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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

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

Ulcer Code with Venous Stasis

Our doctor gave a code of L97.322 Ulcer Ankle Left w∕ Fat Exposed which requires the underlying condition to be coded first. He also gave us I87.8 which is Venous Stasis. Per what I read in the ICD 10 book, venous stasis does not fit the criteria to be used an underlying condition for this ulcer code. We have a difference of opinion at my job. Can I87.8 be used as the underlying condition to the Ulcer code or no? Thanks!

Medical Billing and Coding Forum

Pressure Ulcer Excision – ostectomy?

My provider documented excision of ischial pressure ulcer with debridement of the bone. Is this considered ostectomy even though he documents it as debridement? He then performs a gluteal muscle flap, so i was looking at coding 15946 and 15734.

"We began the case by marking the left ischial ulcer with methylene blue. The edges of the ischial wound were incised with 15 blade scalpel, and dissection was carried down to the level of the subcutaneous tissues using monopolar electrocautery. The ischial ulcer was systematically excised down to the level of the ischium. The ischium was then debrided by rongeur, and bone cultures were sent. In addition, soft tissue was excised and sent for culture. We then proceeded to raise a gluteal muscle flap for coverage of the fascial defect. A 12 cm incision was made from the inferior aspect of the ischial wound extending laterally along the inferior gluteal crease. Dissection was carried down to the level of the fascia using monopolar electrocautery. A lipocutaneous flap was then raised using monopolar electrocautery. The gluteus maximus was identified and incised with electrocautery to allow rotation into the ischial defect. The gluteal muscle flap was mobilized and introduced to the ischial defect and secured in place using 0 Vicryl sutures. The wound was then subsequently closed in 3 layers using 0 Vicryl sutures in Scarpa’s fascia, followed by 0 Vicryl sutures in the deep dermis, followed by 0 nylon sutures for skin reapproximation. A dressing consisting of Xeroform, gauze, and ABD was applied."

Medical Billing and Coding Forum

Sacral ulcer debridement calculation (x-post from derm)

I need clarification on how to calculate the debridement of a sacral ulcer. The surgeon did not specify the total amount of debrided tissue, but he did give the before and after wound sizes;

"Pre debridement measurements of this full-thickness stage IV ulcer were 9cm long by 8 cm wide by 4 cm deep. There was foul-smelling necrotic tissue at the superior margin and in the depth of the wound. The inferior margin was actually somewhat clean and with evidence of granulation tissue. That caudal or inferior margin was also only about 15 mm away from the anal verge. This also was then sharply debided with the Bovie such that the ultimate wound measurements were 9 cm long by now 10 cm wide by 7 cm deep. The debridement was into subcutaneous fat as well as musculature of the buttock, as well as exposed periosteum of the sacrum in several areas, but no bony debridement was done nor thought to be required as that periosteum appeared to be healthy…"

Surface area of wound before debridement: 9×8 = 72 sq cm
Surface area after debridement: 9×10 = 90 sq cm
Depth of debridement: (7-4) = 3 cm
So (90×3)-72 = 198 sq cm debrided

Am I calculating this right??

If so, I’m suing codes 11044, and 11047×9

Any insight welcome.
Thanks :)

Medical Billing and Coding Forum

Pressure injury/pressure ulcer

Our Wound Care Nurses state in their progress notes the following:
Present on admission pressure injuries for current encounter. It has all kinds of other information as well such as staging, which for this patient is a stage 3. this document is reviewed and signed by the physician. The coder said she is not comfortable coding it as a pressure ulcer because it says pressure injury and not decubitus. Is she correct?

Medical Billing and Coding Forum

documentation of ulcer sizes with debridement

Is there any guidelines stating if an ulcer size needs to be documented before or after debridement? My General Surgery office documents size prior to debridement but a coworkers Plastic Surgeon office documents size after debridement. Or should they both be documenting before and after sizes?

Thanks,
Tammy King, CPC

Medical Billing and Coding Forum

Pressure Ulcer and Non-Pressure Ulcer ICD-10 Coding

Pressure ulcer and non-pressure chronic ulcer diagnostic codes are located in ICD-10-CM chapter 12, Disease of the skin and subcutaneous tissue. The concept of laterality (e.g., left or right) is pertinant, and should be included in the clinical documentation for skin ulcers. ICD-10-CM codes for Pressure ulcers, located in Category L89, are combination codes that […]
AAPC Knowledge Center

Please help code Ulcer resection and aneurysmectomy off/at AV fistula

DX: Right arm AV fistula with ulceration and aneurysm in the setting of end stage renal disease.

Operation performed:

1. Aneurysmectomy of the right upper extremity AV fistula aneurysm.
2. Ulcer resection of this ulceration of the skin in the right upper extremity.
3. Aneurysmorrhaphy and aneurysmectomy with ulcer resection.

Indications for procedure: t
This is a patient, who has right upper extremity AV fistula and he then has had aneurysmal disease dilatation in _____ segments as well as an ulceration of the skin that is at risk of rupturing.

Procedure:
The patient was appropriately consented and brought to the operating room, prepped and draped in sterile fashion. Right upper extremity was prepped in sterile field. Infusion of lidocaine anesthetic was infused around the larger of the 2 masses and an encompassing separation of the ulceration from the AV fistula took place. Sharp elliptical incision was made around the larger of the 2 masses _____ was made, carried around the proximal and distal portions of the AV fistula and the ulceration was resected, sent off to pathology. The same was done for the aneurysm. Aneurysm was encircled proximally and distally. There was control that was made and a subsequent aneurysmectomy took place with aneurysmorrhaphy using running 6-0 prolene suture as well as a endo-gia stapler _____ . After the case, there was a good thrill through the fistula and good hemostasis and the fistula was in good shape and much more _____ caliber and size postprocedure. the patient tolerated the procedure well. A running 3-0 nylon was used to close the suture.

Medical Billing and Coding Forum

Please help code Ulcer resection and aneurysmectomy off/at AV fistula

DX: Right arm AV fistula with ulceration and aneurysm in the setting of end stage renal disease.

Operation performed:

1. Aneurysmectomy of the right upper extremity AV fistula aneurysm.
2. Ulcer resection of this ulceration of the skin in the right upper extremity.
3. Aneurysmorrhaphy and aneurysmectomy with ulcer resection.

Indications for procedure
: t
This is a patient, who has right upper extremity AV fistula and he then has had aneurysmal disease dilatation in _____ segments as well as an ulceration of the skin that is at risk of rupturing.

Procedure:
The patient was appropriately consented and brought to the operating room, prepped and draped in sterile fashion. Right upper extremity was prepped in sterile field. Infusion of lidocaine anesthetic was infused around the larger of the 2 masses and an encompassing separation of the ulceration from the AV fistula took place. Sharp elliptical incision was made around the larger of the 2 masses _____ was made, carried around the proximal and distal portions of the AV fistula and the ulceration was resected, sent off to pathology. The same was done for the aneurysm. Aneurysm was encircled proximally and distally. There was control that was made and a subsequent aneurysmectomy took place with aneurysmorrhaphy using running 6-0 prolene suture as well as a endo-gia stapler _____ . After the case, there was a good thrill through the fistula and good hemostasis and the fistula was in good shape and much more _____ caliber and size postprocedure. the patient tolerated the procedure well. A running 3-0 nylon was used to close the suture.

Medical Billing and Coding Forum

Ulcer wound care (debridement) and office visit

I understand the modifier 25 issue – however, my doc’s are concerned that when pt’s are coming into our office for wound care (debridement of an ulcer) that they are losing money by not being able to bill an office visit with it. I have explained what the modifier means to them, but, their argument is that they may be changing medications, off loading shoes, orthotics, etc to accommodate the wound and the area surrounding that.

My question is with enough documentation can they bill an office visit (it would be utilizing the same diagnosis codes as the ulcer)?

Thoughts / suggestions ?

Thanks

Medical Billing and Coding Forum