2017 CPC Final WITH ANSWERS

1. While whittling a piece of wood, the patient sustained an avulsion injury to a portion of his left index finger and underwent formation of a direct pedicle graft with transfer from his left middle finger. Immobilization was accomplished with a plaster splint. What CPT® code is reported? a. 15574 c. 15750 b. 15740 d. 15758 ANS: A Rationale: In the CPT® Index look for Pedicle Flap/Formation, you are directed to . Code selection is based on location. Subsection guidelines for Flaps state the codes refer to the recipient site not the donor site. The term pedicle indicates this is a flap not a direct graft, where skin is removed from one site and transferred to another. Instead, a flap of skin is raised, leaving it attached to its source location to maintain blood supply until it is established sufficiently in the new site. Code 15574 describes a direct pedicle graft of the hands with or without transfer. 2. A 3 year-old is brought to the burn unit after pulling a pot of hot soup off the stove and spilling it on herself. She sustained 18% second degree burns on her legs and 20% third degree burns on her chest and arms. Total body surface area burned is 38%. What ICD-10-CM codes are reported for the burns (do not include external cause codes for the accident)? a. T21.21XA, T22.20XA, T24.209A, T31.23 b. T21.31, T22.20, T24.209, T31.32 c. T21.31XA, T22.399A, T24.299A, T31.32 d. T21.31XA, T22.20XA, T24.209A, T31.32 ANS: C Rationale: ICD-10-CM guideline I.C.19.d.1 states to sequence first the code that reflects the highest degree of burn when more than one burn is present. In this case, the burns on her chest and arms are third degree and are reported first. In the ICD-10-CM Alphabetic Index look for Burn/chest wall/third degree, referring you to subcategory T21.31. Because the question indicates arms and legs (plural) we will code multiple sites of the upper and lower limbs. In the Alphabetic Index look for Burn/upper limb/multiple sites/third degree directing you to subcategory T22.399, and Burn/lower/limb/multiple sites/second degree directing you to subcategory T24.299. The Tabular List indicates a 7th character is needed for all three of these codes; a placeholder X is required for T21.31. The 7th character A is reported for the initial encounter. Refer to ICD-10-CM guideline I.C.19.d.6 for instructions on assigning a code from category T31 to report the extent of body surface involved. The 4th character represents the total body surface area (TBSA) (all degrees) that was burned. The 5th character represents the percentage of third degree burns to the body. In the scenario, 38% is documented as the TBSA making 3 the appropriate 4th character; 20% is third degree burns, making 2 the 5th character. In the Alphabetic Index look for Burn/extent (percentage of body surface)/30-39 percent/with 20-29 percent third degree burns directing you to code T31.32. The external cause codes would also be reported for the accident. Verify code selection in the Tabular List.