Question 1

Patient has basal cell carcinoma on his upper back. A map was prepared to correspond to the area of skin where the excisions of the tumor will be performed using Mohs micrographic surgery technique. There were three tissue blocks that were prepared for cryostat, sectioned, and removed in the first stage. Then a second stage had six tissue blocks which were also cut and stained for microscopic examination. The entire base and margins of the excised pieces of tissue were examined by the surgeon. No tumor was identified after the final stage of the microscopically controlled surgery. What procedure codes are reported?

A. 17313, 17314, 17314

B. 17313, 17315

C. 17260, 17313, 17314

D. 17313,17314, 17315

Question 2

A 45-year-old male is in outpatient surgery to excise a basal cell carcinoma of the right nose and have reconstruction with an advancement flap. The 1.2 cm lesion with an excised diameter of 1.5 cm was excised with a 15-blade scalpel down to the level of the subcutaneous tissue, totaling a primary defect of 1.8 cm. Electrocautery was used for hemostasis. An adjacent tissue transfer of 3 sq cm was taken from the nasolabial fold and was advanced into the primary defect. Which CPT® code(s) is (are) reported?

A. 14060

B. 11642, 14060

C. 11642, 15115

D. 15574

Question 3

A 24-year-old patient had an abscess by her vulva which burst. She has developed a soft tissue infection caused by gas gangrene. The area was debrided of necrotic infected tissue. All of the pus was removed and irrigation was performed with a liter of saline until clear and clean. The infected area was completely drained and the wound was packed gently with sterile saline moistened gauze and pads were placed on top of this. The correct CPT® code is:

A. 56405

B. 10061

C. 11004

D. 11042

Question 4

The patient is a 66-year-old female who presents with Dupuytren’s disease in the right palm and ring finger. This results in a contracture of the ring digit MP joint. She is having a subtotal palmar fasciectomy for Dupuytren’s disease right ring digit and palm. A Brunner incision was then made beginning in the proximal palm and extending to the ring finger PIP crease. This exposed a large pretendinous cord arising from the palmar fascia extending distally over the flexor tendons of the ring finger. The fascial attachments to the flexor tendon sheath were released. At the level of the metacarpophalangeal crease, one band arose from the central pretendinous cord-one coursing toward the middle finger. The digital nerve was identified, and this diseased fascia was also excised. What procedure code(s) is (are) used?

A. 26123-RT, 26125-F7

B. 26121-RT

C. 26035-RT

D. 26040-RT

Question 5

This is a 32-year-old female who presents today with sacroiliitis. On the physical exam there was pain on palpation of the left and right sacroiliac joint and fluoroscopic guidance was done for the needle positioning. Then 80 mg of Depo-Medrol and 1 mL of bupivacaine at 0.5% was injected into the left and right sacroiliac joint with a 22 gauge needle. The patient was able to walk from the exam room without difficulty. Follow up will be as needed. What CPT® coding is reported?

A. 20611

B. 27096-50, 77012

C. 27096-50

D. 27096, 27096-51, 77012

Question 6

The patient is a 51-year-old gentleman who has end-stage renal disease. He was in the OR yesterday for a revision of his AV graft. The next day the patient had complications of the graft failing. The patient was back to the operating room where an open thrombectomy was performed on both sides getting good back bleeding, good inflow. Select the appropriate code for performing the procedure in a post-operative period:

A. 36831-76

B. 36831

C. 36831-78

D. 36831-58

Question 7

The patient is a 77-year-old white female who has been having right temporal pain and headaches with some visual changes and has a sed rate of 51. She is scheduled for a temporal artery biopsy to rule out temporal arteritis. A Doppler probe was used to isolate the temporal artery and using a marking pen the path of the artery was drawn. Lidocaine 1% was used to infiltrate the skin, and using a 15 blade scalpel the skin was opened in the preauricular area and dissected down to the subcutaneous tissue where the temporal artery was identified in its bed. It was a medium size artery and we dissected it out for a length of approximately 4 cm with some branches. The ends were ligated with 4-0 Vicryl, and the artery was removed from its bed and sent to Pathology as specimen. What CPT® code is reported?

A. 37609

B. 37605

C. 36625

D. 37799

Question 8

A 50-year-old female has recurrent lymphoma in the axilla. Ultrasound was used to localize the lymph node in question for needle guidance. An 11 blade scalpel was used to perform a small dermatotomy. An 18 x 10 cm Biopence needle was advanced through the dermatotomy to the periphery of the lymph node. A total of 4 biopsy specimens were obtained. Two specimens were placed an RPMI and 2 were placed in formalin and sent to laboratory. The correct CPT® code(s) is (are):

A. 10005

B. 38500, 77002-26

C. 38505, 76942-26

D. 38525, 76942-26

Question 9

Patient is going into the OR for an appendectomy with a ruptured appendicitis. Right lower quadrant transverse incision was made upon entry to the abdomen. In the right lower quadrant there was a large amount of pus consistent with a right lower quadrant abscess. Intraoperative cultures anaerobic and aerobic were taken and sent to microbiology for evaluation. Irrigation of the pus was performed until clear. The base of the appendix right at the margin of the cecum was perforated. The mesoappendix was taken down and tied using 0-Vicryl ties and the appendix fell off completely since it was already ruptured with tissue paper thin membrane at the base. There was no appendiceal stump to close or to tie, just an opening into the cecum; therefore, the appendiceal opening area into the cecum was tied twice using figure of 8 Vicryl sutures. Omentum flap was tacked over this area and anchored in place using interrupted 3-0 Vicryl sutures to secure the repair. What CPT® and ICD-10-CM codes are reported?

A. 44950, K35.890

B. 44960, 49905, K35.33

C.44950, 49905-51, K35.20

D. 44970, K37

Question 10

A 15 year-old female is to have a tonsillectomy performed for chronic tonsillitis and hypertrophied tonsils. A McIver mouth gag was put in place and the tongue was depressed. The nasopharynx was digitalized. No significant adenoid tissue was felt. The tonsils were then removed bilaterally by dissection. The uvula was a huge size because of edema, a part of this was removed and the raw surface oversewn with 3-0 chromic catgut. Which CPT® code(s) is (are) reported?

A. 42821

B. 42825, 42104-51

C. 42826, 42106-51

D. 42842

Question 11

A 34-year-old male developed a ventral hernia when lifting a 60 pound bag. The patient is in surgery for a ventral herniorrhaphy. The abdomen was entered through a short midline incision revealing the fascial defect. The hernia sac and contents were able to easily be reduced and a large plug of mesh was placed into the fascial defect. The edge of the mesh plug was sutured to the fascia. What procedure code(s) is (are) reported?

A. 49560

B. 49561, 49568

C. 49652

D. 49560, 49568

Question 12

A 25-year-old female in the OR for ectopic pregnancy. Once the trocars were place a pneumoperitoneum was created and the laparoscope introduced. The left fallopian tube was dilated and was bleeding. The left ovary was normal. The uterus was of normal size, shape and contour. The right ovary and tube were normal. Due to the patient’s body habitus the adnexa could not be visualized to start the surgery. At this point the laparoscopic approach was terminated. The pneumoperitoneum was deflated, and trocar sites were sutured closed. The trocars and laparoscopic instruments had been removed. Open surgery was performed incising a previous transverse scar from a cesarean section. The gestation site was bleeding and all products of conception and clots were removed. The left tube was grasped, clamped and removed in its entirety and passed off to pathology. What CPT® code(s) is (are) reported for this procedure?

A. 59150, 59120

B. 59151

C. 59121

D. 59120

Question 13

A 23-year-old who is pregnant at 39-weeks and 3 days is presenting for a low transverse cesarean section. An abdominal incision is made and was extended superiorly and inferiorly with good visualization of the bladder. The bladder blade was then inserted and the lower uterine segment incised in a transverse fashion with the scalpel. The bladder blade was removed and the infant’s head delivered atraumatically. The nose and mouth were suctioned with the bulb suction trap and the cord doubly clamped and cut. The placenta was then removed manually. What CPT® and ICD-10-CM codes are reported for this procedure?

A. 59610, O34.211, Z37.0, Z3A.39

B. 59510, O64.1XX0, Z37.0, Z3A.39

C. 59514, O82, Z37.0, Z3A.39

D. 59515, O82, Z37.0, Z3A.39

Question 14

A 55-year-old female has a symptomatic rectocele. She had been admitted and taken to the main OR. An incision is made in the vagina into the perineal body (central tendon of the perineum). Dissection was carried underneath posterior vaginal epithelium all the way over to the rectocele. Fascial tissue was brought together with sutures creating a bridge and the rectocele had been reduced with good support between the vagina and rectum. What procedure code should be reported?

A. 45560

B. 57284

C. 57250

D. 57240

Question 15

A craniectomy is being performed on a patient who has Chiari malformation. Once the posterior inferior scalp was removed a C-1 and a partial C-2 laminectomy was then performed. The right cerebellar tonsil was dissected free of the dorsal medulla and a gush of cerebrospinal fluid gave good decompression of the posterior fossa content. Which CPT® code is reported?

A. 61322

B. 61345

C. 61343

D. 61458

Question 16

Under fluoroscopic guidance an injection of a combination of steroid and analgesic agent is performed on T2-T3, T4-T5, T6-T7 and T8-T9 on the left side into the paravertebral facet joints. The procedure was performed for pain due to thoracic root lesions. What are the procedure codes?

A. 64479, 64480 x 3, 77003

B. 64490, 64491, 64492 x 2, 77003

C. 64520 x 4, 77003

D. 64490, 64491, 64492

Question 17

An entropion repair is performed on the left lower eyelid in which undermining was performed with scissors of the inferior lid and inferior temporal region. Deep sutures were used to separate the eyelid margin outwardly along with stripping the lateral tarsus to provide firm approximation of the lower lid to the globe. The correct CPT® code is:

A. 67914-E4

B. 67924-E2

C. 67921-E2

D.67917-E1

Question 18

CC: Follow up on Atrial Fibrillation

 

History: A 62-year-old is here today to follow-up on her atrial fibrillation. She is a patient of my partner Dr. J, but he is out of the office today. She had no new problems. No chest pressure, fluttering or shortness of breath.

 

Physical Exam

Constitutional: BP 125/85   T 98.6F   PR 72

Chest: Clear 

Cardiac: Normal sinus rhythm

Assessment: F/U on atrial fibrillation

Plan: Continue with meds prescribed by Dr. J. Follow-up in the next 3 months. 

 

What E/M code is reported for this service?

A. 99202

B. 99203

C. 99212

D. 99213

Question 19

CC: Osteoarthritis flare ups in both knees

History: Patient is here today with continued pain in both knees due osteoarthritis. The left knee bothers her a more that her right knee.  She has been having this issue for over a year. She is requesting a steroid injection. She uses one over-the-counter ibuprofen daily. No weakness or numbness.

Exam: Weight is 167 Lbs. Blood pressure is 118/60  Pulse is 72 beats/min. There is some pain but not in distress. There is crepitus at the knees with some tenderness with flexion and extension of the knees which is mildly noted today. No effusion is clearly noted. No warmth of the knees noted. There are some flexion contractures of the fingers as noted before. Elbow flexion contracture noted on the left side.

Assessment: As above with what appears to be continued progression of primary osteoarthritis of the knees.

Prescription of Celebrex given. Note given for work today as well.

 

What is the overall E/M for this office visit?

A. 99215

B. 99214

C. 99213

D. 99212

Question 20

A 2-year-old is brought to the ER by EMS for near drowning. EMS had gotten a pulse. The ER physician performs endotracheal intubation, blood gas, and a central venous catheter placement. The ER physician documents a total time of 30 minutes on this critical infant in which the physician already subtracted the time for the other billable services. Select the E/M service and procedures to report for the ER physician?

A. 99291-25, 36555, 31500

B. 99291-25, 36556, 31500, 82803

C. 99285-25, 36556, 31500, 82803

D. 99475-25, 36556

Question 21

Cardiologist Office Visit – New Patient

CC: CHEST ACHES-tightness

History: Patient has chest pain. Describes it as being tight. Shortness of breath and fatigue. Occasional pain in both arms. Started with these symptoms a month ago. Has been under a lot of pressure from work.

Family History: Sister with Wolf-Parkinson-White syndrome.

Review of Systems

Constitutional: Positive for fatigue

Respiratory: Positive for dyspnea

Cardiovascular: Negative for edema, orthopnea, PND; positive for chest pain, dyspnea, palpitations

PHYSICAL EXAM

Vital Signs: BP 120/86 sitting, left arm

General/Constitutional: No apparent distress. Well-nourished and well developed.

Nose/Throat: Mucous membranes normal. Oropharynx appears normal. No mucosal lesions.

Neck/Thyroid: Supple, without adenopathy or enlarged thyroid.

Respiratory: Normal to inspection. Lungs clear to auscultation.

Cardiovascular: Regular rhythm. No murmurs gallops or rubs.

Assessment/Plan

Chest pain consistent with anxiety. Will need to order further tests to confirm.

EKG ordered. CBC ordered. Chest CT scan ordered.

Prescription given of isosorbide dinitrate (tablets) to relieve the chest pain.

What is the E/M visit and ICD-10-CM codes to report?

A. 99203, R07.9

B. 99203, F41.9

C. 99204, F41.9

D.99204, R07.9

Question 22

A very large lipoma is removed from the chest measuring 8 sq cm and the defect is 12.2 cm requiring a layered closure with extensive undermining. MAC is performed by a medically directed Certified Registered Nurse Anesthetist (CRNA). Code the anesthesia service.

A. 00400-QX-QS

B. 00400-QS

C. 00300-QS

D. 00300-QX-QS

Question 23

PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal. The patient is placed on heart and lung bypass during the procedure. Anesthesia time: 6:00 PM to 12:00 AM Surgical time: 6:15 PM to 11:30 PM What is the correct anesthesia code and anesthesia time?

A. 00567, 6 hours

B. 00566, 6 hours

C. 00567, 5 hours and 30 minutes

D. 00566, 5 hours and 30 minutes

Question 24

A CT density study is performed on a post-menopausal female to screen for osteoporosis. Today’s visit the bone density study will be performed on the spine. Which CPT® code is reported?

A. 77075

B. 77080

C. 77078

D. 72081

Question 25

The patient is 15-weeks pregnant with twins coming back to her obstetrician to have a transabdominal ultrasound performed to reassess anatomic abnormalities of both fetuses that were previously demonstrated in the last ultrasound. What ultrasound code(s) is (are) reported?

A. 76815

B. 76816, 76816-59

C. 76801, 76802

D. 76805, 76810

Question 26

A patient is undergoing an aortogram in which the left femoral artery was cannulated with a catheter advanced into the infrarenal abdominal aorta. Contrast medium was injected, and films were taken by serialography.  What CPT® codes are reported for the professional component?

A. 36200, 75625-26

B. 36200, 75630-26

C. 36200, 75605-26

D. 36200, 75635-26, 75716-26

Question 27

A 53-year-old woman with ascites consented to a procedure to withdraw fluid from the abdominal cavity. Ultrasonic guidance was used for guiding the needle placement for the aspiration. What CPT® coding is reported?

A. 49083

B. 49180, 76942-26

C. 49082, 77002-26

D. 49180, 76998-26

Question 28

Cells were taken from amniotic fluid for analyzation of the chromosomes for possible Down’s syndrome. The geneticist performs the analysis with two G-banded karyotypes analyzing 30 cells. Select the lab code(s) for reporting this service.

A. 88248

B. 88267, 88280, 88285

C. 88273, 88280, 88291

D. 88262, 88285

Question 29

Sperm is being prepared through a washing method to get it ready for the insemination of five oocytes for fertilization by directly injecting the sperm into each oocyte. Choose the CPT® codes to report this service.

A. 89257, 89280

B. 89260, 89280

C. 89261, 89280

D. 89260, 89268

Question 30

A pathologist performs a comprehensive consultation and report after reviewing a patient’s records and specimens from another facility. The correct CPT® code to report this service is:

A. 88325

B. 99244

C. 88323

D. 88329

Question 31

Patient with hemiparesis on the dominant side due to having a CVA lives at home alone and has a therapist at his home site to evaluate meal preparation for self-care. The therapist observes the patient’s functional level of performing kitchen management activities within safe limits. The therapist then teaches meal preparation using one handed techniques along with adaptive equipment to handle different kitchen appliances. The total time spent on this visit was 45 minutes. Report the CPT® and ICD-10-CM codes for this encounter.

A. 97530 x 3, I67.89, G81.91

B. 97535 x 3, G81.90, I69.959

C. 97530 x 3, I69.959, I67.89

D. 97535 x 3, I69.959

Question 32

A 10-year-old patient had a recent placement of a cochlear implant. She and her family see an audiologist to check the pressure and determine the strength of the magnet. The transmitter, microphone and cable are connected to the external speech processor and maximum loudness levels are determined under programming computer control. Which CPT® code should be used?

A. 92601

B. 92603

C. 92604

D. 92562

Question 33

A cardiologist pediatrician sends a four week-old baby to an outpatient facility to have an echocardiogram. The baby has been having rapid breathing. He is sedated and a probe is placed on the chest wall and images are taken through the chest wall. A report is generated and sent to the pediatrician. The interpretation of the report by the pediatrician reveals the baby has an atrial septal defect. Choose the CPT® code the cardiologist pediatrician should report.

A. 93303

B. 93315-26

C. 93303-26

D. 93315

Question 34

Glomerulonephritis is an inflammation affecting which system?

A. Digestive

B. Nervous

C. Urinary

D. Cardiovascular

Question 35

When a patient has fractured the proximal end of his humerus, where is the fracture located?

A. Upper end of the arm

B. Lower end of the leg

C. Upper end of the leg

D. Lower end of the arm

Question 36

What is another term for when a physician performs a reduction on a displaced fracture?

A. Casting

B. Manipulation

C. Skeletal traction

D. External fixation

Question 37

What does oligospermia mean?

A. Presence of blood in the semen

B. Deficiency of sperm in semen

C. Having sperm in urine

D. Formation of spermatozoa

Question 38

Thoracentesis is removing fluid or air from the:

A. Lung

B. Chest cavity

C. Thoracic vertebrae

D. Heart

Question 39

An angiogram is a study to look inside:

A. Female Reproductive System

B. Urinary System

C. Blood Vessels

D. Breasts

Question 40

When a person has labyrinthitis what has the inflammation?

A. Inner ear

B. Brain

C. Conjunctiva

D. Spine

Question 41

Patient is going back to the OR for a re-exploration L5-S1 laminectomy for a presumed cerebrospinal fluid leak following a decompression procedure. A small partial laminectomy was slightly extended, however revealed no real evidence of leak. Valsalva maneuver was performed several times, no evidence of leak. There was a hematoma, which was drained. What ICD-10-CM code(s) is (are) reported by the physician?

A. G96.00

B. G97.61

C. G96.8

D. G96.00, T81.4XXA

Question 42

A patient that has hypertensive heart disease with congestive heart failure is coded:

A. I11.0, I50.9

B. I13.0

C. I13.0, I11.0, I50.9

D. I50.9, I11.0

Question 43

A 10-year-old-male sustained a Colles’ fracture in which the pediatrician performs an application of short arm fiberglass cast. Select the HCPCS Level II code that is reported for the cast.

A. Q4012

B. A4580

C. A4570

D. Q4024

Question 44

If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines?

A. As unspecified AMI

B. As a subendocardial AMI

C. As STEMI

D. As a NSTEMI

Question 45

Which place of service code is reported on the physician’s claim for a surgical procedure performed in an ASC?

A. 21

B. 22

C. 24

D. 11

Question 46

A 35-year-old-female is getting a Levonorgestrel implant system with supplies. The HCPCS Level II code for the implant is:

A. S4989

B. J7306

C. A4264

D. J7301

Question 47

Local Coverage Determinations (LCD) are published to give providers information on which of the following?

A. Information on modifier use with procedure codes

B. CPT® codes that are bundled

C. Fee schedule information listed by CPT® code

D. Reasonable and necessary conditions of coverage for an item or service

Question 48

PREOPERATIVE DIAGNOSIS: Left Breast Abnormal MMG or Palpable Mass; Other Disorders of Breast 

 

PROCEDURE: Automated Stereotactic Biopsy Left Breast

INDICATIONS: Lesion is located in the lateral region, just at or below the level of the nipple on the 90 degree lateral view. There is a subglandular implant in place. I discussed the procedure with the patient today including risks, benefits and alternatives. Specifically discussed was the fact that the implant would be displaced out of the way during this biopsy procedure. Possibility of injury to the implant was discussed with the patient. Patient has signed the consent form and wishes to proceed with the biopsy.

PROCEDURE DESCRIPTION: The patient was placed prone on the stereotactic table; the left breast was then imaged from the inferior approach. The lesion of interest is in the anterior portion of the breast away from the implant which was displaced back toward the chest wall. After imaging was obtained and stereotactic guidance used to target coordinates for the biopsy, the left breast was prepped with Betadine. 1% lidocaine was injected subcutaneously for local anesthetic. Additional lidocaine with epinephrine was then injected through the indwelling needle. The SenoRx needle was then placed into the area of interest. Under stereotactic guidance we obtained 9 core biopsy samples using vacuum and cutting technique. The specimen radiograph confirmed representative sample of calcification was removed. The tissue marking clip was deployed into the biopsy cavity successfully. This was confirmed by final stereotactic digital image and confirmed by post core biopsy mammogram left breast. The clip is visualized projecting over the lateral anterior left breast in satisfactory position. No obvious calcium is visible on the final post core biopsy image in the area of interest. The patient tolerated the procedure well. There were no apparent complications. The biopsy site was dressed with Steri-Strips, bandage and ice pack in the usual manner. The patient did receive written and verbal post-biopsy instructions. The patient left our department in good condition.

IMPRESSION: 1. SUCCESSFUL STEREOTACTIC CORE BIOPSY OF LEFT BREAST CALCIFICATIONS. 2. SUCCESSFUL DEPLOYMENT OF THE TISSUE MARKING CLIP INTO THE BIOPSY CAVITY 3. PATIENT LEFT OUR DEPARTMENT IN GOOD CONDITION TODAY WITH POST-BIOPSY INSTRUCTIONS. 4. PATHOLOGY REPORT IS PENDING; AN ADDENDUM WILL BE ISSUED AFTER WE RECEIVE THE PATHOLOGY REPORT.

What CPT® coding is reported?

A. 19081

B. 19283

C. 19081, 19283

D. 19100, 19283

Question 49

PREOPERATIVE DIAGNOSIS: Medial meniscus tear, right knee

POSTOPERATIVE DIAGNOSIS: Medial meniscus tear, extensive synovitis with an impingement medial synovial plica, right knee 

 

PROCEDURE: Diagnostic operative arthroscopy, partial medial meniscectomy and synovectomy, right knee. 

 

ANESTHESIA: General

 

PROCEDURE DESCRIPTION: Patient placed in the supine position. The right knee was then prepped and draped in the usual sterile fashion. The arthroscope was introduced through an anterolateral portal, interim portal created anteromedially. The suprapatellar pouch was inspected. The findings on the patella and the femoral groove were as noted above. An intra-articular shaver was introduced to debride the loose fibrillated articular cartilage from the medial patellar facet. The hypertrophic synovial scarring between the patella and the femoral groove was debrided. The hypertrophic impinging medial synovial plica was resected. The hypertrophic synovial scarring overlying the intercondylar notch and lateral compartment was debrided. 

 

The medial compartment was inspected. An upbiting basket was introduced to transect the base of the degenerative posterior horn flap tear. This was removed with a grasper. The meniscus was then further contoured and balanced with an intra-articular shaver, reprobed and found to be stable. The cruciate ligaments were probed, palpated and found to be intact. The lateral compartment was then inspected. The lateral meniscus was probed and found to be intact. The loose fibrillated articular cartilage along the lateral tibial plateau was debrided with the intra-articular shaver. The knee joint was then thoroughly irrigated with the arthroscope. The arthroscope was then removed. Skin portals were closed with 3-0 nylon sutures. A sterile dressing was applied. The patient was then awakened and sent to the recovery room in stable condition. 

 

What CPT® and ICD-10-CM codes should be reported?

A. 29880-RT, M23.203, M65.80, M94.261, M22.41

B. 29881-RT, M23.211, M65.861, M94.261, M22.41

C. 29881-RT, M23.221, M65.861, M94.261, M22.41

D. 29880-RT, 29877-59-RT, M23.621, M65.80, M94.261, M22.41

Question 50

Preoperative Diagnosis: Displaced odontoid fracture

Postoperative Diagnosis: Displaced odontoid fracture

 

Procedure: Open reduction of odontoid fracture

 

Indications: A 61-year-old gentleman with a history of a fall while intoxicated suffered a blow to the forehead and imaging revealed a posteriorly displaced odontoid fracture. 

 

Procedure Description: Patient was taken into the Operating Room, and placed supine on the operating room table. Under mild sedation, the patient was placed in Gardner-Wells tongs and gentle axial traction under fluoroscopy was performed to gently try to reduce the fracture. It did reduce partially without any change in the neurologic examination. More manipulation would be necessary and it was decided to intubate and use fiberoptic technique. The anterior neck was prepped and draped and an incision was made in a skin crease overlying the C4-C5 area. Using hand-held retractors, the ventral aspect of the spine was identified and the C2-C3 disk space was identified using lateral fluoroscopy. Using some pressure upon the ventral aspect of the C2 body, we were able to achieve a satisfactory reduction of the fracture. Under direct AP and lateral fluoroscopic guidance, a Kirschner wire was advanced into the C2 body through the fracture line and into the odontoid process. This was then drilled, and a 42 millimeter cannulated lag screw was advanced through the C2 body into the odontoid process. 

 

What procedure code is reported?

A. 22505

B. 22326

C. 22315

D. 22318