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

38531: Inguinofemoral Node Biopsy or Excision

CPT® 2019 introduced 38531 Biopsy or excision of lymph node(s); open, inguinofemoral node(s) to report open biopsy or excision of inguinofemoral lymph node(s), which are located near the groin. During this procedure, the provider incises the skin over the groin and femoral region and dissects down to the lymph nodes, to remove all or a […]

The post 38531: Inguinofemoral Node Biopsy or Excision appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Excision of left internal jugular lymph node help please

Operations:
#1. Left carotid artery endarterectomy with Hemashield patch closure 35301 LT
#2. Post endarterectomy duplex analysis with interpretation 93882 26
#3. Excision of left internal jugular lymph node at the C sent to pathology for permanent evaluation) ?
*
Preoperative note: Patient is 63 y.o.-old female with severe left carotid artery disease now being taken to the operative for operative therapy.
*
Operative findings:
#1. Duplex findings: Following the endarterectomy the carotid artery was scanned in longitudinal and transverse planes including the common, bifurcation, internal, and external vessels. There were no filling defects or obstructive findings involving any of the vessels on on this imaging. Doppler analysis was carried out and the velocities in the meters per second are as follows: Common 47/11, bifurcation 38/0, external 41/0, internal 102/9.
#2. Operative findings: There was a significantly enlarged left internal jugular lymph node at the level of the carotid bifurcation. The common carotid bifurcation was extremely calcified and diseased. Disease extended well into the left internal carotid artery. The internal carotid artery was quite small measuring roughly 5 mm in maximum diameter.
*
Description of operation: The patient was placed on the operating table in a supine position and adequate general anesthesia was administered monitoring the arterial pressure, electrocardiogram, and oxygen saturation. The entire left neck was prepped and draped in a sterile manner. A skin incision was placed on the anterior border of the left neck and deepened down through the platysma. The facial vein was doubly ligated and divided. The common, bifurcation, internal, and external carotid vessels were dissected out. An enlarged left internal jugular lymph node was excised and sent for pathology. Heparin was administered. With a satisfactory ACT greater than 250 seconds, the vessels were occluded and a common carotid arteriotomy was constructed and carried onto the internal carotid artery beyond the disease endpoint. An indwelling shunt was then placed in the usual manner. The endarterectomy was then carried out in the usual meticulous manner under optical magnification. Following satisfactory endarterectomy, the arteriotomy was closed utilizing 7-0 Prolene and a Hemashield patch. Before placing the last few sutures, the shunt was removed, flushing sequence was carried out, and the final sutures were placed tied and cut. Duplex analysis was carried out and findings are described above. Protamine was administered and hemostasis was obtained. The wound was closed in layers. Sterile dressing was applied. The patient was extubated in the operating room and taken to the recovery room in stable neurologic condition.

Medical Billing and Coding Forum

Radical Hysterecomy vs Hysterecomy and Pelvic Lymphadenecomy/Para Aortic node Samp

Hello,

I code for Gyn/Onc surgeons and I am wondering if anyone knows the required documentation in order to report 58210/58548 vs 58150/58572 with 38572.
Is it simply the total bilateral pelvic lymphadenectomy and para aortic node sampling done during the hysterectomy that makes the procedure radical or do more structures need to be removed than a normal TAHBSO as well as the bilateral pelvic lymphadenectomy and para aortic node sampling?

This is confusing me on what documentation needs to be there in order to report a radical hysterectomy.

Any help is greatly appreciated!!!

Thank you :)

Medical Billing and Coding Forum

Fine needle aspiration bx with U/S lymph node

Would it be appropriate to bill 10021 and 10004 due to him not stating in the procedure note used US for guidance of needle. Or should I code 10005 and 10006 since he documented PROCEDURE: Ultrasound-guided fine-needle aspiration of left neck lymph
node x2. This procedure was done in Rural Health Clinic and we own the US machine.

Any help would be greatly appreciated.:confused:

Patient A
Date:

PREOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the left
upper neck.

POSTOPERATIVE DIAGNOSIS: Malignant-appearing lymphadenopathy of the
left upper neck.

PROCEDURE: Ultrasound-guided fine-needle aspiration of left neck lymph
node x2.

STAFF SURGEON: M.D.

PROCEDURE: After discussing the procedure with the patient, the left neck was prepped with Betadine prep swab. We then used
ultrasound to examine the left neck region, identified two packets of
lymph nodes, decided to biopsy the lower packet first. I placed a
25-gauge needle into the lymph node packet and aspirated until fluid
was in the hub. I then placed this onto a microscopic slide and spread
it between two different side slides, one was fixed and one was air
dried and I placed the remainder into the CytoLyt solution. I then
changed needle and syringes and aspirated a second higher level lymph
node packet until I got blood return into the hub of the needle.
Again, I placed this on to a slide and spread it between two separate
slides, one was air dried and one was fixed. The remaining solution
was placed into the CytoLyt solution. These were both sent to
pathology. We will await our biopsy results.

_____________________________
M.D.
CC:

Medical Billing and Coding Forum

CPT for Sentinel Lymph node biopsy

I have seen to use an unlisted code for the "deep" inguinal CPT 38999. I have also read to use 38500 and 38505, or 38525 so I am kind of at a loss as to what direction to go.

Plan for incision was made in the right inguinal region overlying the area of the 2 lymph nodes that had been detected on lymph node mapping. At the site of the greatest counts on the Neoprobe, an incision was made after infiltration into the skin with 0.5% sensorcaine with epinephrine. The incision was carried down through the subcutaneous tissue and through the fascia overlying the lymph nodes. The Neoprobe was used to detect a lymph node and dissection of this lymph node was performed. The lymphatic channels were clipped with Hemoclips. The lymph node was then passed off the sterile field and sent to pathology…the wound was closed in layers using 3-0 vicryl for the deep dermis and 4-0 monocryl for the skin in a running subcuticular fashion.

Provider then goes on to do an excision of a lesion on the right inner thigh.

I would appreciate any help as to what CPT would be correct regarding this type of scenario.
KM

Medical Billing and Coding Forum

Single Pelvic Lymph Node Resection – Laparoscopic

Can anyone tell me how you would code for a single enlarged pelvic lymph node that was resected during a TLH/BSO (58571) due to severe endometriosis? I wanted to use 38570, but I am not sure that is correct. I am thinking I may need to use the unlisted code?

Thank you!

Medical Billing and Coding Forum

Need help with deep inguinal sentinal node bx with intraoperative mapping

Good morning Forum!! I am working on a report for Deep subfascial sentinel node biopsies identified by intraoperative mapping. One node with an update of 239 and the other with an uptake of 249 CPS. The surgeon is working near the Saphenous vein. The mapping code 38900 does not include a primary procedure remotely related to deep inguinal nodes? How would you all code this to include the deep dissection and the mapping?? I understand that there is a Part B News article from January 2009 and have seen an excerpt from that article but still am baffled.

Thank you!!
Carol J Self, CPPM, CPC, EMT

Medical Billing and Coding Forum