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A 12-year-old boy was seen in an ambulatory surgical center for
pain in his right arm. The x-ray showed fracture of ulna. Patient
underwent closed reduction of fracture right proximal ulna and
an elbow-to-finger cast was applied. What diagnostic and
procedure codes should be assigned?
S52.101AUnspecified fracture of upper end of right radius, initial
encounter for closed fracture
S52.101BUnspecified fracture of upper end of right radius, initial
encounter for open fracture
S52.001AUnspecified fracture of upper end of right ulna, initial
encounter for closed fracture
S52.001BUnspecified fracture of upper end of right ulna, initial
encounter for open fracture
0PSH0ZZReposition right radius, open approach
0PSK0ZZReposition right ulna, open approach
24670Closed treatment of ulnar fracture, proximal end (eg,
olecranon or coronoid process(es) ); without manipulation
24675Closed treatment of ulnar fracture, proximal end (eg -
correct answer- Correct Answer: D
,The patient has a fracture of the right proximal ulna and closed
reduction is necessary. In the ICD-10-CM Code Book, under
Fracture, ulna, proximal, the coder is referred to Fracture, ulna,
upper end. The term "manipulation" is used to indicate
reduction in CPT. According to CPT guidelines, cast application or
strapping (including removal) is only reported as a replacement
procedure or when the cast application or strapping is an initial
service performed without a restorative treatment or procedure
(AMA CPT Professional Edition 2020, 182). (Note: Since this is an
ambulatory surgery center case, CPT codes are assigned rather
than ICD-10-PCS codes.)
A 64-year-old female is admitted to the hospital with nausea,
vomiting, and edema. Lab values indicate the patient has
dehydration. The patient takes Lisinopril as prescribed along
with Levothyroxine for hypothyroidism. On the discharge
summary, the final diagnoses of acute renal failure,
hypothyroidism and dehydration are documented. What
discrepancy should a coding professional note in this
documentation?
a. There is not enough detail in the documentation to assign the
dehydration.
b. There is no explanation for the patient's vomiting.
c. There is no correlating diagnosis for the Lisinopril.
,d. The nausea, vomiting, and edema are indicative of chronic
renal failure not acute. - correct answer- Correct Answer: C
The patient should have a diagnosis related to taking the
medication Lisinopril, which is usually hypertension (Brinda
2020, 186-187).
A 64-year-old female was discharged with the final diagnosis of
acute renal failure and hypertension. What coding guideline
applies?
a. Use combination code of hypertension and chronic renal
failure.
b. Use separate codes for hypertension and chronic renal failure.
c. Use separate codes for hypertension and acute renal failure.
d. Use combination code for hypertension and acute renal
failure. - correct answer- Correct Answer: C
There is not a combination code for acute renal failure and
hypertension. Acute kidney failure is not the same as chronic
kidney disease (CMS 2020a, Section I.C.9. 2-3, 46-47; Leon-
Chisen 2020, 262).
A 75-year-old patient is admitted for a complex, ventral hernia
repair. While in the hospital, the patient slips and falls, suffering
, a left hip fracture. Will the hip fracture be identified as part of
the facility's patient safety indicators (PSI)? Why or why not?
a. No, the hip fracture is the principal diagnosis and will not be
part of the PSI
b. Yes, the hip fracture is the principal diagnosis and would still
be part of the PSI
c. No, the hip fracture is a secondary diagnosis and therefore,
will not be part of the PSI
d. Yes, the hip fracture is a secondary diagnosis and will be part
of the PSI - correct answer- Correct Answer: D
Patient safety indicators are designed to capture adverse effects
following surgery, procedures, or childbirth. Therefore, it is a
secondary diagnosis of hip fracture that will necessitate capture
of the PSI (CMS 2020d).
A bronchoscopy with multiple biopsies of the left bronchus was
completed and revealed adenocarcinoma. What, if any, modifier
should be added to the procedure code billed by the facility?
a. -59, Distinct procedural service
b. -51, Multiple procedures
c. -76, Repeat procedure or service by same physician