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[answered] M132 Final Exam 1. What are the seven characters of the ICD

M132/HIM1126C Section 01 ICD-PCS Coding??I need help with question 9 through 26

M132 Final Exam


1. What are the seven characters of the ICD-10-PCScodes?














g. 2. 3. 4. Character 1 = SECTION


Character 2 = BODY SYSTEM


Character 3 = ROOT OPERATION


Character 4 = BODY PART


Character 5 = APPROACH


Character 6 = DEVICE


Character 7 = QUALIFIER What is the overall organization of ICD-10-PCS?




How many sections are included in ICD-10-PCS?






What are the three main sections?


Medical & Surgical, Medical & Surgical related sections, Ancillary section




What is contained in the first section?


Medical & Surgical ?0?




What is included in the Ancillary Section?


Imaging, Nuclear Medicine, Radiation Oncology, Physical Rehab, Diagnostic Audiology,


Mental Health, Substance Abuse Treatment


What are the root operations in ICD-10-PCS?


The third character in the Medical and Surgical section is the root operation. There are a


total of 31 root operations. Excision, Resection, Detachment, Destruction,




How does ICD-10-PCSdefine ?approach? and what are the approaches identified?


Method or technique to reach the operative site. Open ? Open Endoscopic ? Percutaneous ? Percutaneous Endoscopic ? Via Natural or Artificial Opening ? Via Natural or Artificial Opening Endoscopic ? Open with Percutaneous Endoscopic Assistance ? External 5. How does ICD-10-PCS define ?device? as the sixth character in the Medical and Surgical




Depending on the procedure performed, there may or may not be a device left in


place at the end of the procedure. The sixth character defines the device. Device


values fall into four basic categories. Grafts and Prostheses, Implants, Simple or


Mechanical Appliances, Electronic Appliances. 6. How is an ICD-10-PCS code assigned?


Each character in the seven-character code represents an aspect of the procedure.


This code is derived by choosing a specific value for each of the seven characters.


Based on details about the procedure performed, values for each character


specifying the section, body system, root operation, body part, approach, device,


and qualifier are assigned. 7. ICD-10-PCS procedure codes are required to be used to code patients in which of the


following settings? Check all that apply.




Hospital inpatient settings




Physician offices ?


? Hospital outpatient departments


Hospital emergency departments 8. What is the maximum number of digits in a valid ICD-10-PCSprocedure code?
















Eight 9. Identify the main term in Index for each procedure:




Percutaneous biopsy of prostate


Click here to enter text. b. Laparoscopic appendectomy c. Exploratory laparotomy of abdomen Click here to enter text.


Click here to enter text. d. Suture repair of laceration of foot e. Closed reduction of fracture of left radius Click here to enter text.


Click here to enter text. 10. What is the main term in the Index and the first three characters and the root


operation to be used for the following procedure titles?


a. Bunionectomy b. Esophagogastroduodenoscopy Click here to enter text.


Click here to enter text. c. Femoral herniorrhaphy without synthetic substitute d. Excisional biopsy of breast, left Click here to enter text.


Click here to enter text. e. Transfusion of packed red cells via peripheral vein f. Laparoscopic total cholecystectomy Click here to enter text.


Click here to enter text. g. Amputation of right fifth toe h. Low cervical Cesarean delivery Click here to enter text.


Click here to enter text. i. Right hip replacement j. Resection of lower lobe, left lung Click here to enter text.


Click here to enter text. k. Open reduction, hip fracture, right l. Artificial rupture of membranes (AROM) Click here to enter text.


Click here to enter text. m. Permanent colostomy of left descending colon


Click here to enter text. 11. Bilateral open direct inguinal herniorrhaphy


Click here to enter text. 12. Coronary artery bypass graft of the left anterior descending artery using the left internal


mammary artery.


Click here to enter text. 13. Right thyroid lobectomy using an open approach to excise the entire right thyroid lobe


Click here to enter text. 14. Open reduction with internal fixation, left fibula


Click here to enter text. 15. Right total hip replacement using an uncemented ceramic?on?ceramic device through open


Click here to enter text. 16. Laparoscopic assisted total vaginal hysterectomy


Click here to enter text. 17. Left below knee amputation of proximal tibia and fibula


Click here to enter text. 18. Right kidney transplant with organ donor match


Click here to enter text. 19. Mitral valve replacement using porcine tissue by open approach


Click here to enter text. 20. Case study:


PREOPERATIVE DIAGNOSIS: Left inguinal hernia.


POSTOPERATIVE DIAGNOSIS: Large left inguinal hernia, direct.


PROCEDURE: Repair of large direct left inguinal hernia with Prolene Hernia System Mesh (PHS) and


resection of lipoma of the cord.


FINDINGS: Large direct left inguinal hernia and large lipoma of the cord.


DESCRIPTION OF PROCEDURE: After routine preparation, the patient was prepped and draped under


general anesthesia in supine position. The bladder was decompressed with a Foley catheter. An incision


was made in the left groin parallel to the left inguinal ligament after the skin had been infiltrated with


0.5% plain Marcaine. Subcu was incised. Superficial epigastric vessels were identified, clamped,


transected and ligated with 2-0 Vicryl. Scarpa's was incised. The external oblique aponeurosis was


identified and incised. The incision was carried down to the external ring superior to the internal ring.


The ilioinguinal nerve was identified, freed from the surrounding tissues and retracted medially. The cord


structures were encircled with a Penrose drain. A large lipoma of the lumbar cord was dissected off all


the way to the base, clamped, transected and ligated with 2-0 Vicryl. The cremasteric muscles were


transected at the anteromedial aspect of the cord structures. A hernia sac was identified, which was a


small indirect hernia. The sac was dissected all the way to the level of the preperitoneal fat. The contents


were mobilized. Then, there was a large bulge in the direct space, almost occupying the entire direct


space. It was dissected from the surrounding tissues. Deep epigastric vessels were identified. The fascia


was transected. Deep epigastric vessels were skeletonized and retracted cephalad anteriorly. The transversalis was transected circumferentially. The direct space was bluntly dissected until completely


dissecting the direct and indirect space. A Prolene Hernia System mesh was placed. The innerlay was


unfolded inferiorly, superiorly, medially and laterally. The transversalis was closed over it with 2-0 Vicryl.


The overlay was unfolded and sutured to the pubic tubercle inferiorly, cut at the 1 o'clock location,


wrapped around the cord structures and placed over the internal oblique muscle. The wound was


irrigated. Cord structures were placed in the usual anatomic location. The external oblique aponeurosis


was closed with 3-0 Vicryl. Again, the gallbladder was also placed in the usual anatomic location. The


external oblique aponeurosis was closed with 3-0 Vicryl. Subcu was closed with interrupted 4-0


Monocryl. Each layer was infiltrated with 0.5% plain Marcaine. The skin was closed with subcuticular 4- o


Monocryl. Dermabond was applied. The patient tolerated the procedure well under general anesthesia


and left the operating room to Recovery in good condition.


ICD-10-PCS Codes: Click here to enter text.


21. Case study:


PREOPERATIVE DIAGNOSIS: Large right subdural hematoma.


POSTOPERATIVE DIAGNOSIS: Large right subdural hematoma.


PROCEDURE PERFORMED: Right craniotomy with evacuation of subdural hematoma.


HISTORY: This 58-year-old patient was transferred from an outside hospital after she was found


unresponsive. She was on Coumadin, and she was found to have a large right-sided subdural hematoma


with significant midline shift. On exam, she is noted to have, anisocoria and large right pupil,


decerebrating, to pain. The patient had received FFP as well as factor VII and emergently rushed to the


operating room.


PROCEDURE: The patient was brought into the general operating theater. Following the induction of


general anesthesia, the patient was supine. The scalp was clipped, prepped and draped. We made a


hairline incision frontal temporal parietal, reflecting it and incised down through the temporalis muscle.


Fascia reflected with the skin flap. Bone flap was elevated without dural violation, tacked up to the bone


edges with 4-0 Nurolon. As the dura was tacked up, the dura was opened. We encountered a very large


subdural membrane. We circumferentially evacuated it. We did find a cortical arterial bleeder. Once it


started bleeding, we removed the clot. This was coagulated, and the bleeding was stopped. We


copiously irrigated, circumferentially inspecting the edges to make sure there was no venous bleeding.


All seemed dry. We next reapproximated the dura. We did place a red rubber catheter in the subdural


space. The dura was approximated with 4-0 Nurolon. Bone was placed back in place. Temporalis muscle


and fascia were approximated with 2-0 Vicryl, the galea with inverted interrupted 2-0 Vicryl and the skin


with staples.


Following this procedure, all instrument, sponge, needle and padding counts were correct.


ICD-10-PCS code: Click here to enter text. 23. Case study:


Title of Operation: Pterygium removal with conjunctival graft.


Procedure in Detail: Local anesthesia was achieved with a 50/50 mixture of 2% Xylocaine and 0.75%


Marcaine with Wydase. The right eye was prepped and draped in the usual sterile fashion. The lashes


were isolated on Steri-Strips and the lids separated with the wire speculum. The pterygium was marked


with a marking pen and subconjunctival injection of 1% lidocaine with epinephrine was injected


underneath the pterygium. The pterygium was then resected from the conjunctiva and the body of the


pterygium was resected with sharp dissection with Westcott scissors. The head of the pterygium was


dissected off the cornea with Martinez corneal dissector. The cornea was then smoothed with an


ototome bur. Hemostasis was achieved with bipolar cautery.


A conjunctival graft measuring 10 x 8 mm was harvested from the superior bulbar conjunctiva by


marking the area, injecting it with subconjunctival 1% lidocaine with epinephrine. This was dissected


with Westcott scissors and sutured in place with multiple interrupted 9-0 Dexon sutures. Subconjunctival


Decadron and gentamicin injections were given. A bandage contact lens was placed on the eye. Maxitrol


ointment was placed on the eye. A patch was placed on the eye. The patient tolerated the procedure


well and was taken to the recovery room in good condition.


ICD-10-PCS Codes: Click here to enter text.


24. Case study:


Procedure: Laparoscopic gastric band.




History : Morbid obesity, body mass index (BMI) of 42.


Description: The patient was placed in the supine position on the operating table and sterilely draped.


Abdomen was prepped with Betadine and a trocar was applied to the left abdomen on the right side.


15mHg carbon dioxide was used for insufflation. Additional ports were placed under visualization.


The liver was raised and peritoneum divided using electrocautery. A small window was formed in the


peritoneum at the left and right crus of the diaphragm, and a grasping instrument was placed via the


right lateral port site into the window and advanced to the peritoneum. After this the band was dropped


into the abdomen and brought through and properly closed. Upon examination it was determined that


there was adequate space between the stomach and the band and it was secured and sutured to the


stomach above the band. This was accomplished via fundoplication, which commenced at the angle of


His and to within 2.5 cm of the band buckle. Band tubing was removed sing the left upper abdominal


site of the trocar. At this time all of the trocars were removed from the abdomen and the liver retractor


was removed. Hemostasis was evaluated and found to be adequate. The band tubing was clipped to


measure 15 cm from the edge of the kin and secured to the port, with the port held to the rectus fascia on the left using 5 Ethibond 2-0 interrupted sutures and putting the excess band tubing into the


abdomen. The skin edges were secured with 4-0 sutures and sterile dressing.


The patient was taken to the recovery room in stable condition.


ICD-10-PCS: Click here to enter text.


25. Case study:


Preoperative Diagnosis: Extensive ductal carcinoma in situ, left breast.


Postoperative Diagnosis: Extensive ductal carcinoma in situ, left breast.


Procedure: Sentinel lymph node mapping, injection, and 4 biopsies.


Left simple mastectomy.


Anesthesia: General endotracheal.


DESCRIPTION OF PROCEDURE: The patient was transferred to the operating room and in the supine


position. After general endotracheal anesthesia was administered, the left breast, chest wall, axilla, and


arm were prepped and draped en bloc and draped. The previous marking of the sentinel lymph nodes


was identified. A needle probe was used and transcutaneous readings of the sentinel lymph node area


were taken and recorded. Isosulfan blue was injected into the periareolar region and massaged.


Using a 10-blade scalpel, a transverse mastectomy incision was made in the breast around the nippleareolar complex. Flaps were raised superiorly to the clavicle, medially to the sternum, inferiorly to the


rectus sheath, and laterally to the latissimus dorsi border. Retraction was placed on the skin flaps in a


cephalad direction and readings in the axilla were obtained.


Three hot sentinel lymph nodes in the left axilla were traced using the needle probe, each had readings


recorded in vivo and ex vivo. Within the field there was a fourth lymph node which was at least 2.0 cm in


size, and this was biopsied just on the basis of size and lymphadenopathy. It was not radioactively hot.


The 4 samples were labeled and sent to pathology and frozen section proved them to be benign.


The simple mastectomy was performed next, with the breast taken off the chest wall in a medial to


lateral fashion. This was sent to pathology.


Irrigation was performed and hemostasis was accomplished with cautery. Two 10-mm Jackson-Pratt


drains were placed into the superior skin flap and into the left axilla and the wound was closed in 2


layers with 3-0 Vicryl suture and 4-0 Vicryl suture with Steri-Strips. The drains were sutured to the chest


wall. The patient was awakened and taken to the recovery room in stable condition.


ICD-10-PCS Code: Click here to enter text.


26. Case study: OPERATIVE REPORT


PREOPERATIVE DIAGNOSIS: Equinus contractures secondary to spastic diplegia, bilateral


POSTOPERATIVE DIAGNOSIS: Equinus contractures secondary to spastic diplegia, bilateral


PROCEDURE: Bilateral percutaneous Achilles tendon lengthening.


ANESTHESIA: General via laryngeal mask.


DESCRIPTION OF PROCEDURE: The patient was placed on the operating room table, in a supine position


and after adequate induction of general laryngeal mask anesthesia, both lower extremities were


prepped and draped in the usual sterile orthopedic fashion. Pneumatic tourniquets were placed


bilaterally about the upper thighs. First to the left lower extremity was addressed, where the leg was


exsanguinated with an elastic Martin bandage, and a pneumatic tourniquet elevated to 200 mmHg.


With the foot placed in neutral dorsiflexion of 90 degrees to his leg, a percutaneous stab incision was


made at the distal end of the Achilles tendon along the medial side. The 15 blade knife was then used to


cut the medial half of the tendon through the stab incision. A second stab incision was made on the


medial side at the proximal pole of the tendon, approximately 7 to 8 cm proximal to the distal stab


wound. Using a 15 blade,the tendon was cut through half its width through the stab incision. A third


lateral incision was then made percutaneously midway between the proximal and distal incisions, and


the lateral half of the tendon was cut through the stab wound incision. The foot could then be


dorsiflexed 20 degrees above neutral with the knee extended. The wounds were then dressed with


Mastisol and Steri-Strips followed by Xeroform, dry sterile dressing, and sterile Webril. The tourniquet


was released with a total tourniquet time of 5 minutes.


Next the right leg was addressed, and an identical procedure was performed using three stab incisions


cut distal and proximal along the medial half of the tendon with a lateral stab incision made midway


between the two medial stab incisions. The lateral half of the tendon was cut. This foot was dorsiflexed


20 degrees with the knee extended and the wounds were dressed as on the other site. The tourniquet


was also released with a time of 4 minutes.


Short leg casts were then placed with the feet in neutral position to the right and left side. Sponge,


needle, and instrument counts were correct. The patient tolerated the procedure well and returned to


the PACU in satisfactory condition.


ICD-10-PCS Code: Click here to enter text.


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