RESPIRATORY SYSTEM Buck Step by Step Medical Coding 2010 Edition Chapter 15 by mikesanye

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									                     Buck: Step-by-Step Medical Coding, 2010 Edition
                                   Chapter 15: Respiratory System
                                            Test Review

1. A chest tube may be used as an indwelling method of draining the accumulated fluid in the
   pleural space.
2. Thoracoplasty is a procedure that is performed to separate the inside of the chest cavity from the
   lung to permit the collapse of the lung.
3. All “sinus” codes are reported as bilateral procedures only.
4. When multiple therapeutic procedures are performed through a scope during the same operative
   session, only the major (most extensive) procedure should be reported.
5. A “direct” laryngoscopic procedure means that the physician uses a tongue depressor to hold the
   tongue down and view the epiglottis with a mirror.
6. A surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy.

1. Endoscopic procedures are reported on the ____ place(s) to which the scope is advanced.

2. A diagnostic endoscopic procedure is reported only when:

3. Because most third-party payers do not pay for cosmetic surgery, the physician must carefully
   document ____ to ensure reimbursement for noncosmetic procedures.

4. What is the method that a physician uses to control a nosebleed?

5. If the physician performs a lavage of the maxillary sinus, what is he/she doing?

6. Thoracentesis is performed to withdraw fluid from the pleural space for a variety of conditions

7. Select the term that describes a procedure in which a scope is placed into a body cavity.

8. Which of the following terms does not describe the nasal turbinates?
     Test Bank                                                                                    15-2

 9. The procedure in which a scope is passed into the larynx and the physician can look at the larynx
    is what type of laryngoscopy?

10. In what Surgery subsection would you find the code for the incision and drainage of a nasal
    abscess using an external approach to the abscess?

11. The name of the procedure in which mucus is removed from the sinuses by flushing a saline
    solution through the sinus cavities is ____. For example, the Proetz procedure (saline irrigation
    combined with suction).

12. This surgical procedure is performed to reshape the nose.

13. What is the name of the surgical procedure for the rearrangement of the nasal septum?

14. The term that describes destruction by removing, usually by cutting, is:

15. The term that describes obtaining a tissue sample is:

16. Which modifier would you use if polyps were removed from both the left and the right sides of
    the nose?
 1. The physician views the trachea using a bronchoscope placed through an established
    tracheostomy. The physician examines the conducting airways. The bronchoscope is removed.
    CPT Code: ____________________
 2. Simple excision of a nasal polyp.
    CPT Code: ____________________
 3. A 14-year-old boy presents at the Emergency Department experiencing an uncontrolled anterior
    nosebleed. The ED physician packs his nose with gauze and within 10 minutes the nosebleed
    CPT Code: ____________________
 4. Three-year-old Hannah is playing with a marble and sticks it in her nose. Her mother is unable to
    dislodge the marble so she takes Hannah to the physician’s office. The physician removes the
    marble with hemostats.
    CPT Code: ____________________
 5. A physician performs an emergency transtracheal tracheostomy to remove a foreign object.
    CPT Code: ____________________
     Test Bank                                                                                    15-3

 6. The physician removes fluid from the chest cavity by puncturing through the space between the
    ribs. Using an aspirating needle attached to a syringe, the physician carefully passes the needle
    over the top of a rib, punctures through the chest tissues, and enters the pleural cavity. With the
    end of the needle in the chest cavity, the physician withdraws the fluid from the chest cavity by
    pulling back on the plunger of the syringe.
    CPT Code: ____________________
 7. Removal of a lung cyst by major thoracotomy.
    CPT Code: ____________________
 8. Endoscopic segmental lobectomy.
    CPT Code: ____________________
 9. Bilateral total lung lavage.
    CPT Code: ____________________
10. Endoscopic biopsy of the lung.
    CPT Code: ____________________
11. Pleural biopsy by percutaneous needle.
    CPT Code: ____________________
12. Insertion of a chest tube for pneumothorax.
    CPT Code: ____________________
13. Excision of a cervical tracheal tumor.
    CPT Code: ____________________
14. Bronchoscopy with placement of catheter for intracavitary radioelement application.
    CPT Code: ____________________
15. Plastic surgery to the nose (primary) without nasal septum involvement.
    CPT Code: ____________________
16. Reshaping of the nasal septum to correct airway obstruction.
    CPT Code: ____________________
17. Irrigation of the sphenoid sinus.
    CPT Code: ____________________
18. The physician uses an endoscope for a diagnostic evaluation of the nose. A polyp is identified
    and removed using forceps.
    CPT Code: ____________________
19. The physician uses an endoscope for surgical access to decompress the optic nerve in the
    posterior orbit.
    CPT Code: ____________________
20. Drainage of an abscess in the nose via internal approach.
    CPT Code: ____________________
21. Using an existing tracheostomy incision, the physician places a bronchoscope through the
    incision to view the airway (tracheobronchoscopy).
    CPT Code: ____________________
22. Secondary rhinoplasty with major reconstruction of nasal tip to correct results of an initial
    rhinoplasty done elsewhere.
    CPT Code: ____________________
23. Percutaneous introduction of a needle wire dilator to provide for insertion of an indwelling
    oxygen tube.
    CPT Code: ____________________
    Test Bank                                                                                    15-4

24. Surgical thoracoscopy with excision of pericardial tumor.
    CPT Code: ____________________
25. Excision of tracheal tumor using cervical approach.
    CPT Code: ____________________
26. Surgical thoracoscopy with pleurodesis.
    CPT Code: ____________________
27. Total pulmonary decortication.
    CPT Code: ____________________
28. Flexible bronchoscopy with use of laser therapy to relieve stenosis.
    CPT Code: ____________________
29. Diagnostic, rigid bronchoscopy for the evaluation of chronic hemoptysis.
    CPT Code: ____________________
30. Jennifer Prescott, age 47, has developed chest pain and difficulty breathing. Jennifer has had
    several episodes of coughing up thick blood-tinged sputum. A diagnostic bronchoscopy is
    performed, with a specimen taken of the mass. The pathology report is positive for carcinoma.
    CPT Code: ____________________
31. PREOPERATIVE DIAGNOSIS: Right pneumothorax

    PROCEDURE PERFORMED: Placement of anterior chest tube
    PROCEDURE: The patient was draped and prepped in the usual manner. The area was
    infiltrated with 1% lidocaine. A 1-cm incision was made in the second intercostal space about 7
    cm to the right of the midline in the anterior chest and a 20-F chest tube was passed. Good tidal
    volume was confirmed. The chest tube was anchored using 1-0 silk. The area was dressed and
    the chest tube placed on suction. The patient tolerated the procedure well. Complications—none.

    CPT Code: ____________________

32. Douglas O’Mally, 31, has been having difficulty breathing and has had long-standing sinusitis. It
    is decided that Douglas will have a sinus endoscopy with anterior and posterior total
    ethmoidectomy with removal of polyps.
    CPT Code: ____________________
33. Catheterization with bronchial brush biopsy.
    CPT Code: ____________________
34. Diagnostic, indirect laryngoscopy with vocal cord injection of Gelfoam.
    CPT Code: ____________________
35. Location: Inpatient Hospital

        INDICATION: Cardiogenic shock and the need to initiate mechanical ventilation.
        PROCEDURE PERFORMED: Intubation.
        ANESTHESIA: Versed and fentanyl.
    Test Bank                                                                                    15-5

       PROCEDURE: After the procedure was explained and consent was obtained from the
       patient's family, the patient was prepped for an endotracheal intubation. The patient was
       premedicated with Versed and fentanyl. After adequate anesthesia and analgesia was
       achieved, the patient's vocal cords were directly visualized with the aid of a laryngoscope
       using a Miller 3 blade. A size 8.5 endotracheal tube was then inserted and passed through the
       vocal cords atraumatically and without any difficulty. The CO2 monitor did confirm correct
       placement of the tube. The cuff was then inflated and the tube secured around 22 cm at the

       The patient tolerated the procedure well. There were no acute complications. A chest x-ray
       had been ordered to confirm correct placement of the endotracheal tube.

       CPT Code: ____________________
36. Location: Outpatient Hospital

       INDICATION FOR THE PROCEDURE: Patient with chronic emphysema and chronic
       obstructive pulmonary disease, and a significant smoking history.
       PROCEDURE: Bronchoscopy procedure
       PREPROCEDURE MEDICATIONS were given: Atropine 0.5 mg and codeine 60 mg
       intramuscularly, and then also hydroxyzine. Topical anesthesia was applied with cocaine mix
       along with the Lidocaine topically into the throat. He was lying supine in the fluoroscope unit
       and with video monitoring, the bronchoscope was introduced through the nose and into the
       upper airway. The vocal cords were visualized. There were no endobronchial lesions noted.
       The vocal cords were moving equally with phonation and respiration. The bronchoscope was
       introduced through the vocal cords and negotiated into the trachea, the left upper lingula and
       lower lobe branches were visualized. No endobronchial lesions were noted. The right main,
       middle, lower and upper lobe bronchi up to subsegmental branches were visualized; no
       endobronchial lesions were noted either. The procedure was uneventful. He did not have any
       significant cough during the procedure.

       CPT Code: ____________________
37. Location: Outpatient Hospital

       PREOPERATIVE DIAGNOSIS: Septal deviation.
       PROCEDURE PERFORMED: Septoplasty.
    Test Bank                                                                                  15-6

        OPERATIVE NOTE: The patient was admitted through same day surgery department and
        taken to the operating room and was administered general anesthetic by intravenous injection
        and was intubated endotracheally. His nose was decongested with 4 cc of 4% cocaine
        solution on nasal pledgets. A small amount of Afrin was also used. The patient was draped in
        the usual fashion. The packing was then removed and the left septum was injected with 1%
        lidocaine with epinephrine. A left hemitransfixion incision was created with a Beaver blade
        and a mucoperichondrial flap was elevated on this side, this was extended posteriorly over
        the perpendicular plate of ethmoid and vomer, extended inferiorly over a septal spur. We
        then separated the bony and cartilaginous septum to elevate it on the opposite side. We
        elevated on either side of the maxillary crest. A 4-mm osteotome was used to remove this. A
        portion of inferior cartilage was also removed. Once this was completed we laid the mucosa
        back into position and the septum was nicely reduced. We closed the caudal hemitransfixion
        incision with interrupted 3-0 Chromic suture. The septum was closed with 4-0 plain gut
        suture. Doyle splints were then placed on either side of the nose. The patient was then
        allowed to recover from the anesthetic and taken to the postanesthesia care unit in stable
        condition. There were no complications during this procedure.

        CPT Code: ____________________
38. ____________________ is a procedure in which the nose is reshaped internally, externally, or
    internal and external reshaping during the same surgical procedure.
39. The code range ____________________ is for the control of nasal hemorrhage and is located in
    the Other Procedures category.
 Define the following: Word list will be provided on exam.

        A.   Repair of damaged trachea
        B.   Incision made over the larynx
        C.   Creation of an opening into the trachea
        D.   Establishment of an airway
        E.   Removal by cutting
        F.   Washing out an organ
        G.   Destruction of tissue by burning
        H.   Free flow or withdrawal of fluids

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