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In this scenario, the procedure involved the excision of a large sacral pressure ulcer with deep tissue damage that required muscle and bone removal and was followed by a layered flap closure. The coding reflects both the extent of the ulcer and the procedure performed:

1. CPT® Code 15937: This code describes excision of a pressure ulcer with muscle and bone removal followed by flap closure, which matches the detailed procedure performed on the sacral ulcer.

2. ICD-10-CM Code L89.156: This code is used for a stage 4 sacral pressure ulcer, indicating the presence of deep tissue damage down to muscle and possibly bone, which aligns with the clinical findings.

Explanation of other options:

A. 15933, L89.153 and B. 15931, L89.153: These codes do not adequately describe the excision with muscle and bone removal nor the stage 4 severity of the ulcer.

C. 15935, L89.156: Although L89.156 is correct for a stage 4 ulcer, 15935 does not account for both muscle and bone excision with flap closure.

Therefore, the correct answer is D. 15937, L89.156, accurately capturing the procedure performed and the severity of the ulcer.

CPT® code 49083 describes an abdominal paracentesis with imaging guidance, such as ultrasound. This code includes the imaging guidance as part of the procedure, so it is not necessary to separately report the ultrasonic guidance.

1. Procedure and CPT® Code Selection:

The procedure involves a tympanoplasty with a radical mastoidectomy to remove a cholesteatoma in the middle ear. Additionally, the procedure includes ossicular chain reconstruction and grafting to repair the eardrum.

CPT® Code 69646 is appropriate for tympanoplasty with a radical mastoidectomy, including removal of the cholesteatoma and ossicular chain reconstruction. This code accurately describes the combination of tympanoplasty, radical mastoidectomy, and ossicular chain reconstruction, making it the correct choice.

2. Rationale for Excluding Other Options:

Code 69643 describes a tympanoplasty with a simple mastoidectomy, which is not appropriate since a radical mastoidectomy was performed.

Code 69645 covers a tympanoplasty with radical mastoidectomy but does not include ossicular chain reconstruction, which was part of this procedure.

Code 69641 is for a tympanoplasty without mastoidectomy, making it incorrect for this case.

3. AAPC and CPT® Coding Guidelines:

According to AAPC and CPT® guidelines, 69646 is the appropriate code when a tympanoplasty includes a radical mastoidectomy with ossicular chain reconstruction, as documented in this case.

Therefore, the correct answer based on CPT® guidelines is D. 69646.

CPT® code 69644 refers to a tympanoplasty with mastoidectomy, which includes canalplasty, middle ear surgery, and tympanic membrane repair. The specific procedure described by this code is performed with an intact or reconstructed canal wall and includes ossicular chain reconstruction. The use of a semicolon in the CPT® description helps distinguish between different variations of the procedure.

AMA's CPT® Professional Edition, specific code descriptions and guidelines.

80430 = Growth hormone suppression panel

Individual tests are reported with units

MEDICINE & CARDIOLOGY

72158 = MRI lumbar spine without and with contrast

M54.42 = Low back pain with sciatica, left side

Separate pain codes are not reported redundantly

CPT code 99450 is used for the examination of a patient for the purpose of establishing medical baseline information or for insurance purposes. Since Eric's primary care provider completed the required physical exam documentation for his life insurance policy, this is appropriately reported with code 99450. References: CPT® Professional Edition (current year), AMA.

The scenario describes an emergency basic life support (BLS) ambulance service. The appropriate HCPCS Level II code for BLS emergency transport is A0429.

Modifier QN indicates that the service was provided by an ambulance supplier, and SH indicates the services were provided in an emergency situation.

HCPCS Level II, current year

Shave removal → CPT 11300–11313, not excision (11400–11646).

Face (nose) → 11310–11313

0.6–1.0 cm → 11311

Inflamed seborrheic keratosis → L82.0

1. Procedure and CPT® Code Selection:

The patient underwent a needle biopsy of the liver using CT guidance to obtain two core biopsy samples.

CPT® Code 47000 is for a percutaneous needle biopsy of the liver, which covers the liver biopsy procedure.

CPT® Code 77012 is the correct code for CT guidance for needle placement in soft tissue, which includes the guidance required to obtain accurate liver biopsy samples.

2. Rationale for Excluding Other Options:

Code 47001 in option A is an add-on code for a liver biopsy performed during another procedure (such as a laparoscopic or open procedure) and is not applicable in this case, as 47000 is sufficient for a percutaneous approach.

Code 76942 (in option A) represents ultrasound guidance, not CT guidance, and thus is incorrect.

Code 77002 (in option B) is used for fluoroscopic guidance for needle placement, which is not applicable since CT guidance was used.

Option C incorrectly includes 47001, which is not needed as 47000 fully covers the percutaneous needle biopsy.

3. AAPC and CPT® Coding Guidelines:

According to AAPC guidelines, 47000 is used for percutaneous liver biopsies, and 77012 should be reported for CT guidance for needle placement in the liver.

Therefore, the correct answer is D. 47000, 77012.