Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Tag Archives: Cyst

Excision of pilonidal cyst

Posted on by
Would this procedure be 11772 ? or 11771. I keep going back and forth between the two codes. Also what is meant by subcutaneous extensions?

Op report states: an elliptical excision was then executed with at #15 blade scapel and carried down through the subcutaneous tissue. A tuft of hair was seen within the cyst wound and this area was completely excised. The excision was essentially 1.5 cm in length and after hemostasis was assured to be complete, it was closed with interrupted 2-0 Vicryl suture. Two stab incisions were made lateral to this excision site and a silastic vessel loop was placed through these incisions into the wound cavity as a drain. This was tied to itself and the skin was closed with 4-0 Monocryl in a running subcuticular fashion.

I read and re-read the cpt codes in my desk reference procedures book but their code descriptions and the op report don’t counterpart for me.

TIA
KAM

Medical Billing and Coding Forum

Excise Mucous Cyst & debride osteophytes left ring finger DIP Joint

Posted on by
Radiographic Findings consistent with mucous cyst & significant degenerative arthritis in the DIP joint.

Op Report: A curvilinear incision was made over dorsum of the left ring finger DIP joint. Dissection was carried through subcutaneous tissue. Full-thickness skin & subcutaneous tissue flaps were elevated. The mucous cyst was localized pretty centrally over the extensor mechanism distal to the DIP joint. The cyst was identified & mobilized & excised and originated from the dorsal ulnar corner of the joint. Both the dorsal Ulnar & dorsal Radial corner of the joint were identified & osteophytes were debrided with a rongeur off the base of the distal phalanx. The penrose drain was removed & bleeding controlled with electrocautery. The incision was irrigated & closed.

Coded with 26210 & 26160. One of our coders says per Margie Vaught that this is how we should be billing these. I feel that 26160 would include the debridement of the osteophytes since all through same incision. Can anyone advise on this issue. I found several questions similar to this, but am confused on why would these billed together when done through same incision. CPT Code 26210 is a Column 1 code with 26160 being a column 2 code, but unbundling is allowed. Thanks in advance for anyone who may be able to help.

Medical Billing and Coding Forum

Help Please…. Excision of Elbow Mass CPT or Excision/Curettage of Bone Cyst CPT?

Posted on by
I am thinking this should be CPT 24116 (Excision or curettage of bone cyst, humerus;with allograft)
Dr office coded this to CPT 24071(Excision of tumor, elbow area, subcutaneous)

PREOPERATIVE DIAGNOSIS: Left elbow mass.
POSTOPERATIVE DIAGNOSIS: Left elbow mass, a cyst that went down
to the bone. It was an intraosseous cyst that became
extraosseous. There was clear gelatinous fluid and measured
about 7 mm x 7 mm.
PROCEDURE PERFORMED: Excision of the mass and curettage of the
bone with insertion of allograft bone putty.

CLINICAL NOTE: The patient is a 53-year-old gentleman who has
had a mass on the tip of his lateral epicondyle for prolonged
period of time. Every time he banged or hit it, it was quite
uncomfortable for him. He wished to have it excised. The risks
and complications of the procedure including, but not limited to
nerve damage, tendon damage, problems of infection, continued
pain, stiffness, soreness, recurrence, possible diagnosis of
both benign and malignant, as well as others were explained to
him prior to the surgery. He asked me questions and all
questions were answered to his satisfaction, and he signed the
consent form prior to the surgery
DESCRIPTION OF PROCEDURE: The patient was brought to the
operating room and placed in the supine position on the
operating table after receiving IV antibiotics for prophylaxis.
He then had general anesthesia administered by the
anesthesiologist. Once adequate anesthesia was obtained, he had
a tourniquet placed high on his left arm with some Webril and
had his left upper extremity prepped and draped in the normal
sterile fashion. Appropriate time-out was taken. An Esmarch
bandage was used to exsanguinate the arm and tourniquet was
inflated to 250 mmHg. An incision was made directly over the
mass for about 2 cm. The mass was right at the very tip of the
lateral epicondyle. Sharp dissection was carried down through
the skin and blunt dissection. There was an obvious cyst and it
was filled with clear gelatinous fluid. The cyst was excised
and traced down to its stalk. The stalk did emanate from a void
in the bone and went down intraosseous. The bone window was
opened up sightly and then, inside the bone was curettaged out.
It got down the casing of the cyst. Once this was completed, we
got down to a nice bony surface. The wound was copiously
irrigated with sterile irrigant. The void in the bone was then
filled with 1 mL of bone putty to promote healing. The
subcutaneous tissue was then closed with 2-0 Vicryl and skin was
closed with 4-0 nylon. Xeroform and bulky dressings were
applied and tourniquet was deflated with total tourniquet time
of about 14 minutes. He was then brought to the recovery room
in stable condition with good capillary refill on his
fingertips.

Medical Billing and Coding Forum

Excision of Choledochal Cyst w/ Roux-en-Y biliary Reconstruction

Posted on by
Hello,
I was hoping to get some feedback on this surgery.
The doc wants to bill 47715 but I do not see documentation that supports this. My thoughts for coding: CPT 47780 or 47760 with 74300.
Any help is much appreciated!

POSTOPERATIVE DIAGNOSIS: Forme fruste choledochal cyst with
chronic pancreatitis.

NAME OF OPERATION/PROCEDURE: excision of choledochal
cyst with Roux-en-Y biliary reconstruction and cholangiogram.

ANESTHESIA: General.

FINDINGS: At operation, there was some certain amount of
inflammation in the right upper quadrant especially around the
bile ducts. The cholangiography confirmed the presence of a long
common channel. There were no abnormal ducts, otherwise, such as
a low insertion of a right posterior bile duct.

INDICATION FOR PROCEDURE: Patient had been having daily abdominal pain thought to
be due to low-grade pancreatic inflammation. Patient has had three
episodes in the past that had required hospital admission. MRCP
had showed a common channel and abnormally long common channel
between the pancreatic and common bile duct that measured
approximately 2-3 cm.

DESCRIPTION OF OPERATIVE PROCEDURE: Under general anesthesia with
appropriate monitoring lines in place, the patient’s abdomen was
prepped and draped. A time-out was performed and abdomen had been
marked with the appropriate site marking. Patient was given
perioperative cefazolin. A right upper quadrant incision was used
to enter the abdomen. The gallbladder was dissected free from
the gallbladder bed and a cystic duct was cannulated. A cystic
duct cholangiogram was obtained. The result of the cholangiogram
showed an abnormal common bile duct and pancreatic duct junction
with reflux into the intrahepatic bile ducts. The intrahepatic
bile ducts did not have any abnormalities and there were no
anomalus ducts joining the common hepatic duct or the common bile
duct or down.

At the completion of the cholangiogram, a Roux loop was
constructed, which was 40 cm that was constructed by dividing
the jejunum 20 cm distal to the ileocecal valve.

The jejunum was stapled with a GIA stapler. 40 cm beyond the
stapled jejunum, the jejunostomy was made on the
antimesenteric side. The proximal end of the stapled jejunum was
opened and end-to-side jejunojejunostomy was created with a single
running layer of 5-0 PDS. The mesenteric defect was then closed.

We then turned our attention to the common bile duct, which was
divided just proximal to the disappearance of the common duct
behind the pancreatic duct.

A anomalous right hepatic artery was seen behind the common bile
duct as was the portal vein. These structures were carefully
preserved and the adhesions behind the bile duct were carefully
taken down to well beyond the insertion of the cystic duct. We
were able to dissect up more proximally to visualize the common
hepatic duct and could see where the ducts bifurcated. The
proximal transection margin of the common hepatic duct was
approximately 1 cm distal to the bifurcation where the duct was
clearly normal in caliber.

The duct was then spatulated on its anterior border in order to
increase its effective diameter, which was only about 4-5 mm.

The Roux loop which was then brought up behind the retrocolic
fashion had a small enterotomy made on the antimesenteric side
near the stapled end of the Roux. An end-to-side
choledochojejunostomy was done with series of interrupted 6-0 PDS
sutures. No internal stent was made.

We then closed the mesenteric defect in the mesocolon by
reapproximating the cut ends to pull through jejunum.

The distal end of the common bile duct was then inspected and it
was decided not to go ahead and close it since there appeared to
be no pathology beyond it.

We then placed a 10-French Jackson-Pratt drain behind the
choledochojejunostomy and brought out through a small separate
incision. The abdomen was then closed in two layers with running
#0 PDS subcuticular stitch for the skin. A Prolene suture fixing
JP drain in position. The patient was returned to the recovery
room in satisfactory condition.

Medical Billing and Coding Forum

Claim denial 10060 for I&D sebaceous cyst

Posted on by
Hi,

I recently got a denial for a claim where a sebaceous cyst was drained from a patient’s face (LT cheek). ICD-10 code was billed as L72.3 with CPT code 10060. I checked the LCD and L72.3 is not covered. The CPT index directly refers you to 10060 for I&D sebaceous cyst. The LCD doesn’t even have unspecified cyst on the list and my provider does not feel abscess or cellulitis is appropriate. Has anyone else come across this?

Thanks,
Crystal

Medical Billing and Coding Forum

Arthroscopic Excavation of Parameniscal Cyst

Posted on by
Hello,

How would you code the following?

The area was prepped and draped in a sterile fashion. Time-out was performed prior to making an incision. This is an arthroscopic surgery. Medial and lateral arthrotomies were performed. The patient was found to have C3, C4 chondromalacia of the patellofemoral joint. Chondroplasty of the patellofemoral joint was performed. Medial gutter was then swept. No evidence of any loose bodies. Medial joint space was then entered. The patient was found to have a parameniscal cyst. Excavation of parameniscal cyst was performed. No evidence of any meniscal pathology. The patient did have C1, C2 chondromalacia of the medial femoral condyle, medial tibial plateau. The ACL was partially torn and debridement of ACL was performed. Lateral joint space was entered. The patient was found to have C1, C2 chondromalacia of the lateral femoral condyle, lateral tibial plateau. Chondroplasty of the lateral femoral condyle, lateral tibial plateau was performed. Lateral gutter was then swept. No evidence of any loose bodies. The patient tolerated the procedure well.

I came up with 29877 for the chondroplasty and ACL debridement but would this include the excavation of the parameniscal cyst or would this get coded with an unlisted code (29999)?

Thank you in advance.

Medical Billing and Coding Forum

Resection of large intra-abdominal cyst along with left neprectomy

Posted on by
I am having trouble finding the correct cpt codes to use for the following surgery:

Operation: Exploratory laparotomy, resection of large left-sided intra-abdominal cyst along with left nephrectomy, closure of enterotomy.

Description of Operative Procedure:
With the patient on the operation room table in the supine position, a 16 French Foley catheter was place for 200 ml amber urine; then, the abdomen was shaved, prepped and draped in the usual sterile fashion. A xiphoid to pubis mid-line abdominal incision was made and carried through into the peritoneum. Retractors were placed, and the cyst was gradually freed from the surrounding tissue with a combination of blunt and sharp dissection. The gonadal vessels were doubly ligated between 0 silk ties and divided in order to free up the medial aspect of the cyst. The transverse mesocolon was incised with the harmonic scalpel in order to expose the left renal fossa. It became obvious that the cyst was intimately associated with the left kidney, and as the latter appeared to be end-stage, we elected to remove the kidney en block with the specimen. Accordingly, the left renal vein was doubly ligated with 0 silk ties and suture-ligated with a 2-0 silk tie prior to dividing. The left renal artery was double=y tied with 0 sild ties and divided, and then the harmonic scalpel was used to divided the remaining attachments; the specimen was then removed.

A 2 cm tear was noted along the antimesenteric border of the distal transverse colon. A small serosal avulsion was repaired by including this in the enterotomy closure with the TA-55 stapler, and then the enterotomy site was imbricated with interrupted 2-0 silk lambert sutures. The abdomen was closed with interrupted 0 vicryl suture and the skin was loosely closed with the stapler.

Any ideas?

Medical Billing and Coding Forum

Discontinued Excision of Cyst

Posted on by
I am hoping for some help/reassurance with CPT code/modifier selection on a procedure. The patient presented to our family practice clinic to have a cyst removed from scalp. The physician started to excise the cyst but noted that it went further into the skull than she had anticipated. She stopped the procedure and repaired the defect (5 cm). Would it be appropriate to bill the cpt code for the cyst excision and append modifier 53 discontinued procedure?

Thank you in advance for your help!!

Medical Billing and Coding Forum