© 2010 Delmar, Cengage Learning Chapter 12 CPT Surgery II

© 2010 Delmar, Cengage Learning Musculoskeletal Subsection Arranged from head to toe according to body area Headings include: –General –Head –Neck –Back and flank –Spine (continued)

© 2010 Delmar, Cengage Learning Musculoskeletal Subsection Headings include: –Abdomen –Shoulder –Humerus –Forearm and wrist –Hand and fingers –Pelvis and hip joint (continued)

© 2010 Delmar, Cengage Learning Musculoskeletal Subsection Headings include: –Femur (thigh region) and knee joint –Leg (tibia and fibula) and ankle joint –Foot and toes –Application of casts and strapping –Endoscopy/Arthroscopy

© 2010 Delmar, Cengage Learning Musculoskeletal Subheadings Incision Excision Introduction and removal Repair Fracture (continued)

© 2010 Delmar, Cengage Learning Musculoskeletal Subheadings Dislocation Arthrodesis Amputation

© 2010 Delmar, Cengage Learning Types of Fractures Closed fracture –Simple fracture Dislocation –Luxation Open fracture –Compound fracture

© 2010 Delmar, Cengage Learning Fractures and Dislocations (continued)

© 2010 Delmar, Cengage Learning Fractures and Dislocations (continued)

© 2010 Delmar, Cengage Learning Fractures and Dislocations

© 2010 Delmar, Cengage Learning Fracture Treatment Three methods of closed fracture treatment: –Manipulation Reduction –Without manipulation Stabilize or immobilize –With or without skeletal traction

© 2010 Delmar, Cengage Learning Closed Manipulation (Reduction) Fractured left humerus

© 2010 Delmar, Cengage Learning Open Fracture Treatment Percutaneous skeletal fixation –Two types: External fixation device Internal fixation device

© 2010 Delmar, Cengage Learning External Fixation (a)(b) (a) Fracture of femur epiphysis b) External fixation stabilizes bone and is removed after bone has healed

© 2010 Delmar, Cengage Learning Internal Fixation (a)(b) (a) Fracture of femoral neck (b) Internal fixation pins are placed to stabilize bone permanently

© 2010 Delmar, Cengage Learning Fracture Management Codes Found throughout musculoskeletal subsection: –Pinning –Open or closed treatment of fracture –Application and removal of cast or splint –Normal, uncomplicated follow-up care

© 2010 Delmar, Cengage Learning General Subheadings include: –Incision –Wound exploration –Excision –Introduction or removal –Replantation –Grafts –Other procedures

© 2010 Delmar, Cengage Learning Wound Exploration: Trauma Results from penetrating trauma: –Surgical exploration –Debridement –Removal of foreign body –Ligation or coagulation of blood vessels

© 2010 Delmar, Cengage Learning Introduction or Removal Removal of foreign body Insertion of surgical hardware Aspirations Injections

© 2010 Delmar, Cengage Learning Replantation Surgical reattachment of a finger, hand, toe, foot, leg, or arm that has been completely severed from a person’s body Includes: –Arthrodesis –Cleansing –Debridement –Internal fixation –Repair of tendons

© 2010 Delmar, Cengage Learning Modifier -52 Add modifier -52 to replantation code to indicate that patient suffered a partially severed finger, hand, toe, foot, leg, or arm

© 2010 Delmar, Cengage Learning Grafts (Implants) Key terms: –Autogenous –Harvesting –Allogenous grafts –Xenografts

© 2010 Delmar, Cengage Learning Repair, Revision, and/or Reconstruction LeFort I LeFort II –Pyramidal fracture Colpocleisis –LeFort procedure Wagstaff-LeFort fracture

© 2010 Delmar, Cengage Learning Head Incision Excision Manipulation –Temporomandibular joint (TMJ) disorder Head prosthesis Repair, revision, and/or reconstruction Fracture and/or dislocation

© 2010 Delmar, Cengage Learning Neck and Thorax Incision and drainage Excisional biopsies Repairs, revisions, and reconstruction Fracture and/or dislocation Back and flank

© 2010 Delmar, Cengage Learning Spine (Vertebral Column) Includes procedures performed on cervical, thoracic, and lumbar spine When reporting codes for spinal procedures, be sure to differentiate between spinal segments and interspaces.

© 2010 Delmar, Cengage Learning Spinal Deformities (a) Kyphosis (b) Lordosis (c) Scoliosis

© 2010 Delmar, Cengage Learning Incision Cervical Thoracic Cervicothoracic Lumbar Sacral Lumbosacral

© 2010 Delmar, Cengage Learning Excision Report modifier -62 when two surgeons work together to perform a spinal procedure during the same operative session on the same patient.

© 2010 Delmar, Cengage Learning Vertebral Body Percutaneous vertebroplasty –Performed to relieve pain due to vertebral compression fractures –For example, pathologic fractures due to osteoporosis

© 2010 Delmar, Cengage Learning Arthrodesis Artificial ankylosis –Surgical fixation of a joint Lateral extracavitary approach Anterior or anterolateral approach Posterior, posterolateral, or lateral transverse process

© 2010 Delmar, Cengage Learning Spinal Instrumentation Spinal instrumentation procedures are reported in addition to arthrodesis codes Add modifier -51 to code for instrumentation Bone graft procedures are reported in addition to arthrodesis

© 2010 Delmar, Cengage Learning Abdomen Subheadings –Excision –Other procedures

© 2010 Delmar, Cengage Learning Shoulder Heading contains codes for: –Clavicle –Scapula –Humerus head and neck –Sternoclavicular joint –Acromioclavicular joint –Shoulder joint

© 2010 Delmar, Cengage Learning Humerus (Upper Arm) and Elbow Heading contains codes for: –Humerus –Elbow –Head and neck of the radius –Olecranon process

© 2010 Delmar, Cengage Learning Forearm and Wrist Radius Ulna Carpal bones and joints

© 2010 Delmar, Cengage Learning Hands and Fingers Two types of tendons: –Flexor –Extensor Tendon repair codes include the following procedures: –Application of immobilization –Extending excision –Repair and closure of tendon sheath

© 2010 Delmar, Cengage Learning Pelvis and Hip Joint Head and neck of femur (hip joint)

© 2010 Delmar, Cengage Learning Femur (Thigh Region) and Knee Joint Femur –Long bone to the thigh Tibial plateaus –Lower portion of femur –Articulates with tibial (continued)

© 2010 Delmar, Cengage Learning Femur (Thigh Region) and Knee Joint Tibial –Larger of two lower bones Knee –Hinge joint comprised of bone, cartilage, ligaments, and tendons

© 2010 Delmar, Cengage Learning Leg (Tibia and Fibula) and Ankle Joint Tibia Fibula Ankle joint

© 2010 Delmar, Cengage Learning Foot and Toes Procedures: –Keller –McBride –Mitchell

© 2010 Delmar, Cengage Learning Application of Case and Strapping Report codes when cast or splint application is a(n): –Replacement procedure performed during or after the period of follow-up care –Initial service performed without restorative treatment or procedure to stabilize or protect a fracture, a dislocation, or another injury to provide comfort to a patient

© 2010 Delmar, Cengage Learning Endoscopy/Arthroscopy Endoscopy –Visual examination of interior of a body cavity or organ Arthroscopy –Visual examination of inside of a joint Surgical endoscopy/arthroscopy –Always includes a diagnostic endoscopy/arthroscopy procedure

© 2010 Delmar, Cengage Learning Arthroscope in Use

© 2010 Delmar, Cengage Learning Respiratory System Subsection Headings include: –Nose –Accessory sinuses –Larynx –Trachea and bronchi –Lungs and pleura –Endoscopy

© 2010 Delmar, Cengage Learning Respiratory System

© 2010 Delmar, Cengage Learning Respiratory System Subheadings Incision Excision Introduction and removal Removal of foreign body Repair (continued)

© 2010 Delmar, Cengage Learning Respiratory System Subheadings Destruction Endoscopy Other procedures

© 2010 Delmar, Cengage Learning Nose Subheading Nose Nasal Septum Intranasal tissue Nasal turbinates –Inferior, middle, and superior Skin of the nose

© 2010 Delmar, Cengage Learning Upper Respiratory System Structures of the upper respiratory system

© 2010 Delmar, Cengage Learning Accessory Sinuses Subheading Maxillary Frontal Ethmoid Sphenoid

© 2010 Delmar, Cengage Learning Endoscopy Codes classify unilateral procedure unless code indicates otherwise Add modifier -50 to code if procedure is performed bilaterally Diagnostic endoscopy includes inspection of interior of nasal cavity and its meatus, turbinates, and sphenoethmoid recess (continued)

© 2010 Delmar, Cengage Learning Endoscopy Diagnostic endoscopy includes and is bundled into surgical endoscopy: –Administration of local anesthesia –Electrocautery –Access to different cavities –Some shaving/debridement Extensive shaving/debridement has separate code –Add Right (-Rt) or Left (-Lt) modifier to indicate which side endoscopy occurred Do not report if surgical procedure is done

© 2010 Delmar, Cengage Learning Larynx Subheading Epiglottis Larynx Inside the trachea

© 2010 Delmar, Cengage Learning Larynx and Vocal Cords View of larynx and vocal cords from above A) Open during breathing B) Cords vibrate together during speech

© 2010 Delmar, Cengage Learning Laryngoscopy –Visualization of back of the throat, larynx, and vocal cords Direct Indirect Operating microscope Fiberoptic scope

© 2010 Delmar, Cengage Learning Trachea and Bronchi Subheadings Bronchoscopy interior of the bronchus Tracheoscopy interior of the trachea Tracheobronchoscopy interior of the trachea and bronchus

© 2010 Delmar, Cengage Learning Trachea and Bronchi Trachea, bronchi, bronchial tree, and alveoli (air sacs)

© 2010 Delmar, Cengage Learning Bronchoscopy

© 2010 Delmar, Cengage Learning Lungs and Pleura Subheadings Transplantation Surgical collapse therapy and thoracoplasty

© 2010 Delmar, Cengage Learning Lungs and Pleura

© 2010 Delmar, Cengage Learning Thoracentesis A) Thoracentesis B) Lung with pleural effusion