AAPC CPC Chapter 10 Practical Application question and answers graded A+ 2023/2024

AAPC CPC Chapter 10 Practical ApplicationCASE 1 Preoperative diagnosis: Sinus of Valsalva aneurysm on the left coronary sinus. (This is the working diagnosis the unless report gives a different diagnosis or more defining information.) Postoperative diagnosis: Same Operation: Repair sinus of Valsalva aneurysm with a pericardial patch. (This is the procedure performed, but coders must confirm the procedure was performed in the body of the notes.) Procedure: The patient was taken to the operating room and placed supine on the table. After general endotracheal anesthesia was induced, a rectal temperature probe, a Foley catheter, and a TEE probe were placed. The extremities were padded in the appropriate fashion. Her neck, chest, abdomen, and legs were prepared and draped in standard surgical fashion. The chest was opened through a standard median sternotomy. (This describes the approach.) The patient was fully heparinized and placed on cardiopulmonary bypass. ( - correct answer 33720, Q25.49 CASE 2 Preoperative diagnosis: Acute renal failure. (This is the diagnosis.) Postoperative diagnosis: Same. Indication: The patient is a 23-year-old critically ill woman who went to the operating room for a lung transplant. A Vas-Catheter(Catheter.) was indicated to proceed with CVVHD upon arrival in the ICU. Procedure: Left subclavian Vas-Cath placement (insertion). (This is the working description of the procedure.) The left chest was draped and prepped in the usual sterile fashion and the patient was placed in the Trendelenburg position. The subclavian vein was readily located with a needle,(Entry directly into the subclavian vein indicates a non-tunneled catheter.) and the Seldinger technique was used to place a Vas-Cath for dialysis. (This is the description of the placement.) The excellent flow was returned through both lumens. The catheter was secured in place and a sterile dressing was applied. The patient is - correct answer 36556-LT, N17.9 CASE 3 Preoperative diagnosis: 6.7cm descending thoracic aortic aneurysm. Type B aortic dissection, chronic. (This is the working diagnosis until the report is reviewed.) Postoperative diagnosis: Same Operation: Left thoracotomy. (This is the surgical approach.) Repair of a descending thoracic aortic aneurysm with a 34 mm Gelweave graft. (This is the surgical procedure.) Bypass time: 1 hour, 15 minutes(Our first indication that cardiopulmonary bypass was used.) Procedure: The patient was brought to the operating room, placed on the table in the supine position. A blocker was placed on the left mainstem bronchus, and we isolated the left lung. We proceeded to place the patient in the right lateral decubitus position. He was padded and secured with all pressure points relieved, and at this point, we prepared and draped the patient in the usual sterile fashion. We performed a left posterolateral thoracotomy;(This is our - correct answer 33875, I71.2, I71.01 CASE 4 Preoperative diagnosis: Cardiac tamponade secondary to malignant effusion due to the pericardial metastasis from the lung. (This is the diagnosis as the pre and post-operative diagnoses are the same.) Postoperative diagnosis: Same Procedure: Pericardial Window via subxiphoid approach. (This is the working procedure description, but it must be verified in the report.) Details: The patient was positioned supine on the table and prepped and draped. A low midline incision approximately 5cm in length was made over the sternum and xiphoid. (This is the approach used to gain access to the pericardium.) This was carried down to the linea alba, which was opened. The xiphoid was divided. We then found the pericardium and opened the pericardium again with electrocautery. We enlarged the site so it was easily 1cm across. (The pericardium is cut open for drainage.) At this time, there was a gush of fluid under pressure. It - correct answer 33025, C79.89, C34.90, I31.4 CASE 5 Preoperative diagnosis: Prosthetic valve endocarditis. (This is the working diagnosis, coming into the surgery.) Postoperative diagnosis: Same Operation: Re-replacement of a 10-year-old tricuspid valve using a 31 mm Carpentier-Edwards pericardial bioprosthesis. (This is the planned procedure statement, replacement of the tricuspid valve.) Procedure: The patient was brought to the operating room, and after having the appropriate monitoring devices placed, he was intubated and general endotracheal anesthesia was achieved. The patient was prepared and draped in the usual sterile fashion.