Question 1

Dr. Brown, a dermatologist, opened and drained multiple complicated acne pustules and comedones on a 19-year-old patient with severe acne. For one of the more complicated acne pustules, Dr. Brown incised, drained, and marsupial zed the acne cyst by suturing the right and left sides, leaving the cyst open for drainage. What is the correct code for the procedure?

Accepted Answer

The correct code for the procedure is 10040 (Acne Surgery). This is the only code necessary, as it includes the opening of acne comedones, cysts, and pustules. It also includes the marsupialization of the acne cysts. Codes: 10060 and 10061 are used for the incision and drainage of unspecified abscesses or cysts, rather than acne cysts.

Question 2

Dr. Brown, a dermatologist, is seeing a patient for an acne surgery follow-up that was performed eight months ago. The surgery was successful and the patient's skin condition has rapidly improved due to a strict hygiene regimen and acne medications. Today the patient stated that he would like to reduce acne scarring by having dermabrasion on his entire face. Although the patient requested the entire face, the dermatologist only performed the dermabrasion on the areas on the patient's face that were not currently prone to acne breakouts (his forehead and brow area). What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 15781(Dermabrasion; Segmental, Face). Code 15780 is not appropriate because it refers to the total face, which in this case, did not apply because the dermatologist only performed the procedure on certain parts of the patient's face. Code 15786 is inappropriate because it refers to an abrasion of a lesion, rather than dermabrasion. Code 15788 is also inappropriate because it refers to a chemical peel, not dermabrasion.

Question 3

The physician performed the excision of two 1.5 cm malignant lesions on a patient's upper back. During the surgery, the physician noted four additional lesions, which looked to be pre-malignant. These lesion excisions were 0.3, 0.7, 1.0, and 1.45 cm, respectively. The suspect lesions were sent to pathology lab, where they were determined to be benign. What are the appropriate codes for the service?

Accepted Answer

The appropriate codes for the service are: 11400, for the excision of the 0.3 cm benign lesion, 11401 (X2) for the excision of both 0.7 and 1.0 benign lesions, 11402 for the excision of the 1.45 cm benign lesion, and 11602 (X2) for the excision of both of the 1.5 cm malignant lesions. CPT coding guidelines state that each malignant/benign lesion excised needs to be reported separately; therefore each lesion removal needs to be coded separately.

Question 4

A 22-year-old woman with excessive skin of her upper eyelid presented to her physician's office for the revision of her right eyelid. Her physician decided that she would perform a blepharoplasty of the right eyelid, during which she would remove the excessive skin weighing down the lid. When the physician performs this procedure, what code should she report?

Accepted Answer

When the physician performs this procedure, she should report code 15823 (Blepharoplasty, Upper Eyelid; with Excessive Skin weighting Down Lid). Modifier -50 is inappropriate because the procedure is only going to be performed on the right side not bilaterally. Code 15820 is inappropriate because it refers to a blepharoplasty of the lower eyelid.

Question 5

Two weeks ago, a 32-year-old male suffered a thumb injury at work. He was using a belt grinder on a small piece of steel when the belt caught the tip of his left thumb in the grinder. His thumb was ground down to the tip, his thumb nail was removed and a small piece of his anterior phalange bone was broken off. The patient has an appointment scheduled today to see if his nail bed on his left thumb can be reconstructed using a graft from his left great toe. What is code for this procedure?

Accepted Answer

The appropriate code for this procedure is 11762-LT (Reconstruction of the Nail Bed with Graft). The physician is planning on using a graft of the nail bed from the left great toe, therefore the code 11760-LT would not be correct because it only applies to the unspecified repair of the nail bed not a repair performed with a graft.

Question 6

A 10-year-old boy was running through his house and ran into a sliding glass door, breaking the glass and suffering severe lacerations on his trunk and arms and minor lacerations on his face and legs. The emergency department physician performed the simple closure of one 2 cm laceration on the boy's cheek and two 2.3 cm lacerations on the boy's left leg. The physician performed the simple closure of one 4 cm laceration on the right arm and the layered closure of two lacerations on the left arm, which were 1.5 and 3 cm, respectively. The physician treated the 5 cm laceration on the boy's chest, which required the removal of particulate glass and a single layer closure. What are the correct codes for the wound repair performed by the emergency department physician?

Accepted Answer

The correct codes for the wound repair performed by the emergency department physician are 12004, for the simple repair of the 4.6 cm and 4 cm lacerations of the left leg and right arm; 12011 for the simple repair of the 2 cm laceration of the cheek; and 12034 for the intermediate repair of the 4.5cm and 5cm lacerations of the left arm and chest. According to CPT guidelines, when multiple wounds are repaired, the coder must "add together the lengths of those in the same classification and from all anatomic sites that are grouped together into the same code descriptor." The repair of the chest laceration is an intermediate repair because it required the removal of particulate matter (glass).

Question 7

A 32-year old woman with severe gynecomastia and a prevalent family history of breast cancer elected to have a complete bilateral mastectomy with immediate insertion of breast prosthesis implants. What is/are the correct code(s) for the procedure?

Accepted Answer

The correct codes for the procedure are 19300 (Mastectomy for Gynecomastia) and 19340 (Immediate Insertion of Breast Prosthesis following Mastopexy, Mastectomy or in Reconstruction). Both codes need to be appended with modifier -50 to indicate that they were performed bilaterally. Code 19303 is not appropriate, in this case, because the mastectomy was performed due to gynecomastia.

Question 8

A 56-year-old male presents to a podiatry office with complaints of recurrent problems with an ingrown toenail on his right great toe. He has been treated multiple times with antibiotics, but the pain and swelling is causing him difficulty wearing his work boots. He currently does not have an infection, although the ingrown toenail is present and painful. The doctor performs a wedge excision of the skin of the nail fold to his right great toe. Which of the following codes should you use?

Accepted Answer

11765 is correct because it is the only code that is specific to wedge excision of the skin of nail fold.
Code 10060 is incorrect because the ingrown toenail was not infected and did not require drainage. Code 11760 is incorrect because there was no repair done to the nail bed and 11750 is incorrect because the wedge excision was performed to the skin, not the nail itself, and the nail was not removed

Question 9

A 10-year-old girl comes to her pediatrician's office after smashing the nail of her right 2nd digit in the car door the previous night. This morning, the tip of her finger is edematous, there is a large amount of ecchymosis present, and the pain is worse than when the injury initially occurred. The pediatrician uses a disposable Bovie high-temperature cautery pen to cauterize a hole in the nail to allow the subungual hematoma to drain. A small amount of serosanguineous fluid is removed and pain rapidly decreased. Which of the following codes should you use?

Accepted Answer

11740 is correct because the subungual hematoma was able to be evacuated by using a disposable Bovie cautery pen in the office.
Code 11720 is incorrect because there was no debridement done of the nail. Code 11730 is incorrect because there was no avulsion and 11750 is incorrect because there was no excision of the nail for permanent removal

Question 10

A 31-year-old male arrives at general surgery for a pilonidal cyst that has been unresponsive to antibiotic therapy at his primary care physician's (PCP) office. There is a large amount of tenderness and edema at the site and the area is erythematic and warm to the touch. The patient's pain has been increasing and, on palpation, the surgeon notes that the cyst is larger than six cm in diameter and appears to be deep. After discussion with the patient, it is decided to perform an incision and drainage (I&D) at the surgeon's office, with \ no sedation other than local use of Lidocaine. The area was prepped and numbed with Lidocaine and an incision was made, allowing a large amount of purulent drainage to be expressed. The area was packed with gauze and the procedure was completed without any complications. The patient will follow up in the office in one week for recheck and is to continue on the antibiotic prescribed by his PCP. Which of the following codes should you use?

Accepted Answer

10080 is correct because this was a straightforward I&D of a pilonidal cyst. There were no complications mentioned during the procedure.
Code s10060 and 10061 are incorrect because they are used for I&Ds of abscesses, but are not specific to pilonidal cysts. Code 10081 is incorrect because it is for a complicated I&D of a pilonidal cyst and the scenario specified that this was an uncomplicated procedure.

Question 11

A 35-year-old male returns to the general surgeon's office with recurrent episodes of infected pilonidal cysts. He has had the cyst incised and drained (I&D) once at his primary care physician's office and once at the surgeon's office. The last I&D was approximately four months ago. He returns to the office today to discuss further treatment. It is decided that he will undergo outpatient surgery so he can be sedated and the cyst will be excised with the base curetted. During surgery, it was noted that there was an extensive sinus tract. The wound will be packed open, requiring daily dressing changes and he will return to the postop clinic for a recheck in one week. Which of the following codes should you use?

Accepted Answer

11771 is correct for an extensive procedure because it involved excising the cyst and curetting it.
Code 11772 is not correct because, while extensive, the excision was not complicated. A complicated excision may include removal down to the sacral fascia or using the surgical technique called marsupialization. Code 11770 is incorrect because this pilonidal cyst was more complicated and was not just a simple pilonidal cyst. Code 10080 is incorrect because this was a complicated pilonidal cyst and it required more than just an I&D because it was also excised

Question 12

A surgeon is doing a pilonidal cyst incision and drainage with excision in the operating room. What he initially thought was an uncomplicated but deep pilonidal cyst developed into an extensively complicated cyst excision with a z-plasty required to repair the incision. How would you code this procedure?

Accepted Answer

11772 is correct for this extensively complicated cyst excision requiring a z-plasty closure.
Code 11770 is incorrect because this was not a simple pilonidal cyst and it was found to have extensions. Code 10081 is incorrect because, although it is a complicated cyst, it is also being excised and closed. Code 11771 is incorrect because while extensive, this cyst was excised and repaired and also required a complicated excision and closure.

Question 13

A 22-year-old male was chopping wood with his friends and accidently slashed his right lower leg with the axe. Upon assessment at the emergency room, it was determined that he had sliced through all layers of skin and the wound was down to muscle, but no arteries were involved. He required layered sutured closure including the deeper layers of subcutaneous tissue, and superficial fascia as well as the epidermis and dermis. His wound was measured at approximately 25 cm. How would you code this procedure?

Accepted Answer

12036 is correct because this wound is considered an intermediate repair due to the multiple layer closure. Also, the wound size was 25 cm on the lower leg.
Code 12035 is incorrect because, although it is the correct location, the size is too small. Codes 12045 and 12046 are incorrect because the location is not correct.

Question 14

A 6-year-old boy was bitten by a dog and sustained multiple lacerations as a result. He has a 5 cm laceration on his right lower arm, a 2 cm laceration on his left hand, and a 2.6 cm laceration to the right side of his lower cheek. While in the ER, the wounds were flushed, then the patient was sedated and the arm and hand lacerations were repaired. Intermediate repair was necessary for the facial laceration due to the depth of the wound and layered closure was performed. The patient was also given a tetanus shot and started on antibiotics. What CPT codes would you use for the laceration repairs of this child and what order is correct?

Accepted Answer

Code 12032 is being used as the primary procedure code because this code is for 2.6-5 cm facial lacerations and was considered an intermediate repair. The total length of laceration for the arm and hand lacerations was 7 cm, so 12002 is also correct. Because this was for a simple repair that is less complicated than the other repair, it is listed as the secondary procedure code. Modifier -59 is used because there was more than one classification of wounds repaired on this patient.
Code 12002 is correct but must be listed as the second code due to it being the less complicated repair. Code 12013 is incorrect because this code is for simple repair of a wound 2.6 cm to 5.0 cm in length and the length of the simple repairs was a total of 7 cm. This code is also specific to the face, ears, eyelids, nose, lips and/or mucous membranes.

Question 15

A 78-year-old male arrives at a dermatology office with multiple skin tags on his arms, neck, and torso. There are a total of 14 lesions that need to be removed and the dermatologist removes all 14 tags within the office. What is the correct code for this procedure?

Accepted Answer

11200 is correct because this code can be used for the removal of up to and including 15 skin tags.
Code 11101 is incorrect because these are skin tags that are being removed and no biopsy was performed. Code 11201 is incorrect because this is an "add-on" code for each additional 10 lesions after the initial 15. 11300 is incorrect because there was no mention of a shaving being performed.

Question 16

A 60-year-old woman presents to her dermatologists office with a reddish brown lesion on her right upper arm. It is approximately 0.8 cm in diameter and is raised. The patient and provider decide to proceed with a shave excision and will send this to pathology for confirmation. The dermatologist suspects this is a benign angiofibroma. The patient receives local anesthetics at the site and the area is excised with a sharp razor. What is the correct code for this procedure?

Accepted Answer

11301 is correct because this lesion was removed by shaving. It is also 0.6 to 1.0 cm in diameter and is located on the arm.
Code 11300 is incorrect because this code is for 0.5 cm diameter lesions or smaller and this patient's lesion is 0.8 cm. Code 11302 is incorrect because this code is used for longer than 1.1 cm to 2 cm diameter lesions. Code 11305 is incorrect because the lesion location is wrong for this code and it is longer than this code indicates.

Question 17

A 12-year-old boy presents to his pediatrician's office with multiple molluscumcontagiosum on his face, neck and upper right shoulder. They have been present for about 15 months and are getting larger. His parents are concerned about his appearance and that he keeps scratching them. He was treated once for a local infection on his neck, about three months ago. His parents would like to have these removed or be referred to dermatology. The pediatrician discusses options and the parents opt to use cryotherapy with Histofreeze that the pediatrician has in his office. In total, there are six lesions on his right shoulder, eight on his neck and five on his cheek. What CPT code would you use?

Accepted Answer

17111 is correct because he has a total of 19 lesions that were frozen in the pediatrician's office. This code is for destruction of 15+ lesions.
Code 17110 is incorrect because this code is for up to 14 lesions such as warts, molluscum, or milia. Codes 17000 and 17004 are both incorrect because they are for actinic keratosis which is not what this little boy was being treated for.

Question 18

A 24-year-old woman found a lump in her right breast during a routine exam. She had a mammogram, which confirmed the lump, and then met with a surgeon for a needle biopsy without imaging. What code would you use for this procedure?

Accepted Answer

19100 is correct because the needle biopsy was completed without imaging guidance.
Codes 19085 and 19086 are incorrect because these involve biopsy with breast localization device placement. Code 19101 is incorrect because this was done through needle biopsy and not an open incisional biopsy.

Question 19

A 22-year-old female is concerned about her inverted nipples. She would like them to be corrected and sees a plastic surgeon for a consult. She is self-conscious about this issue and wants to fix it. The plastic surgeon explains her options and they decide to correct this complaint. What code would you use for this procedure?

Accepted Answer

19355 is for correction of inverted nipples.
Code 19350 is incorrect because, although it is listed as nipple/areola reconstruction, there is a specific code for correction of inverted nipples. Code 19357 is incorrect because there was no reconstruction with tissue expander. Code 19499 is incorrect because there is a specific procedure code for this issue.

Question 20

A physician took an impression of a 47-year-old woman's left orbital socket and created a custom prosthesis. What is the correct code for this service?

Accepted Answer

The correct code for this service is 21077 (Impression and Custom Preparation; Orbital Prosthesis). According to the CPT guidelines, code 21077 is used when a physician or other qualified health care professional designs and prepares the prosthesis. The modifier -LT should be appended to indicate that the prosthesis was created for the left orbital socket.

Quiz 2: Series

A 32-year old woman with severe gynecomastia and a prevalent family history of breast cancer elected to have a complete bilateral mastectomy with immediate insertion of breast prosthesis implants. What is/are the correct code(s) for the procedure?

A 78-year-old male arrives at a dermatology office with multiple skin tags on his arms, neck, and torso. There are a total of 14 lesions that need to be removed and the dermatologist removes all 14 tags within the office. What is the correct code for this procedure?

A 24-year-old woman found a lump in her right breast during a routine exam. She had a mammogram, which confirmed the lump, and then met with a surgeon for a needle biopsy without imaging. What code would you use for this procedure?

A physician took an impression of a 47-year-old woman's left orbital socket and created a custom prosthesis. What is the correct code for this service?