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Musculo Skeletal

Musculoskeletal System

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Milla Tan
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104 views

Musculo Skeletal

Musculoskeletal System

Uploaded by

Milla Tan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Musculoskeletal (Series 20000)

Question 1
52 year-old female has a mass growing on her right flank for several years. It has finally gotten
significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive
excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous
tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was
excised primarily bluntly with a few attachments divided with electrocautery. What CPT® and ICD-10-
CM
codes are reported?

A. 21932, D17.39
B. 21935, D17.1
C. 21931, D17.1
D. 21925, D17.9

Rationale: Answer is C. The mass growing turned out to be a lipoma found in the subcutaneous tissue of
the flank. In the ICD-10-
CM Alphabetic Index, look for Lipoma/subcutaneous/trunk. You are referred to code D17.1, eliminating
multiple choice answers A and D. Because the 4 cm tumor was found in the subcutaneous tissue code
21931 is the correct CPT® code to report.

Question 2
42 year-old male has a frozen left shoulder. An arthroscope was inserted in the posterior portal in the
glenohumeral joint. The articular cartilage was normal except for some minimal grade III-IV changes,
about 5% of the humerus just adjacent to the rotator cuff insertion of the supraspinatus. The biceps was
inflamed, not torn at all. The superior labrum was not torn at all, the labrum was completely intact. The
rotator cuff was completely intact. An anterior portal was established high in the rotator interval. The
rotator interval was very thick and contracted. Adhesions were destroyed with electrocautery and the
Bovie. The superior glenohumeral ligament, the middle glenohumeral ligament and the tendinous portion
of the subscapularis were released. The arthroscope was placed anteriorly, adhesions were destroyed
and the shaver was used to debride some of the posterior capsule and the posterior capsule was
released in its posterosuperior and then posteroinferior aspect. What CPT® code(s) is (are) reported?

A. 23450-LT
B. 23466-LT
C. 29805-LT, 29806-51-LT
D. 29825-LT

Rationale: Answer is D. To narrow down your choices decide if the procedure is an open procedure or
performed with an
arthroscope? It was performed with an arthroscope, eliminating multiple choice answers A and B. The
diagnostic arthroscopy (29805) is a separate procedure, and according to CPT® Surgery Guidelines: The
codes designated as “separate procedure” should not be reported in addition to the code for the total
procedure or service of which it is considered an integral component. Meaning code 29806 already
includes the diagnostic arthroscopy code, so you only report code 29806. Code 29806 represents
suturing of the capsule (capsulorrhaphy); however, this was not the procedure performed. The procedure
performed was a lysis of adhesions for a frozen shoulder (29825) noted in multiple choice answer D.

Question 3
Patient is having ongoing back and hip pain. The physician elects to perform a sacroiliac injection at an
ambulatory surgery center. After sterile prep, the patient is placed prone position. A needle is placed
under fluoroscopic guidance into the SI joint and a mixture of 20 mg of Celestone and Marcaine is
injected for pain relief. Report the CPT® code(s).
A. 27096, 77003-26
B. 20611
C. 20552
D. 27096

Rationale: Answer is D. 27096 is the correct code because a steroid injection (Celestone and Marcaine) is
placed into the
sacroiliac (SI) joint. Fluoroscopic and computed tomography (CT) guidance is included and is not
reported
separately. There is a parenthetical note under the code description that states: (27096 is to be used only
with CT or fluoroscopic imaging confirmation of the intra-articular needle positioning).

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