A 61-year-old female patient is seen for a complaint of severe heartburn, lightheadedness, skin reddening, and shortness of breath. The physician renders a diagnosis of GERD, sickle cell anemia, lymphangitis, and diaphragmatic

A 61-year-old female patient is seen for a complaint of

severe heartburn, lightheadedness, skin reddening, and

shortness of breath. The physician renders a diagnosis of

GERD, sickle cell anemia, lymphangitis, and diaphragmatic

paralysis. What code(s) should be assigned?

ICD-10: __________________________________________

2. A 37-year-old patient comes in complaining of swollen

joints and headaches. The physician’s diagnosis is SLE.

The patient also has rheumatoid arthritis and asthma

with status asthmaticus. What code(s) are assigned?

ICD-10: __________________________________________

3. A 52-year-old patient is seen for mouth pain, knee pain,

and fluid buildup in the chest. The physician renders a

diagnosis of pulp degeneration, old disruption of the posterior

cruciate ligament, and pleural effusion. The

physician also performed a chest tube insertion (draining

the right pleural cavity with a drainage device using a

percutaneous approach) prior to diagnosing the patient’s

pleural effusion. What diagnosis and procedure code(s)

are assigned?

ICD-10: __________________________________________

4. A 30-year-old male is admitted to the hospital with

lymphadenitis, acute lymphoid leukemia in relapse, and

von Willebrand disease. What code(s) are reported?

ICD-10: __________________________________________

5. A 47-year-old male is involved in a motor vehicle accident.

He was driving on the highway when his car

collided with another vehicle. He was brought to the hospital

with a lower arm injury. The physician obtained an

x-ray of the arm and, after careful review and interpretation

of the x-ray, rendered a diagnosis of lower arm

fracture. The physician repaired the arm fracture using

open reduction and internal fixation (reposition of the

right radius with internal fixation using a percutaneous

endoscopic approach). What diagnosis and procedure

code(s) are reported?

ICD-10: __________________________________________

Review each of the following medical coding scenarios. Assign

the CPT code for the services and procedures indicated in

each scenario.

1. A 48-year-old male patient comes to the emergency room

with complaints of GERD. The physician performs a

laparoscopic fundoplasty with a Collis gastroplasty. What

CPT code(s) should be assigned?

CPT: _________________________________________________

2. A 40-year-old female patient is diagnosed with cervical

cancer. She also complains about difficulty breathing.

She is admitted to the hospital, where the physician

begins to perform a bronchoscopy after anesthesia

administration. However, the procedure is discontinued

due to unforeseen complications. Later the same day, a

bilateral cervical lymphadenectomy is performed to

address the patient’s cervical cancer. What CPT code(s)

are assigned?

CPT: _________________________________________________

3. A 50-year-old patient is admitted for a repair of a laceration

to the diaphragm resulting from an accident

involving a bus that ran into a ditch. She also received

eight trigger point injections into the transverse abdominus

muscle due to pain resulting from the accident.

What CPT code(s) are assigned?

CPT: _________________________________________________

4. A 23-year-old patient comes to the emergency room after

being physically assaulted by her boyfriend. She complains

of nasal pain and bleeding from the left nostril.

The physician obtains an x-ray of the nasal cavity, and

the x-ray confirms a nasal septum fracture. The physician

performs an open treatment of the nasal fracture

with a concomitant open treatment of the fractured septum.

What CPT code(s) should be assigned?

Explanation & Answer

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