A Short Integumentary System (Procedure Codes) Quiz!

1. Two weeks ago a 32 year male suffered a thumb injury at work he was using a belt grinder on a small piece of steel when the belt caught the tip of his left thumb in the grinder his thumb nail was removed and a small piece of his anterior phalange bone was broken off. The patient has appointment scheduled today to see if his nail bed on his left thumb can be reconstructed using a graft from his left great toe. What is code for this procedure?

11760- LT

11765

11762-LT

11730, 11732

The correct answer, 11762-LT, is the code for the procedure of reconstructing the nail bed on the left thumb using a graft from the left great toe.

Explanation

The correct answer, 11762-LT, is the code for the procedure of reconstructing the nail bed on the left thumb using a graft from the left great toe.

2. A 50 year old male present to physician office with complaints of recurrent problems with ingrown toenail on his right great toe. The doctor performs a wedge excision of the skin of the nail fold to his right great toe. Which of the following codes should you code?

10060

11760

11765

11750

The correct code to use in this scenario is 11765. This code is used for the excision of a nail and nail matrix, partial or complete (e.g., ingrown or deformed nail), for permanent removal. In this case, the physician performed a wedge excision of the skin of the nail fold, which falls under the description of this code. The other codes listed do not accurately describe the procedure performed in this case.

Explanation

The correct code to use in this scenario is 11765. This code is used for the excision of a nail and nail matrix, partial or complete (e.g., ingrown or deformed nail), for permanent removal. In this case, the physician performed a wedge excision of the skin of the nail fold, which falls under the description of this code. The other codes listed do not accurately describe the procedure performed in this case.

3. A 10 year old girl come to physician office after smashing the nail of her right 2^nd digit in the car door last night. This morning the tip of her finger is edematous, there is large amount of ecchymosis resent , the pediatrician uses a disposable bovie high temperature cautery pen to cauterize a hole in the nail to allow subungual hematoma to drain. A small amount of fluid is removed. What code should you use?

11720

11730

11740

11750

The correct code to use in this scenario is 11740. This code is used for the drainage of a subungual hematoma, which is the accumulation of blood under the nail. In this case, the physician used a disposable bovie high temperature cautery pen to cauterize a hole in the nail and allow the hematoma to drain. The removal of a small amount of fluid further supports the use of code 11740.

Explanation

The correct code to use in this scenario is 11740. This code is used for the drainage of a subungual hematoma, which is the accumulation of blood under the nail. In this case, the physician used a disposable bovie high temperature cautery pen to cauterize a hole in the nail and allow the hematoma to drain. The removal of a small amount of fluid further supports the use of code 11740.

4. A 22 year old women with excessive skin on her upper eye lid presented to physician for the revision of her right eye lid her physician decided that she would perform a blepharoplasty of the right eye lid during which she remove excessive skin down the lid. When physician perform the procedure, what code should be reported?

15822

15823

15823-50

15820

The correct code to report in this scenario is 15823. This code is used for blepharoplasty procedures involving excessive skin removal on the upper eyelid. The physician in this case decided to perform a blepharoplasty of the right eyelid to remove the excessive skin. Therefore, the appropriate code to report is 15823.

Explanation

The correct code to report in this scenario is 15823. This code is used for blepharoplasty procedures involving excessive skin removal on the upper eyelid. The physician in this case decided to perform a blepharoplasty of the right eyelid to remove the excessive skin. Therefore, the appropriate code to report is 15823.

5. A physician biopsied the skin on a 30 year old woman's upper eye lid with a possible fungal infection three site were biopsied. How you code?

11100, 11101 X2

11100X3

11100, 67810

67810

The correct answer is 11100, 11101 X2. The question states that the physician biopsied the skin on the woman's upper eyelid with a possible fungal infection, and three sites were biopsied. CPT code 11100 is used for a biopsy of a single lesion, and code 11101 is used for each additional lesion. Since three sites were biopsied, the correct coding would be 11100 for the first lesion and 11101 X2 for the additional two lesions. This accurately represents the procedure performed.

Explanation

The correct answer is 11100, 11101 X2. The question states that the physician biopsied the skin on the woman's upper eyelid with a possible fungal infection, and three sites were biopsied. CPT code 11100 is used for a biopsy of a single lesion, and code 11101 is used for each additional lesion. Since three sites were biopsied, the correct coding would be 11100 for the first lesion and 11101 X2 for the additional two lesions. This accurately represents the procedure performed.

6. Dr Yang is seeing a patient for an acne surgery follow up that was performed eight month ago. The surgery was successful and the patient skin condition has rapidly improved. Today patient stated that he would like to reduce acne scarring by having dermabrasion on his entire face. Although the patient requested entire face the dermatologist Dr Yang performed the dermabrasion on the area of face that are not currently prone to acne break outs (his forehead and brow area). What is correct code for this procedure?

15781

15780

15786

15788

The correct code for this procedure is 15781 because the patient requested dermabrasion on his entire face, but the dermatologist only performed it on the area of the face that is not currently prone to acne breakouts. Code 15781 specifically refers to dermabrasion of the face.

Explanation

The correct code for this procedure is 15781 because the patient requested dermabrasion on his entire face, but the dermatologist only performed it on the area of the face that is not currently prone to acne breakouts. Code 15781 specifically refers to dermabrasion of the face.

7. A dermatologist opened and drained multiple complicated acne pustule and comedones on a 20 year old patient with severe acne. For one of the most complicating acne pustule Dr incised drained, and marsupial zed the acne cyst by suturing the right and left side, leaving the cyst open for drainage, what is the correct procedure code?

10060

10061, 10040

10040

10061

The correct procedure code for the described scenario is 10040. This code is used for "Incision and drainage of hematoma, seroma or fluid collection." In this case, the dermatologist performed an incision and drainage procedure on the acne cyst, leaving it open for drainage.

Explanation

The correct procedure code for the described scenario is 10040. This code is used for "Incision and drainage of hematoma, seroma or fluid collection." In this case, the dermatologist performed an incision and drainage procedure on the acne cyst, leaving it open for drainage.

8. Which layer of the skin is primarily responsible for the production of new skin cells?

Epidermis

Dermis

Hypodermis

Subcutaneous layer

The epidermis is the outermost layer of the skin and is primarily responsible for the production of new skin cells. The basal layer of the epidermis contains stem cells that continuously divide and produce new cells to replace those that are shed from the surface. The dermis, hypodermis, and subcutaneous layer play different roles in skin structure and function, such as providing support, insulation, and cushioning.

Explanation

The epidermis is the outermost layer of the skin and is primarily responsible for the production of new skin cells. The basal layer of the epidermis contains stem cells that continuously divide and produce new cells to replace those that are shed from the surface. The dermis, hypodermis, and subcutaneous layer play different roles in skin structure and function, such as providing support, insulation, and cushioning.

9. The emergency physician performed the simple closure of one 2 cm laceration on a 10 year boy's cheek and two 2.3 cm lacerations on the left leg. The physician performed the simple closure of one 4 cm laceration on right arm and the layered closure of two laceration on the left arm, which were 5 cm and 3 cm respectively. The physician treated the 5 cm laceration on the boy's chest, which required the removal of a particle of glass and a single layer closure. What are the correct codes for the wound repair for the physician to be coded?

12001, 12002x2, 12032x 2

12005, 12011x 51, 12032-51

12004, 12011-51, 12032x2

12004, 12011-51, 12034-51

When coding for wound repairs, the key factors to consider include the type of closure (simple, intermediate, complex), the location of the wound, and the length of the laceration. Here's how the provided information breaks down according to the Current Procedural Terminology (CPT) codes:

Simple Closure:

Cheek: One 2 cm laceration

Left leg: Two 2.3 cm lacerations (total of 4.6 cm)

Right arm: One 4 cm laceration

Layered Closure:

Left arm: Two lacerations, 5 cm and 3 cm (total of 8 cm)

Complex Closure:

Chest: One 5 cm laceration requiring removal of a glass particle and single-layer closure. This might still be considered complex due to the removal of a foreign object and the care required.

Given this breakdown:

For the simple closures, you combine the lengths by anatomical site as follows:

The cheek and right arm can be coded together because they are both on the body's trunk and extremities, and the sum of lengths (2 cm + 4 cm) falls under a single code for simple repair.

The left leg's total length is 4.6 cm, which might require a separate code depending on the specific CPT guidelines for combining lacerations across different limbs.

For the layered closures, the total length on the left arm is 8 cm, which requires its own specific code.

The complex closure on the chest due to the removal of glass and the care needed would be coded separately.

Based on the 2023 CPT codes:

12002 is for simple repair of 2.6 to 7.5 cm wounds on the trunk, arms, and/or legs.

12004 might cover larger simple repairs up to 10 cm, which might be necessary depending on whether the cheek and right arm are coded together or separately.

12011 is for simple repair of 2.5 to 5.0 cm wounds on the face, ears, eyelids, nose, lips, and/or mucous membranes.

12032 is for intermediate repair of wounds on the arms, legs, or scalp of 7.6 to 12.5 cm.

12034 could be considered for complex repair for wounds of similar sizes but with added complexity such as the removal of a foreign object.

Given the scenarios and CPT coding guidelines, the most accurate set of codes for the described procedures could be 12004, 12011-51, 12032x2. The -51 modifier indicates multiple procedures performed at the same session. This set of codes addresses the simple repairs together, the layered repair, and accounts for the complexities involved in the treatment, including the scenario with the glass particle which might alternatively need a complex repair code, potentially 12034-51, if considered complex rather than intermediate.

Therefore, among the options provided, 12004, 12011-51, 12032x2 is the the closest match, assuming a comprehensive interpretation of the procedures. However, the description and options do not perfectly align with standard coding practices, suggesting a possible need for adjustment based on detailed CPT guidelines.

Explanation

When coding for wound repairs, the key factors to consider include the type of closure (simple, intermediate, complex), the location of the wound, and the length of the laceration. Here's how the provided information breaks down according to the Current Procedural Terminology (CPT) codes:

Simple Closure:

Cheek: One 2 cm laceration

Left leg: Two 2.3 cm lacerations (total of 4.6 cm)

Right arm: One 4 cm laceration

Layered Closure:

Left arm: Two lacerations, 5 cm and 3 cm (total of 8 cm)

Complex Closure:

Chest: One 5 cm laceration requiring removal of a glass particle and single-layer closure. This might still be considered complex due to the removal of a foreign object and the care required.

Given this breakdown:

For the simple closures, you combine the lengths by anatomical site as follows:

The cheek and right arm can be coded together because they are both on the body's trunk and extremities, and the sum of lengths (2 cm + 4 cm) falls under a single code for simple repair.

The left leg's total length is 4.6 cm, which might require a separate code depending on the specific CPT guidelines for combining lacerations across different limbs.

For the layered closures, the total length on the left arm is 8 cm, which requires its own specific code.

The complex closure on the chest due to the removal of glass and the care needed would be coded separately.

Based on the 2023 CPT codes:

12002 is for simple repair of 2.6 to 7.5 cm wounds on the trunk, arms, and/or legs.

12004 might cover larger simple repairs up to 10 cm, which might be necessary depending on whether the cheek and right arm are coded together or separately.

12011 is for simple repair of 2.5 to 5.0 cm wounds on the face, ears, eyelids, nose, lips, and/or mucous membranes.

12032 is for intermediate repair of wounds on the arms, legs, or scalp of 7.6 to 12.5 cm.

12034 could be considered for complex repair for wounds of similar sizes but with added complexity such as the removal of a foreign object.

Given the scenarios and CPT coding guidelines, the most accurate set of codes for the described procedures could be 12004, 12011-51, 12032x2. The -51 modifier indicates multiple procedures performed at the same session. This set of codes addresses the simple repairs together, the layered repair, and accounts for the complexities involved in the treatment, including the scenario with the glass particle which might alternatively need a complex repair code, potentially 12034-51, if considered complex rather than intermediate.

Therefore, among the options provided, 12004, 12011-51, 12032x2 is the the closest match, assuming a comprehensive interpretation of the procedures. However, the description and options do not perfectly align with standard coding practices, suggesting a possible need for adjustment based on detailed CPT guidelines.

10. A 32 year old female with sever Gynecomastia and family history of breast cancer elected to have complete mastectomy with immediate insertion of breast prosthesis implants. What is the code for the procedure?

19300-50, 19340-50

19300-50, 193040

19303, 19357

19300-50, 19357-50

The correct coding for a complete mastectomy with immediate insertion of breast prosthesis implants for a case involving severe gynecomastia (assuming the condition is severe enough to warrant such a procedure, though gynecomastia typically refers to men) and a family history of breast cancer would be 19303, 19357.

19303 is the code for Mastectomy, simple, complete.

19357 is the code for Breast reconstruction with tissue expander, including subsequent expansion.

The use of modifier -50 for bilateral procedures is not applicable in this scenario since the description does not specify that the surgery is bilateral. If the surgery were bilateral, the use of modifier -50 might be appropriate for certain codes. However, given the information provided, the most accurate coding is 19303 for the mastectomy and 19357 for the immediate insertion of breast prosthesis implants.

Explanation

The correct coding for a complete mastectomy with immediate insertion of breast prosthesis implants for a case involving severe gynecomastia (assuming the condition is severe enough to warrant such a procedure, though gynecomastia typically refers to men) and a family history of breast cancer would be 19303, 19357.

19303 is the code for Mastectomy, simple, complete.

19357 is the code for Breast reconstruction with tissue expander, including subsequent expansion.

The use of modifier -50 for bilateral procedures is not applicable in this scenario since the description does not specify that the surgery is bilateral. If the surgery were bilateral, the use of modifier -50 might be appropriate for certain codes. However, given the information provided, the most accurate coding is 19303 for the mastectomy and 19357 for the immediate insertion of breast prosthesis implants.