Right carotid endarterectomy and patch angioplasty icd 10 pcs

Medical ICD-PCS Coding

M132 Module 03 Coding Assignment

1. Select the best response for each question below.

A colostomy was performed from the sigmoid colon to the abdominal wall.

The section is _________A_______, the body system is _______B_________the root operation is __________C________. The body part is ________ D_________. The approach is __________E________. The device is ___________F__________. The qualifier is

__________G_________.

Answers:

A. Click here to enter text.

B. Click here to enter text.

C. Click here to enter text.

D. Click here to enter text.

E. Click here to enter text.

F. Click here to enter text.

G. Click here to enter text.

2. Using the following table, the correct code for laparoscopic ventral hernia repair with Paritexmesh is: (Check one answer)

☐0WU44JZ

☐0WU477Z

☐0WUF4JZ

☐0WUF8KZ

3. When using the root operation Fusion, there are very specific rules regarding how the device character (sixth character) is assigned. Use the list of devices listed in the ICD-10-PCS book for character 6 below:

A Interbody Fusion Device

4 Internal Fixation Device

5 External Fixation Device

7 Autologous Tissue Substitute

J Synthetic Substitute

K Nonautologous Tissue Substitute

Z No device

Complete the following table:

Device Used to Render the Joint Immobile

ICD-10-PCS Device (Character 6)

Interbody fusion device alone

Click here to enter text.
Interbody fusion device with bone graft

Click here to enter text.
Bone graft taken from patient

Click here to enter text.
Bone graft taken from bone bank

Click here to enter text.
Bone graft taken from patient and a donor

Click here to enter text.
Bone graft taken from a donor mixed with synthetic binders

Click here to enter text.
4. Case Study 1:

Do not code the fluoroscopy or angiogram for this case.

PREOPERATIVE DIAGNOSIS: High-grade asymptomatic right carotid artery stenosis. POSTOPERATIVE DIAGNOSIS: High-grade asymptomatic right carotid artery stenosis. PROCEDURE PERFORMED: Percutaneous transluminal angioplasty and stenting of the right internal carotid artery. (This was done under the Choice protocol.) ANESTHESIA: Local. INDICATION: The patient is a 72-year-old gentleman who is 10 years status post head and neck surgery for cancer status post radiation and has a tracheotomy in place. He has developed a high-grade asymptomatic right carotid artery stenosis. After reviewing the risks, benefits and alternatives of his options, he wished to proceed with carotid artery stenting, due to his high anatomical risk factors and high risk of nerve injury. He was enrolled under the Choice post market registry protocol. After the patient was correctly identified and consented, he was taken to the cardiac cath lab and placed in supine position. The right groin was prepped and draped in usual sterile fashion and anesthetized with 1% local. Using anatomical landmarks, the right common femoral artery was punctured with a micropuncture needle in a retrograde fashion. A 0.018-inch wire was then passed under fluoroscopy into the aorta. The needle was exchanged out for a 5-French coaxial dilator and subsequently for a 5-French sheath. Omni flush catheter was then taken into the arch in an LAO projection and aortogram was then performed. This demonstrates a mildly to moderately atherosclerotic aortic arch without any evidence of stenosis. The origins of the great vessels are identified and these are widely patent without severe disease. The visualized portions of the right subclavian, vertebral, left subclavian and left vertebral arteries are all widely patent without any evidence of severe disease. The left common carotid artery is patent proximally. The right common carotid artery arises from the innominate in a normal variant. The patient was then systemically heparinized and his ACT was kept over 220 seconds throughout the entire case. The right common carotid artery was negotiated and then cannulated with a with a Bernstein catheter. With a catheter in the common carotid, angiogram was performed which demonstrates a high-grade atherosclerotic lesion of the proximal right internal carotid artery MAC with 80-90% stenosis. Distal to this, the artery is widely patent. The external carotid artery is identified and is otherwise normal. An angled guide wire was then advanced deep into the external carotid artery branches and then the catheter was then tracked into this area. Using an exchange technique over an Amplatz wire, an 8-French JR guiding catheter was then advanced through sheath that had been exchanged into the groin and placed with its tip in the distal common carotid artery. With the catheter in this position, a Spider wire embolic protection filter wire was then advanced very carefully through internal carotid artery lesion and placed 5 cm distal to the area of treatment. The filter wire was deployed and a follow-up angiogram demonstrates excellent position without any evidence of embolism or vasospasm. After making appropriate measurements, an Abbott Xact 6 mm x 30 mm self-expanding stent was then deployed across the lesion under fluoroscopy with the filter in place. The stent opened and moved forward slightly but was otherwise in good position. With the stent completely deployed, a 6 x 20 mm balloon was then used to post dilate the stent to form full apposition. A follow-up angiogram was done which demonstrates excellent treatment of the lesion with less than 20% residual stenosis. The filter wire is in place and does not appear to have a severe amount of debris within it. The filter was then retracted and removed and a cervical carotid angiogram demonstrated wide patency of the common internal and external carotid arteries. The AP and lateral views of the unilateral cerebral carotid demonstrated wide patency with excellent flow through the MCA distribution and cross filling without any evidence of embolism or vasospasm. The guiding catheter and sheath were then removed with direct manual compression held over the groin for 30 minutes. The patient was given protamine to reverse the heparin and then loaded with Plavix, given the placement of the stent. He maintained hemodynamic and neurological stability throughout the entire case. The wound was then cleaned, dried and dressed using gauze and Tegaderm. The patient appeared to tolerate the procedure well. There were no immediate complications. The patient was taken to recovery room in stable condition. A total of 70 mL of contrast was used for the entire case.

· ICD-10-PCS Code: Click here to enter text.

5. Case Study 2:

PREOPERATIVE DIAGNOSES:

1. Left leg claudication.

2. Left superficial femoral artery occlusion and femoropopliteal occlusive disease.

POSTOPERATIVE DIAGNOSES:

1. Left leg claudication.

2. Left superficial femoral artery occlusion and femoropopliteal occlusive disease.

PROCEDURE PERFORMED: A left femoropopliteal bypass (above knee 8-mm PTFE graft with a distal cuff). The patient was brought to the operating room. General anesthesia was given. The left leg was prepped and draped in the usual manner.

A vertical incision was made in the groin and the common femoral profunda and superficial femoral arteries were dissected.

The femoral artery appeared to be fairly calcified on the back. It was soft on the front. However, close to the inguinal ligament after the inguinal ligament was lifted off basically the external iliac artery was found to be fairly smooth in all directions, and appeared to be good place to clamp the artery.

The popliteal artery was isolated above the knee through a medial incision in the thigh. Deep fascia was opened. Popliteal fossa was entered. Artery was dissected free of its adjoining veins and was encircled in vessel loops and a tunnel was made.

The patient was heparinized, after which, the popliteal artery was isolated between clamps and opened longitudinally. Although it had arteriosclerosis and irregular plaque inside, in general it appeared to be open. Anastomosis between the cuff of the graft and the artery was carried out with 6-0 Prolene. The graft was then pulled through the tunnel into the groin.

The external iliac artery and two profunda arteries were clamped. A longitudinal incision was made in the common femoral artery. It appeared that on the back of the artery there was a popcorn-type of calcification extending into the lumen of the artery. This popcorn calcification was removed by a limited endarterectomy and after the artery had been smoothed out on the inside, the area was thoroughly irrigated. The arteries were allowed to bleed forwards and backward, after which the graft was cut at an angle and sutured here as a proximal anastomosis, as well, a patch over the artery anastomosis was made with 6-0 Prolene. Air was evacuated and the clamps were released to allow the blood to flow down into the leg.

Palpation showed a strong posterior tibial pulse and faint dorsalis pedis. These were palpable by hand.

The patient was given protamine. Hemostasis was secured. Irrigation was done and closure was carried out. Vicryl was used for deeper tissues. Skin was closed with surgical clips. Dressings were done. Blood loss was minimal. No transfusion was given.

· ICD-10-PCS Code: Click here to enter text.

6. Case Study 3:

PREOPERATIVE DIAGNOSIS: Recurrent hemoptysis

POSTOPERATIVE DIAGNOSIS: Recurrent hemoptysis

PROCEDURE PERFORMED: Bronchoscopy. Reason for that is recurrent hemoptysis.

DESCRIPTION OF PROCEDURE: After informed consent under local and IV sedation, a

bronchoscopy was attempted at the bedside for evaluation of recurrent hemoptysis. The patient has severe nonischemic cardiomyopathy. Is here for LVAD evaluation with severe RV dysfunction as well. His CAT scan did not show any kind of intraparenchymal or bronchial abnormalities. He had improvement in his symptoms, but started having another episode of hemoptysis, which is dark red color. We went in to evaluate for intrapulmonary source.

Upon inspection of the vocal cords, they opened and closed without any abnormality. No upper airway abnormality was found. No blood was found. We went ahead and inspected the right side as well as the left side. It was completely clean. We flushed it. There was no evidence of any bloody secretions come out. Everything looked normal. We terminated the procedure thereafter.

· ICD-10-PCS Code: Click here to enter text.

7. Case Study 4:

PREOPERATIVE DIAGNOSIS: Lipodystrophy of the abdomen.

POSTOPERATIVE DIAGNOSIS: Lipodystrophy of the abdomen.

OPERATION PERFORMED: Suction-assisted lipectomy of the abdomen.

ANESTHESIA: General.

BLOOD LOSS: Minimal.

COMPLICATIONS: None.

SPECIMENS: None.

INDICATIONS: The patient is a 23-year-old white male who is relatively thin but has mild to moderate fatty prominence of the central abdomen as well as the lateral abdomen focally. He presents for suction-assisted lipectomy of these sites.

DESCRIPTION OF PROCEDURE: The patient was seen in the preoperative area where, in the standing position, the abdominal skin was wiped with alcohol and marked with a marking pen for surgery. The patient was brought into the operative room and placed supine on the operating room table and administered general anesthesia successfully. A total of 5 mL of 50:50 mixture of 1% lidocaine with epinephrine with 0.25% Marcaine with epinephrine was infiltrated into the site of liposuction, access site incisions.

The abdomen was prepped and draped in the usual sterile fashion. Stab incision was performed with #15 blade, which was dilated with a hemostat in the high lateral flank superior margin of the umbilicus and in the groin on each side. Tumescent solution, which is the standard mixture of 20 mL of lidocaine, 1 mL adrenaline and a liter of warm normal saline was injected throughout the subcutaneous plane. Suctioning was then performed after a wait of 10 minutes plus with the 3 mm triport cannula throughout the anterior and lateral abdomen with shorter cannulas being used for the upper abdomen. All sides were remarkably thinner. Good smooth contour. Total infiltration amount was 1100 mL. Total output 950 mL, which appeared to be about 50% to 60% fat by volume.

Incisions were closed with #5-0 Prolene interrupted sutures x2. Incisions were clean, dried and dressed with broad Band-Aid dressings, gauze pads and abdominal binder. The patient tolerated the procedures well with no apparent complications. The patient was then extubated in the operating room and transferred to the recovery room in a satisfactory condition. Postoperatively, following the procedure, I spoke to the patient in regards to procedure and postoperative care.

· ICD-10-PCS Code: Click here to enter text.