Unit 7 - Seminar

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Unit 7 - Seminar
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• A 2 x 2 cm lesion was excised from Mrs. Smiths
  right arm. The lesion and 1mm margins all around
  the lesion were excised.
• What is the excised diameter of this excision?

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• What is the difference between simple closure and
  intermediate closure of a wound?

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• Practice Exercises

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Exercise 11.5 Lesion Removal

• Assign the CPT code(s) and any appropriate
  modifier(s) to each statement

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• A physician excises a 1 cm lesion of the left
  forearm, and the defect is closed with a simple
  repair.

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1. Punch biopsy of a skin lesion on the back and
   another one on the arm.

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1. Excision of a 2.1 cm malignant lesion of the nose
   and two malignant lesions, including margins, of
   the chest, each 1.5 cm diameter, including
   margins.

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1. Four warts were removed by paring.

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1. A physician excised a 2 cm benign lesion from the
   face.

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Exercise 11.6 - Nails

• Assign the CPT code(s) and any appropriate
  modifier(s) to each statement.

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1. A diabetic patient was seen by a podiatrist for
   trimming of nondystrophic nails, which are
   unaffected by abnormal development or changes in
   structure or appearance. Following cleansing and
   drying of all toenails of both feet, clippers are
   used to cut each nail straight across so that it
   is in line with the edge of the end of the toe.

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1. Reconstruction of nailbed, second toe on left
   foot, with graft.

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1. Avulsion of nail plate, simple, 5 nails, right
   foot.

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1. The physician evacuated blood from a hematoma
   located beneath a patients fingernail, second
   digit, left hand. The physician used an
   electrocautery needle to pierce the nail plate so
   the hematoma can drain. Pressure was applied to
   the nailbed to force the blood from beneath the
   nail plate. A loose dressing was applied so the
   area can continue to drain.

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1. Wedge excision of skin of nail fold for ingrown
   toenail, third digit, right foot.

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Exercise 11.7 Pilonidal Cyst

• Assign the CPT code(s) and any appropriate
  modifier(s) to each statement.

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1. Excision of complicated pilonidal cyst.

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1. Pilonidal sinus excision, simple.

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1. Excision of extensive pilonidal cyst.

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1. The physician shaved hair adjacent to a pilonidal
   cyst and made an incision to allow drainage of
   cystic fluid.

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1. The patient presented with an infected pilonidal
   cyst (complicated). The cyst was incised and
   drained.

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Exercise 11.11 Breast

• Assign the CPT code(s) and any appropriate
  modifier(s) to each statement

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1. Excision of two lesions, right breast, identified
   by the placement of radiological markers for each.

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1. A transverse rectus abdominis myocutaneous flap
   procedure for right breast reconstruction is
   performed using a single rectus adbominis muscle
   to transfer the necessary tissue to form a breast
   mound.

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1. Lumpectomy, left breast.

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1. Physician performed a partial mastectomy of the
   right breast with right axillary lymphadenectomy
   and biopsy of the right sentinel node.

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1. Patients left breast lesion was localized for
   needle biopsy. Mammographic images were obtained
   to verify needle placement with regard to the
   lesion. After verifying the position, the biopsy
   was obtained and postbiopsy targeted mammographic
   imaging was performed. A metallic clip marker
   was placed through the same instrument at the
   site of tissue removal, using the same guidance.
   A mammogram after the procedure confirms the
   location of the clip in the breast for future
   reference.

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Review Multiple Choice

• Which is a therapeutic surgical procedure?
• Arthroscopy
• Biopsy
• Endoscopy
• Repair

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• A patient undergoing a surgical procedure was
  draped and positioned. .
• Which service is assigned a separate code?
• Administration of a sedative
• None of the services are reported separately
• Taking cultures
• Transcription of the dictated report

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• Which modifier indicates a staged procedure or
  service?
• -58
• -59
• -66
• -76

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• When a patient receives treatment for an
  unrelated condition during the global period,
  which modifier is added to the CPT code?
• -51
• -57
• -59
• -79

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Chapter 12

• Review
• (pp. 502-504)

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Chapter 12

• Coding Cases
• (pp. 504 506)