Coding

Front 1

Respiratory subsection includes surgical procedures

Back 1

involving the nose and sinuses, larynx, trachea and bronchi, and lungs and pleura

Front 2

Nasal endoscopic procedure

Back 2

allow the physician to visualize the interior of the nasal cavity, the middle and superior meatus, the turbinates, and the sphenoethmoid recess

Front 3

A surgical endoscopy

Back 3

may be performed to stop a nose bleed or to perform a maxillary antrostomy or sphenoidotomy

Front 4

T/F A diagnostic endoscopy should not be reported separately when performed during the same operative episode as a surgical endoscopy.

Back 4

True

Front 5

T/F A sinusotomy is considered part of the endoscopic procedure and not reported separately.

Back 5

True

Front 6

T/F Respiratory can be left and right (bilateral)

Back 6

True

Front 7

What should be assigned when the documentation indicates that a bilateral procedure was performed and the specific code does not state bilateral

Back 7

modifier 50

Front 8

Key points to remember for nasal sinus endoscopy

Back 8

1. seperate codes should not be assigned to identify a diagnostic nasal sinus endoscopy when it is performed with a surgical nasal sinus endoscopy

2. surgical endoscopy includes a sinusotomy

3. modifier 50 should be assigned to identify a bilateral procedure only if the code does not specify bilateral

Front 9

Right lung has how many lobes

Back 9

3

upper, middle, and lower

Front 10

Left lung has how many lobes

Back 10

2

upper lobe and lower lobe

Front 11

The upper respiratory drawing was named

Back 11

Roger

Front 12

What is a Laryngoscopy?

Back 12

an endoscopic procedure that allows the physician to visualize the larynx, or voice box.

Front 13

T/F Laryngoscopy may be performed for surgical purposes or diagnostic purposes

Back 13

True

Front 14

What is an indirect laryngoscopy?

Back 14

simplest way to examine the laynx.

Front 15

How is an indirect laryngoscopy performed?

Back 15

use of a small mirror placed in the back of the throat. It is the simplest and least expensive but does require a lot of skill from the physician. Can not be done on small children or a person with strong gag reflex.

Front 16

What is a direct laryngoscopy?

Back 16

procedures such as biopsy, removal of a lesion, arytenoidectomy, and removal of foreign body. Patient is under general anesthesia to avoid the gag reflex.

Front 17

What is flexible laryngoscopy?

Back 17

performed with flexible equipment, tropical anesthesia and vasoconstrictor, instrument is passed through the nasal cavity. More comfortable approach to visualizing the larynx, pharynx, and nasal cavity. Strobe light may be use so physician can visualize the vocal cords

Front 18

What questions should be asked when assigning a code for a laryngoscopy?

Back 18

1. What is the purpose of the laryngoscopy?

2. Which type of laryngoscope was used? direct, indirect, flexible

3. Was stroboscopy used

Front 19

What is a Bronchoscope?

Back 19

an instrument that can be inserted into either the nose or the mouth and passed through the treachea, the larynx, and into the bronchial tubes.

Front 20

What is the indication for a bronchoscopy?

Back 20

hemoptysis, a persistent cough that is unresponsive to medication, shortness of breath, an acute upper airway obstruction, or abnormal chest x-ray or infection

Front 21

What is a rigid scope?

Back 21

referred to as a open tube bronchoscope. inserted through the mouth and most often used to remove foreign objects or to secure a larger that normal biopsy sample.

Front 22

What is a flexible bronchoscopy?

Back 22

more common, consist of a flexible tube with many small fibers that allow the transmission of light.

Front 23

What is cell washing?

Back 23

introducing saline solution into the airways then sent to the lab for cytological examination.

Front 24

T/F Brushing is another method of specimen collection.

Back 24

True

Front 25

What is the advantage of brushing?

Back 25

brushings allow the diagnosis to be made on the basis of tissue that could not be obtained normally with biopsy

Front 26

Protected specimen brush (PSB)

Back 26

is contained in a double catheter.

Front 27

Bronchial alveolar lavage (BAL)

Back 27

is performed to collect cell from peripheral lung tissue. Sterile saline is instilled into the airways in aliquots of 20 ml to 50 ml. Suctioned out and sent to lab for cytological exam.

Front 28

T/F Transbronchial lung biospy is done when a diagnosis of lung disease is made

Back 28

True -- procedure is less invasive that open lung biopsy and carries less risk of morbidity

Front 29

What is endobronchial ultrasound (EBUS)?

Back 29

procedure used in the diagnosis of lung cancer, lung infection, and othe diasease the cause enlarged lymph nodes in the chest. Minimally invasive procedure allows for samples of lung masses and lymph nodes with ultrasound guidance.

Front 30

Lung Procedures

Back 30

Phenumonectomy

Lobectomy

Wedge resection

Segmental resection

Front 31

Pneumonectomy

Back 31

removal of entire lung

Front 32

Lobectomy

Back 32

removal of one lobe of the lung

removal of two lobes is bilobectomy

Front 33

Wedge resection

Back 33

removal of small, wedge shaped portion of the lung

Front 34

Segmental resection

Back 34

removal of a large portion of the lung

Front 35

Diagnostic vs. Therapeutic Procedures

example

diagnostic

Back 35

biospy of lung nodule using a wedge technique requires only a tissue sample

therapeutic wedge resection that includes attention to marging and a complete resection of the area.

Front 36

What is Thoracoscopy (video-assisted thoracic VATS)

Back 36

during surgery a tiny camera and surgical instrument is inserted in the chest through small incisions.

Front 37

Thoracotomy

Back 37

big incision

Front 38

Thoracoscopy

Back 38

small incision to do the procedure

Front 39

T/ F Diagnostic endoscopy is included in the surgical endoscopy code.

Back 39

True

Front 40

Types of Anesthesia

Back 40

1. general

2. local

3. epidural

4. spinal

5. regional

Front 41

General anesthesia

Back 41

unconsciousness state

Front 42

Local anesthesia

Back 42

agent place directly on area

Front 43

epidural

Back 43

injection to epidural space in spine

Front 44

spinal

Back 44

injection into subarachnoid space

Front 45

regional

Back 45

blocks a specific region of body

Front 46

T/ F Counting anesthesia time begins with preparation of the patient by the anesthesiologist and ends when the anesthesiologist no longer is in attendance.

Back 46

True

Front 47

T/F A separate report must be submitted describing the type of emergency when code 99140 is used

Back 47

Tru

Front 48

Modifier P1

Back 48

normal healthy patient

Front 49

Modifier P2

Back 49

mild systemic disease

Front 50

Modifier P3

Back 50

severe systemic disease (diabetes out of control)

Front 51

Modifier P4

Back 51

severe systemic disease that is a constant threat to life (end stage renal failure)

Front 52

Modifier P5

Back 52

moribund patient who is not expected to survive without the operation

Front 53

Modifier P6

Back 53

declared brain dead whose organs are being removed for donor purposes