was done.

Total hip replacement is performed for aseptic necrosis of the head and neck of the femur. What are the correct CPT and ICD-9-CM codes for this procedure?

Carl Ostrick, a 21-year-old male, slipped on a patch of ice on his sidewalk while shoveling snow. When he fell, his left hand was wedged under his body and his index finger was dislocated. After manipulating the joint back into normal alignment, the surgeon fixed the dislocation by placing a wire percutaneously through the carpometacarpal joint to maintain alignment.

John, an 84-year-old male, tripped while on his morning walk. He stated he was thinking about something else when he inadvertently tripped over the sidewalk curb and fell to his knees. X-ray indicated a fracture of his right patella. With the patient under general anesthesia, the area was opened and extensively irrigated. The left aspect of the patella was severely fragmented, and a portion of the patella was subsequently removed. The remaining patella was wired. The surrounding tissue was repaired, thoroughly irrigated and closed in the usual manner.

Maryann received a blow to her right tibial shaft while moving a large stuffed chair up a flight of stairs when the person in front of the chair slipped and released his hold on the chair. The full weight of the chair was pushed against her; when she was unable to hold the chair in place, both she and the chair fell to the landing a dozen steps below. The chair tipped on its side and landed on her tibia. On x-ray, the right tibia shaft was fractured in 3 places. Percutaneous screws and pins were placed to secure the fracture sites.

Darin was a passenger in an automobile rollover accident and was not wearing a seat belt at the time. He was thrown from the automobile and was pinned under the rear of the overturned vehicle. He sustained craniofacial separation that required complicated internal and external fixation using an open approach to repair the extensive damage. A halo device was used to hold the head immobile.

A young man with left tibial shaft fracture is provided open treatment without intramedullary implant. After the procedure the leg was placed in a short leg cast. Give the appropriate CPT codes.

The physician performs a surgical procedure for the release of a trigger finger condition on the right middle finger. At the same operative session, the surgeon excises a bone cyst on the left fourth metacarpal of the hand (no graft necessary). Select the correct codes,

A surgeon performs a diagnostic knee arthroscopy without synovial biopsy that revealed tears of the medial and lateral menisci. He proceeded with menisectomies of both medial and lateral menisci along with shaving of the surrounding tissue/bone. Select the correct code(s).

A patient presents to an internal medicine provider complaining of wrist pain due to an imbedded foreign body (thorn entered while trimming outside bushes). The internist requests an orthopedist to evaluate the patient’s injury. The orthopedist performs a detailed history and exam and discusses the treatment option & performed low complexity MDM.The patient opts for surgical intervention. The orthopedist relays his findings to the internist and proceeds to explore the wrist area. The thorn is located deep in the tissues of the wrist which the orthopedic surgeon removes without complications. Select the appropriate CPT and ICD-9-CM codes.

A patient is admitted to the hospital outpatient department where an excision of a tumor (2.5 cm) located on the lower back (subcutaneous tissue) is performed. Pathology report comes back verifying a diagnosis of lipoma. Select the appropriate CPT and ICD-9-CM codes.

Patient underwent reconstruction of the mandibular rami due to blunt trauma, undergoing C osteotomy with bone graft.

A 16-year-old patient undergoes excision of an aneurismal bone cyst of the proximal right humerus with allograft.

Surgeon performs removal of Harrington rod in a patient suffering from chronic irritation in the region of insertion.

Patient underwent replantation of thumb after complete amputation from the distal tip to the MP joint

A patient was seen in the office for trigger point injection involving the trapezius and lattismus muscle groups.

Surgeon performed open repair of femoral neck fracture with internal fixation.

A doctor performs an open procedure of ankle arthrodesis for a patient with ankle arthritis. After arthrodesis, the doctor fits a small bone graft obtained from the fibula into the ankle. Code this procedure.

A patient with compartment syndrome undergoes decompression fasciotomy of his right leg posterior compartment. The physician debrided all the nonviable tissue and nerve in that compartment. Code the procedure.

This is a 32 year old female who presents today with sacroilitis. On the physical exam there was pain on palpation of the left sacroiliac joint and imaging confirmation was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 mL of bupivacaine at 0.5% was injected into the left sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. The correct CPT code is:

PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee TITLE OF PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee The patent was brought to the operating room, placed in the supine position after which he underwent general anesthesia. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. What CPT and ICD-9-CM codes should be reported?

PREOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. POSTOPERATIVE DIAGNOSIS: Displaced impacted Colles fracture, left distal radius and ulna. OPERATIVE PROCEDURE: Reduction with application external fixator, left wrist fracture FINDINGS: The patient is a 46-year-old right-hand-dominant female who fell off stairs 4 to 5 days ago sustaining an impacted distal radius fracture with possible intraarticular component and an associated ulnar styloid fracture. Today in surgery, fracture was reduced anatomically and an external fixator was applied. PROCEDURE: Under satisfactory general anesthesia, the fracture was manipulated and C-arm images were checked. The left upper extremity was prepped and draped in the usual sterile orthopedic fashion. Two small incisions were made over the second metacarpal and after removing soft tissues including tendinous structures out of the way, drawing was carried out and blunt-tipped pins were placed for the EBI external fixator. The frame was next placed and the site for the proximal pins was chosen. Small incision was made. Subcutaneous tissues were carried out of the way. The pin guide was placed and 2 holes were drilled and blunt-tipped pins placed. Fixator was assembled. C-arm images were checked. Fracture reduction appeared to be anatomic. Suturing was carried out where needed with 4-0 Vicryl interrupted subcutaneous and 4-0 nylon interrupted sutures. Sterile dressings were applied. Vascular supply was noted to be satisfactory. Final frame tightening was carried out. What CPT and ICD-9-CM codes should be reported?

The patient is a 66-year-old female who presents with Dupuytren's disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren's disease right ring digit and palm. An extensile Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code should be used?

42 year old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes, about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The rotator interval was very thick and contracted and this was released with electrocautery and the Bovie including the superior glenohumeral ligament. After this was all released, the middle glenohumeral ligament was released as well as the tendinous portion of the subscapularis. After this was all done with a shaver and electrocautery, the arthroscope was placed anteriorly and the shaver and used to debride some of the posterior capsule and the posterior capsule was released in its posterosuperior and then posteroinferior aspect. After this was done, the arthroscope was then placed back posteriorly and used to release the anteroinferior capsule down to 6’oclock. This was done with electrocautery. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope was then placed anteriorly and used to release the posteroinferior capsule. The arthroscope was then placed back posteriorly and used to confirm that there was still one little strip of capsule around the biceps superiorly and there was one little strip from 6-7 o’clock posteroinferiorly that was only partially cut. The rest of the capsule was completely circumferentially released. What CPT code describes this procedure?

After adequate anesthesia was obtained the patient was turned prone in a kneeling position on the spinal table. A lower midline lumbar incision was made and the soft tissues divided down to the spinous processes. The soft tissues were stripped way from the lamina down to the facets and discectomies and laminectomies were then carried out at L3-4, L4-5 and L5-S1. Interbody fusions were set up for the lower three levels using the Danek allografts and augmented with structural autogenous bone from the iliac crest. The posterior instrumentation of a 5.5 mm diameter titanium rod was then cut to the appropriate length and bent to confirm to the normal lordotic curve. It was then slid immediately onto the bone screws and at each level compression was carried out as each of the two bolts were tightened so that the interbody fusions would be snug and as tight as possible. Select the appropriate CPT code(s) for this visit?

PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distalward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What code should be used for this procedure?

An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix figure-of-eight plate was placed and checked with x-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl. What procedure code should be used?

PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distalward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What code should be used for this procedure?

An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix figure-of-eight plate was placed and checked with x-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl. What procedure code should be used?

A 35-year-old female patient presents with acute onset of severe pain since October. Her workup has revealed evidence of disk herniation with loss of lordosis at the C5-C6. Intraoperative findings were consistent with two large fragments of free disk fragments in the foramen at C5-C6 on the right side. After general anesthesia, the patient was placed on the operative table in the supine position. All pressure points were cushioned and a transverse skin incision was fashioned under fluoroscopic guidance over the C5-C6 disc space. Dissection through the platysma eventually allowed for exposure of the anterior entrance to the vertebral body of C5 and C6 and retractors were inserted to maintain adequate exposure. The operating microscope was brought into the field. Caspar posts were placed and slight distraction allowed exposure. A complete discectomy was performed at C5-C6 by using endplate curets pituitary rongeurs and Kerrison rongeurs. The posterior longitudinal ligament was resected and beneath the posterior longitudinal ligament, two significant sized disc fragments were noted in the foramen at C5-C6. These were removed using pituitary and Decker instruments. The endplates were then decorticated so that they were parallel to each other and a midline keel was performed on AP and lateral fluoroscopy. A size #1 by 5 mm interbody Kineflex-C device was placed under fluoroscopic guidance. Satisfied with the positioning of the device, the decision was made to close. What is the correct code for this procedure?

52 year old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT should be reported?

Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac injection at an ambulatory surgery center. After sterile prep, the patient is placed prone and under fluoroscopic guidance; the needle is placed into the SI joint with a mixture of 20 mg of Celestone and Marcaine for pain relief. Code the procedure(s).

Patient is seen in the hospital’s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF procedure was performed, which included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places about 90 degrees. It was possible to manually reduce this quite easily, and the manipulation resulted in an almost anatomic reduction. This was fixed with two pins driven across the humerus. The pins were cut off below skin level. The wound was closed with plain catgut subcutaneously and 5-0 nylon for the skin. Dressings and a long arm cast were applied. Which are the correct ICD-9-CM and CPT® codes assignment?

Code the closed treatment of a carpal bone fracture (not scaphoid) with manipulation.

Code a repeat closed treatment of a femoral shaft fracture with manipulation by the same physician who performed the initial treatment.

Code an amputation of the right leg just above the knee.

A 42-year-old man has his "total knee" prosthesis removed after he develops an inflammatory reaction. Choose the best diagnosis and procedure codes for the service

A patient suffered a fracture of the femur head. He had an open treatment of the femoral head with a replacement using a Medicon alloy femoral head and methyl methacrylate cement. How would you report this procedure?

While playing at home, Riley dislocated his patella, when he fell from a tree. The surgeon documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would you report the treatment and diagnoses?

How should you report a deep biopsy of soft tissue of the thigh or knee area?

Mike had a bicycle accident and suffered deep hematomas in both knees. He underwent a bilateral incision and drainage. How would you report the procedure?

A patient had a unilateral percutaneous intradiscal electrothermal annuloplasty on L3-L5 with fluoroscopic guidance for needle placement. How would you report this professional service procedure?

Code the closed treatment of a carpal bone fracture (not scaphoid) with manipulation.

Code a repeat closed treatment of a femoral shaft fracture with manipulation by the same physician who performed the initial treatment.

A 42-year-old man has his "total knee" prosthesis removed after he develops an inflammatory reaction. Choose the best diagnosis and procedure codes for the service

A patient suffered a fracture of the femur head. He had an open treatment of the femoral head with a replacement using a Medicon alloy femoral head and methyl methacrylate cement. How would you report this procedure?

While playing at home, Riley dislocated his patella, when he fell from a tree. The surgeon documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would you report the treatment and diagnoses?

How should you report a deep biopsy of soft tissue of the thigh or knee area?

Mike had a bicycle accident and suffered deep hematomas in both knees. He underwent a bilateral incision and drainage. How would you report the procedure?

A patient had a unilateral percutaneous intradiscal electrothermal annuloplasty on L3-L5 with fluoroscopic guidance for needle placement. How would you report this professional service procedure?

This is a 67-year-old Medicare patient who has an infected acromioclavicular joint of the right shoulder postoperatively. The surgeon decided to take the patient to the operating room for an I&D of the infected acromioclavicular joint of the right shoulder to alleviate the patient’s pain. The patient was placed on the operating room table in the supine position. Conscious sedation was administered and the patient was placed in the modified branch chair position. The right shoulder was prepped and draped in the usual sterile fashion. The previous incision, which had pyogenic granuloma, was opened. The granulomatous tissue was excised and the acromioclavicular joint was exposed. There was some mild purulence in this area. Cultures were taken for anaerobic and aerobic cultures and for gram stain. Tissue specimens were also taken. Ancef was started and the shoulder was irrigated in the acromioclavicular joint with six liters of saline. The AC joint was injected with 10 cc of Marcaine and Epinephrine and the skin was closed with three interrupted sutures, and a one inch drain was placed. A sterile dressing was applied. The patient tolerated the procedure well. All sponge, needle and instrument counts were correct. Blood loss was minimal. What codes should be reported for this procedure?

A 37 year old was admitted to the surgery unit for surgical repair of the left elbow. The surgeon performed a left elbow membrane arthroplasty for the patient’s system sclerosis. What are the correct procedure and diagnosis codes for this encounter?

The physician applies a Minerva-type fiberglass body cast from the hips to the shoulder and to the head. Before application, a stockinette is stretched over the patient’s torso and further padding of the bony areas with felt padding was done.

The patient fell while at home tow and a half weeks ago. She had sudden onset of severe left hip pain. She has been ambulatory with a cane, however, movement is slow and increasingly painful. The patient was noted to have a nondisplaced proximal neck fracture of the left femur. The patient elected to undergo stabilization with percutaneous pinning. The patient was taken to the operating room where spinal anesthetic was administered. The patient was placed on a fracture table in the supine position. Under fluoroscopic visualization, the direction for placement of the pins were noted and the skin was marked. A 1 cm stab incision was made over the the lateral aspect of the left hip at the level of the lesser trochanter. A self-tapping and self drilling Biomer 6.0 cannulated screw system was used. A guide pin was placed through the incision and through the lateral aspect of the proximal femur. It was drilled through the cortex across the fracture site then the femoral neck and femoral head. This portion of the procedure was accomplished under fluoroscopic guidance. It was measured to 85 mm and an 85 mm cannulated screw was placed over the guidewire. It was threaded into the femoral head. The identical procedure was performed with two more screws, one placed posteriorly in an anterior and posterior fashion and the other screw placed in the middle anterior position. The guide pins were removed. A fluoroscopy in AP and lateral projection showed that the screws were within the femoral head. The femoral head was put through a range of motion under fluoroscopy to confirm that there was no penetration of the screws out of the femoral head. The incisions were irrigated with normal saline and closed with 2-0 Vicryl subcutaneous sutures. The wounds were dressed with Adaptic, 4 x 4 gauze and an ABD pad held in place with tape. All sponge, needle, and instrument counts were correct. The patient left the operating room in good condition and there were no complications. Estimated blood loss was less than 20 cc. What are the correct codes to report this service?

Operative Report: Preoperative Diagnosis: Open fracture, left humerus, with possible loss of left radial pulse. Procedure performed: Open reduction internal fixation, left open humerus fracture. Procedure: While under a general anesthetic, the patient’s left arm was prepped with Betadine and draped in sterile fashion. We then created a longitudinal incision over the anterolateral aspect of his left arm and carried the dissection through the subcutaneous tissue. We attempted to identify the lateral intermuscular septum, and progressed to the fracture site, which was actually fairly easily to do because there was some significant tearing and rupturing of the biceps and brachialis muscles. These were partial ruptures, but the bone was relatively easy to expose through this We then identified the fracture site and thoroughly irrigated it wit several liters of saline. We also noted that the radial nerve was easily visible, crossing along the posterolateral aspect of the fracture site. It was intact. We carefully detected it throughout the remainder of the procedure. We then were able to strip the periosteum away from the lateral side of the shaft of the humerus both proximally and distally from the fracture site. We did this just enough to apply a 6-hole plate, which we eventually held in place with six cortical screws. We did attempt to compress the fracture site. Due to some communition, the fracture was not quite anatomically aligned, but certainly it was felt to be very acceptable. Once we had applied the plate, we then checked the radial pulse with a Doppler. We found that the radial pulse was present using the Doppler, but not with palpation. We then applied Xeroform dressings to the wounds and the incision. After padding the arm thoroughly, we applied a long arm splint with the elbow flexed about 75 degrees. He tolerated the procedure well, and the radial pulse was again present on the Doppler examination at the end of the procedure.

Operative Report: Preoperative Diagnosis: Open fracture, left humerus, with possible loss of left radial pulse. Procedure performed: Open reduction internal fixation, left open humerus fracture. Procedure: While under a general anesthetic, the patient’s left arm was prepped with Betadine and draped in sterile fashion. We then created a longitudinal incision over the anterolateral aspect of his left arm and carried the dissection through the subcutaneous tissue. We attempted to identify the lateral intermuscular septum, and progressed to the fracture site, which was actually fairly easily to do because there was some significant tearing and rupturing of the biceps and brachialis muscles. These were partial ruptures, but the bone was relatively easy to expose through this We then identified the fracture site and thoroughly irrigated it wit several liters of saline. We also noted that the radial nerve was easily visible, crossing along the posterolateral aspect of the fracture site. It was intact. We carefully detected it throughout the remainder of the procedure. We then were able to strip the periosteum away from the lateral side of the shaft of the humerus both proximally and distally from the fracture site. We did this just enough to apply a 6-hole plate, which we eventually held in place with six cortical screws. We did attempt to compress the fracture site. Due to some communition, the fracture was not quite anatomically aligned, but certainly it was felt to be very acceptable. Once we had applied the plate, we then checked the radial pulse with a Doppler. We found that the radial pulse was present using the Doppler, but not with palpation. We then applied Xeroform dressings to the wounds and the incision. After padding the arm thoroughly, we applied a long arm splint with the elbow flexed about 75 degrees. He tolerated the procedure well, and the radial pulse was again present on the Doppler examination at the end of the procedure.

DIAGNOSIS: Left knee medial meniscus tear. NAME OF OPERATION: Partial medial menisectomy with limited debridement. ANESTHESIA: General PROCEDURE: In the preoperative holding area the site and side and the procedure were confirmed with the patient. The risks, benefits, and alternatives were discussed. He voiced understanding regarding the limitations of arthroscopic treatment, particularly if there is arthritis involved. The patient was taken to the operating room, and after adequate general anesthesia the left leg was carefully fitted with a tourniquet over a snugly-fitted Webril and placed in the left leg holder. The leg was prepped and draped in sterile fashion. Portals were carefully established using landmarks as a guide. The anterior-medial portal was established using a spinal needle as a guide. Sequential examination of the joint was performed. Generalized arthritis was noted throughout except no full-thickness cartilaginous tears were noted. There was an unstable medial meniscus tear which was carefully debrided. The anterior cruciate ligament was a little bit incompetent with some fraying fibers, but no evidence of gross instability detected as pivot shift was equivocal. Hence this was left intact. The posterior cruciate ligament was normal. The patellofemoral joint tracked well. There were grade III articular changes throughout the knee. A few loose bodies were removed from some of the cartilaginous surfaces. The worst areas were smoothed, but otherwise it was left intact. Final inspection was made for loose bodies. These were removed. The last inspection found none. The joint was irrigated and back-bled. The knee was injected with Xylocaine and Marcaine for pre- and postoperative pain. A sterile dressing was applied. The patient was aroused from anesthesia and taken to the recovery room in stable condition having tolerated the procedure well.

Code the CPT and ICD-9 Procedural Codes for the Op Report Below: DIAGNOSIS: Recurrent dislocation, right shoulder FINDINGS AT OPERATION: Preoperatively, the patient had instability of the shoulder anteriorly. He did not have any posterior or inferior instability. At surgery, he was found to have a large Hill-Sach lesion, as well as very thorough Bankart lesion (link). The inferior part of the labrum was calcified, and this could be seen on preoperative x-rays. The glenohumeral surface was relatively clean. There was no rotator cuff tear or biceps tendon damage. PROCEDURE: He was given a general anesthetic and put in the beach-chair position, and prepped and draped in a sterile fashion. The shoulder was instilled with fluid, followed by diagnostic arthroscopy with the arthroscope in the posterior portal, with findings as noted above. The bursal area was examined, also, and no abnormalities were found. The scope was then removed, and the patient was put back in the semi-reclining position. A deltopectoral incision was made, carried down through the subcutaneous tissue, and the vein was retracted laterally. The deep structures were approached, and clavipectoral fascia incised. The arm was externally rotated, and the subscapularis reflected off the capsule. The capsule was entered, and debridement of the calcified inferior labrum was carried out. The labral tissue was in relatively good condition, and it was freed up by using a knife to allow it to come up over the edge of the glenoid better, and then the edge of the glenoid was roughened.Three Mitek sutures were then placed right at the edge of the glenoid, and these were used to repair the labrum. Copious irrigation was carried out. The arm was then reduced into position, and the lateral capsule tightened down to the labrum, allowing about 15 degrees of external rotation. These sutures were tied and were felt to be quite satisfactory. Again, irrigation was performed. The subscapularis was anatomically closed. The subcutaneous tissue and skin were closed in layers, and a sterile dressing was applied. All the capsular redundancy seemed to be negated by the procedure, and he seemed to be quite stable. Sponge and needle counts were correct. The patient tolerated the procedure well.

Code the CPT and the ICD-9 Procedural Code for the following procedure(s): DIAGNOSIS: Dorsal ganglion cyst, left wrist NAME OF OPERATION: Excision of dorsal ganglion cyst FINDINGS AT OPERATION: This patient had one of these thick, very firm cysts in the classic location beneath the extensor tendon PROCEDURE: The patient was given a general anesthetic, and the arm was prepped and draped in a sterile fashion, with a well-padded tourniquet around the arm. The tourniquet was inflated to 250 mmHg after exsanguination with an Esmarch. A transverse incision was made over the cyst, carried down through subcutaneous tissue. The extensor retinaculum was incised, and tendons were protected with retractors. The cyst was then surrounded and lifted up off the carpus, taking a portion of the dorsal ligament. Irrigation was then carried out. The incision was closed with nylon and Steri-Strips. A sterile dressing was applied. The patient appeared to tolerate the procedure well.

DIAGNOSIS: Scaphoid nonunion, right. NAME OF OPERATION: Open reduction and internal fixation of right scaphoid fracture nonunion with autogenous bone graft from the distal radius; filling of bone graft donor site with coralline bone graft substitute. FINDINGS AT OPERATION: The distal pole of the scaphoid at the level of the tuberosity was fractured and had failed to heal. The distal pole had resorbed partially, leaving a shell of bone which did not allow screw fixation. The proximal pole appeared to be viable, as did the distal pole. The distal radioscaphoid joint appeared normal. The scaphocapitate joint appeared normal. PROCEDURE: The patient was taken to the operating room and placed supine on the operating table. He underwent satisfactory uneventful induction of general inhalation anesthesia. The right upper extremity was scrubbed with Betadine scrub solution, prepared with Betadine prep solution, and sterile drapes were applied to expose the right upper extremity. The limb was exsanguinated with an elastic wrap, and an incision was made along the radiovolar side of the thumb metacarpal base extending across the carpometacarpal joint and the scaphotrapezial joint and the radioscaphoid joint. At the flexor carpi radialis sheath, the incision extended proximally, approximately 6-8 cm. The subcutaneous tissues were dissected sharply. Care was taken to avoid injury to the terminal branches of the superficial radial nerve and to the radial artery. Care was taken to avoid injury to the median nerve. The flexor carpi radialis sheath was opened, and the flexor carpi radialis tendon was reflected ulnarward. The sheath was opened dorsally and the distal radius was exposed, and the radiocarpal joint was exposed, as was the radioscaphoid and scaphotrapezial joint. The crossing vessels from the radial artery were cauterized and suctioned. Care was taken to avoid injury to the terminal branches of the superficial radial nerve. Care was taken to avoid injury to the major trunk of the radial artery. The capsule of the wrist joint was opened. The scaphoid nonunion was identified. The .062-inch Kirschner wires were used as manipulating handles to control the proximal and distal fragments while the nonunion was cleaned of fibrous tissue and scarred, dense bone. A satisfactory, though nonanatomic reduction could be achieved, and it appeared that there was slight flexion of the scaphoid. The pronator quadratus was reflected from the distal radius and a window measuring approximately 1 x 2 cm was opened in the transverse axis of the distal radius. The margins of the window were rounded with Kirschner-wire drill holes to diminish stress-rising effect. Ample, good, viable cancellous bone was removed from the distal radius. The wound was irrigated with saline and packed with coralline bone graft substitute (Interpore). The bone graft was placed in the exposed raw surfaces of the proximal and distal fragments of the scaphoid bone. A corticocancellous bone graft was placed slightly to the volar side to prevent further volar collapse. Using the image intensifier video monitor after placement of .062-inch Kirschner wires across the fracture site, the Kirschner wires appeared to be satisfactory, after they were repositioned. The image intensifier AP and lateral projection revealed satisfactory, though nonanatomic reduction of the carposcaphoid. The radioscaphoid articulation did not appear to be threatened. The fracture was stably fixed with no motion evident on radial or ulnar deviation. The wound was irrigated with saline, infiltrated with 0.25% Marcaine, and the tourniquet was deflated. Hemostasis was ascertained, and the capsular structures were closed with interrupted 4-0 Vicryl suture, so that the capsule-ligamentous portion of the volar wrist capsule was restored. The wound was irrigated with saline. Hemostasis was ascertained and the subcutaneous tissues were closed with interrupted 4-0 Vicryl suture.

The physician performs a surgical procedure for the release of a trigger finger condition on the right middle finger. At the same operative session, the surgeon excises a bone cyst on the left fourth metacarpal of the hand (no graft necessary). Select the correct codes.

A surgeon performs a diagnostic knee arthroscopy without synovial biopsy that revealed tears of the medial and lateral menisci. He proceeded with menisectomies of both medial and lateral menisci along with shaving of the surrounding tissue/bone. Select the correct code(s).

A patient is admitted to the hospital outpatient department where an excision of a tumor (2.5 cm) located on the lower back (subcutaneous tissue) is performed. Pathology report comes back verifying a diagnosis of lipoma. Select the appropriate CPT and ICD-9-CM codes.

What is (are) the correct CPT code(s) for an arthrodesis, anterior interbody technique involving T2-T4?

Total hip replacement is performed for aseptic necrosis of the head and neck of the femur. What are the correct CPT and ICD-9-CM codes for this procedure?

DIAGNOSIS: Foreign body, ball of left foot. NAME OF OPERATION: Excision of foreign body, ball of left foot. ANESTHESIA: General, tube balanced. PROCEDURE: This 24-year-old lady was taken to surgery with the finding of a very tender isolated spot at the ball of the left foot between the first and second toes. By history, she felt like she stepped on something with pain, and over the ensuing week-and-a-half to two weeks the pain has gotten unbearable when she walks. X-rays did not show evidence of a foreign body. However, there is definitely a callous, granulous formation here that could possibly be a plantar wart.In the operating room in the supine position after induction of adequate per Anesthesia, the left foot was prepped with Hibiclens and alcohol for full three-minute prep. Drapes were applied exposing the ball of the footonly. Local infiltration of 0.5 cc of 2% Xylocaine was carried out. The area was elliptically excised, noting a very thick granular reaction beneath this. This was sent for pathology review which gave the final interpretation as a superficial foreign body embedded in the subcutaneous area of the foot. Total excision area was approximately 8 mm x 3 mm. There was no reaction deep to this.With this, the wound was closed with two interrupted 5-0 Monocryl stitches giving complete closure. The area was cleansed with peroxide. A dressing was applied, and the patient was sent to the recovery room in satisfactory condition. Sponge count, needle count, and instrument counts were correct times three.

The patient came to the office for a therapeutic injection, left shoulder subacromial space. How would you code the procedure?

A small incision was made over the left proximal tibia, and a traction pin was inserted through the bone to the opposite side. Weights were then affixed to the pins to stabilize the tibial fracture repair could be performed.