Chapter 18 Practical Applications (Case 6-10)correctly answered to pass 2023/2024

Chapter 18 Practical Applications (Case 6-10) CASE 6 Requested by R Simon, MD CYTOLOGY REPORT Collected: 1/26/20XX Received: 1/27/20XX, Pathologist performing the service is an employee of the lab. SPECIMEN SOURCE: A. Peritoneal Fluid SPECIMEN DESCRIPTION: 100mls yellow fluid CYTOPREPARATION: 2 ccf PERTINENT CLINICAL DATA AND CLINICAL DIAGNOSIS: 26-year-old female with end-stage renal disease (ESRD) due to type 1 diabetes presents for elective kidney transplant. CYTOLOGIC IMPRESSION: Peritoneal dialysis drain fluid: No cytologically malignant cells are identified. COMMENT: 100 mls yellow fluid is received from which two Papanicolaou stained cytocentrifuged slides are made. Slides contain mesothelial cells with a spectrum of reactive changes and histiocytes. No malignant cells are identified. What are the CPT® and ICD-10-CM codes? CPT® Code: [a] ICD-10 Codes: [b], [c], [d] - correct answer 88108, E10.22, N18.6, Z99.2 CPT® code: The test performed is cytopathology on the peritoneal fluid. The documentation indicates cytocentrifuged, meaning that the fluid was removed to concentrate the cells for the smears placed on the slides. In the CPT® Index, look for Cytopathology/Smears/Concentration Technique referring you to 88108. Review of the code description verifies 88108 is the correct code.ICD-10-CM codes: The patient is diagnosed with type 1 diabetes and end-stage renal disease (ESRD). The patient presents for a kidney transplant but the procedure has not been performed yet. The ESRD is a manifestation of the diabetes. In the ICD-10-CM Alphabetic Index, look for Diabetes/type 1/with/chronic kidney disease referring you to E10.22. In the Tabular List there is an instructional note for E10.22 to use additional code to identify stage of chronic kidney disease (N18.1-N18.6). The patient has end-stage renal disease (ESRD) N18.6. There is an instructional note for N18.6 to use additional code to identify dialysis status (Z99.2). Because the case note under Cytologic impression states, "Peritoneal dialysis drain fluid" it is appropriate to also report Z99.2. CASE 7 Requested by D Smith, MD. The pathologist providing the service is an employee of the lab. SURGICAL PATHOLOGY REPORT CLINICAL DATA: Chronic infected skin ulcer status post amputation of first and third toes, current mid transmetatarsal amputation. GROSS AND MICROSCOPIC DESCRIPTION: A) Received in formalin designated "right mid transmetatarsal amputation" is a distal right foot including second, fourth, and fifth toes, measuring 9.0 x 9.0 x 4.0 cm. Also in the container is a piece of tan bone measuring 2.4 x 1.3 x 1.3 cm. The skin and subcutaneous tissue recedes up to 4.0 cm from the smooth bony margins of resection. The skin is tan-white. The first and third toes are missing. The remaining toes are slightly flexed and with a thickened irregular nail of the second toe. There is a round, deep ulcer at the bottom of the foot proximal to the second toe, measuring 1.5 x 1.5 x 0.7 cm. No other lesions are identified - correct answer 88307, 88311, L97.511 CASE 8 Requested by R Williams, MD SURGICAL PATHOLOGY REPORT Collected: 2/1/20XX Received: 2/2/20XX. The pathologist is employed by the lab providing the service. CLINICAL DATA: 26-year-old with end-stage renal disease (ESRD) due to type 1 diabetes, status post kidney, pancreas transplant with subsequent pancreas allograft removal, now with disseminated intravascular coagulation and decreased urine output and kidney allograft showing no flow to the kidney. GROSS DESCRIPTION: A) Received fresh designated "ureteral stent - gross only" is a 15 cm x 0.2 cm piece of plastic tubing with a 1.5 cm hairpin turn at either end. There are 0.05 cm holes at every 2 cm of the device. B) Received fresh in a container labeled "removed kidney-gross and micro" is a 138 gram, 11 x 7 x 3 cm kidney. The specimen has a smooth, glistening, pink capsule with lightly adherent fibrous tissue. There are multiple surgical clips within the hilum - correct answer 88307, 88300, T86.19, N28.0 CASE 9 Requested by D Freeman, MD