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AAPC CPC chapter 7
Integumentary
| Question | Answer |
|---|---|
| Table of neoplasms columns: Primary and _____ malignancy, Ca In Situ, _____ and uncertain behavior, unspecified behavior | secondary, benign |
| Secondary malignancy: cancer spreads and ______ to | Metastasizes |
| Ca In Situ: cancer is ____ and hasn't spread. Uncertain behavior neoplasms table: lesion whose behavior ____ be predicted. Currently benign but chance it could go malignant. | encapsulated, cannot |
| Unspecified behavior neoplasms table: no _____ report indicating what the lesion is. | pathology |
| Skin infections: bacterial or fungal. Common bacterial- ______, carbuncles, cellulitis, lymphandentitis, etc. Common fungal- athletes foot, jock itch, _____ etc. | impetigo, ringworm |
| Furnuncles: (boils) cutaneous abcesses, typically caused by staphylococcus. Several Furnuncles together make up a _____ | carbuncle |
| Although contagious, carbuncles _____ usually without treatment | heal |
| Lymphangitis: infection of lymph _____, can be from acute streptococcal infection of skin superimposed on an existing staphylococcal infection. | vessels |
| Lymphangitis: can be a sign that skin infection is getting _____. Code based on location then whether it's _____ lymphangitis or cellulitis. | worse, acute |
| Pilonidal cyst: a cyst, fistual, or sinus under skin at bottom of ____. Can have hair, debris and other abnormal tissue. If becomes infected it's considered an _____ | tailbone, abcess |
| Seborrheic dermatitis: scaly, itchy, red. Typically on ____. Adults- dandruff, Child- cradle ______ | scalp, cap |
| Atopic dermatitis: _____. Contact dermatitis: caused by _____ irritant. Code depends on the irritant causing reaction. When irritant is a ____or other irritant, cause code is reported in addition to the dermatitis | Eczema, external, drug |
| Actinic Keratosis (solar keratosis) caused by _____ exposure. Scaly, crusty lesion sometimes resembling a wart. Pre ______, first step to leading possible squamous cell carcinoma. | sun, cancerous |
| Seborrheic Keratosis: benign growth, typically not forming into _____ | cancer |
| Pressure ulcers: Stage 1- persistant focal edema. Stage 2- partial thickness loss, epidermis, ______ or both. | dermis |
| Pressure Ulcers: Stage 3- ____ thickness loss, damage or necrosis of sub Q layer. Stage 4- necrossis of _____ tissue extending to muscle, tendon, bone. | full, soft |
| Keloid scar: excess _____ of connective tissue during healing process | growth |
| Burns: 1st degree- epidermis. 2nd degree- epidermis, dermis ____, partial thickness. 3rd degree- epidermis, dermis, sub q, _____ and at times bone. | sub q, muscle |
| TBSA: Category T 31. Rule of ____ to calucate this. | nines |
| Benign mammory dysplasia: abnormal _____. Most common is _____ disease or cysts. | tissue, fibrocystic |
| FNA: Fine needle aspiration, based on imaging _____ is used and type for coding CPT. Add-on codes for each additional lesion that uses the same imaging guidance. | guidance |
| When FNA is done on different lesion during _____ encounter that uses differnt type of imaging guidance, modifier _____ reported. | same, 59 |
| When debridement with tissue removed, etc. pay close attention to ____ area being treated and how much tissue etc. being removed. | body |
| NSTI: necrotizing soft tissue _____. | infection |
| Debridement is not inclued in Global package of treating fracture/dislocation since debridement and treatment of fracture are ____ procedures. | separate |
| If multiple areas of same depth debrided, ____ the surface areas of the wound to select code. | add |
| Debridement: Modifier 59 for multiple sites may be necessary to distinguish separately indentifiable procedures done during same _____ or same day. | session |
| Healing ridge: upon palpatation, induration (hardening) around wound, ____ skin. Expected positive sign. | beneath |
| Sinus tract: course of tissue destruction from surface or edge of wound, ____ space with potential for abcess formation. | dead |
| Undermining: tissue destruction, extends under the intact ____ | skin |
| Pairing or cutting: corns, calluses and keratosis. Code selecting is based on how many ____. | lesions |
| When more than 1 biopsy done by ____ techniques during same procedure only 1 primary biopsy code reported then add-on codes for other techniques. | different |
| Additional biopsies reported with add-on codes for each _____ biopsy lesion. | additional |
| When pathology says "uncertain morphology" choose procedure code for which lesion _____ was performed. | removal |
| Shaving of skin: code based on body _____ and size | area |
| Removal of lesions by excision: codes selected based whether lesion is ____ or malignant. | benign |
| Hidradentis: inflammation of ____ glands | sweat |
| Removal of malignant skin lesions: use code for _____ of removal | method |
| Electrofulguration: removal/destroying of tissue with high frequency ____ current. | electric |
| Elliptical excision: doctor marks the _____ externally before. | skin |
| Excisions: lesion widest ______ for reporting. | diameter |
| For certain repairs _____ is measured. | length |
| Skin grafts size of recipient site in _____ centimeters. | square |
| Melanoma: measured in thickness known as Breslow's ____- Clark's Level ( 5 levels) | Depth |
| Pilonidal cyst: code selected based on whether excision is ____, extensive or complicated. | simple |
| Tattooing for breast reconstruction measure in ____ centimeters. | square |
| Reparied wound must be measured in _____. If adhesive strips used, use E/M in addition. | centimeters |
| Repair codes: 1st group wounds by ____ of repair (simple, intermediate, complex) then by anatomical site. | type |
| When multiple wounds need some type of repair, listed in ____ anatomical region, add lengths of each wound and report as _____ item. | same, single |
| More than 1 classification of wound repaired: list more _____ wound 1st followed by less complicated and add modifier 59 to each procedure after the 1st. | complicated |
| For excision of benign and malignant lesions requiring more than simple ____, report 11400-11446 or 11600-11646 in addition to appropriate closure code. | closure |
| If repairs involve nerves, blood vessels or tendons: code selected from correct _____ (nervous, cardiovascular or musculoskelatal). Exploration of nerves, blood vessels or exposed tendon considered ____ of repair. | system, part |
| Using adjacent tissue transfer or rearrangement for wound repairs: adjacent tissue tranfer involves primary and secondary ____, both are reparied in the procedure. | defect |
| Secondary defect is created from tissue movement ____ to close primary defect. Include both primary and secondary defects as part of ______ for this repair. | needed, measurements |
| Tissue transfer codes: choose code accoding to size of ____ or wound needed to be covered. | defect |
| When 2 different lesions removed from 2 different locations and adjacent tissue repair closes on wound and ______ close other wounds: both services may be reported since 2 different lesions excised. | sutures |
| 2 different lesions removed from 2 different locations, one closed with sutures: when reporting, CPT modifier _____ used to indicate different procedure and not inclued in tissue transfer. Square centimeters. | 59 |
| Composite graft: more than 1 type of _____ | tissue |
| Derma-Fascia-Fat-Graft: smooth out _____ created secondary to surgically created defects or atrophy. | blemishes |
| Heterograft: graft between 2 _____ | species |
| Rotation flap: flap ____ over the defect. Slip thickness graft: epidermis and ____ part of dermis | pivoted, small |
| Skin replacement surgery and skin substitutes: multiple wounds- add surface _____ of all wounds from anatomical site that are grouped together into same code descriptor. Skin substitute graft: append modifier _____ | area, 58 |
| Determining how much body surface involved: based on _____ square cm for adults and 1 percentage of body area for kids under 10 yrs old. | 100 |
| Each free flap code includes: elevation of flap, inset of flap into _____ site. Microvascular anastomosis of one _____. Transfer of flap to recipient site, microvascular anastomosiss of one or 2 _____ | recipient, artery, veins |
| When fat's removed using direct excision or liposuction: reported based on ____of where the graft placed, not where fat ______. | location, harvested |
| Blepharoplasty: HCPCS modifier for eyelid surgery performed on: example ____-upper left eyelid. If bilateral modifier 50 can be used. | E1 |
| Removal of staples/sutures: code based on whether _____ used. These are in addition to E/M code. | anesthesia |
| Pressure ulcer In preparation for muscle or myocutaneous flap or skin graft closure code use addition code for ____ in addition to pressure sore procedure | procedure |
| When reporting skin graft following debridment: code for debridement then skin ____. | graft |
| Burn repair by autologus cultured human Epithelium: unburned epidermal _____ cultured into sheets, attached to petruleum gauze squares. | cells |
| Destruction: ablasion of tissues by any method with or without curettage, including _____ anesthesia and usually not requiring closure. | local |
| Destruction: if lesions destroyed from multiple body sites, more than 1 _____ required. | code |
| Mohs Micrographic Surgery: surgeon acting in 2 distinct roles- 1st surgeon and 2nd as _______ | pathologist |
| Mohs Micrographic Surgery: removes tumor tissue, maps and _____ it into peices. Pieces examined under microscope, if + margins are present the surgeon returns for another _____ and begins again. | divides, portion |
| Mohs Micrographic Surgery: each time surgeon removes a portion of the _____ it is refered to as a stage. Each stage is divided into tissue _____. | tumor, blocks |
| Breast biopsy: percutaneous (needle) with or without _____ guidance. | imaging |
| Radical (mastectomy): breast tissue of skin, nipple, areola, _____, lymph nodes, pectoralis major and minor muscles removed. | axillary |
| Urban (mastectomy): similiar to radical but includes internal _____ lymph nodes. | mammory |
| Breast biopsy and mastectomy on same day and same operative session: if malignancy diagnosed perviously by biopsy and surgeon takes breast tissue ____ mastectomy to examine for malignancy: biopsy not coded _____ when mastectomy also perfomed. | after, separately |
| Breast biopsy and mastectomy on same day and same operative session: the biopsy is "subsumed" as part of the ____ operation and not coded separately. | larger |
| Breast biopsy and mastectomy on same day and same operative session: use of an operating _____ is inclusive to codes 19364 and 19368 and are not reported separately. | microscope |
| CPT code 19302 includes sentinel _____ removal. | node |
| Placement of breast localization devices- clip, metallic pellet, wire, etc. are differentiated by type of _____ being used. | guidance |
| Mastopexy: surgery to ____ breast | lift |
| Photodynamic therapy: ablasion of tumorous tissue by _____ of photoactive drugs. | activation |
| ______: exposing skin to ultraviolet light. | Actenotherapy |
| PUVA (Psoralens ultraviolet A treatment)- photochemotherapy. Patient under direct ______ supervision for 4-8 hrs. | doctor |
| HCPCS level II modifier 25: significant, separately identifiable E/M service by ____ physician or healthcare professional on the same day of procedure or other service. | same |
| HCPCS level II modifier 50: _____ procedure | bilateral |
| HCPCS level II modifier ____: staged or related procedure or service by the same physician or healthcare professional during post op period. | 58 |
| When repeat debridement is done or fracture care performed on the date other than the date fo the debridement add modifier ____ to treatment codes to indicate it was related procedure. | 58 |
| Modifier 59: distinct procedural service. When evacuation of subungal hematoma is reported on more than 1 ____ during same session. | nail |
| In the treatment of burns, if physician performs dressings/debridement at different sessions or patient encounters the same procedure on same date modifier ____ may be used. | 59 |
| Always place a (-) dash _____ CPT and modifier and between multiple modifiers | between |
| Use modifiers on CPT (procedure) codes _____ on ICD codes | not |
| Never put modifier on _____ level I and II code | ICD |
| Report modifiers that affect ____ 1st | payment |
| Report informational modifiers such as right and left ____. Ex: 71100-26-LT | last |
| Code procedure with ____ complexity 1st unless specified in guidelines. Check RVU's on the order. | highest |
| List ICD codes based on guidelines order, if no guideline use the order they _____ in assessment/impression. | appear |
| 1st the diagnosis must give medical _____ to procedure code. | necessity |
| Exteranal cause codes are _____ coded in 1st position. | never |
| Bilateral procedure use modifier _____ | 50 |
| Modifier ____ appended to additional procedures performed during the same session. | 51 |
Created by:
mlovest
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