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Preoperative Diagnosis: Coronary artery disease associated with congestive heart failure. In addition, the patient has diabetes and massive obesity.Postoperative Diagnosis: SameAnesthesia: General endotracheal Incision: Median sternotomy Indications: The patient had presented with severe congestive heart failure associated with her severe diabetes. She had significant coronary artery disease, consisting of a chronically occluded right coronary artery but a very important large obtuse marginal artery coming off as the main circumflex system. She also has a left anterior descending artery which has moderate disease and this supplies quite a bit of collateral to her right system. The decision was therefore made to perform a coronary artery bypass grafting procedure particularly because she is so symptomatic. The patient was brought to the operating room.Description of Procedure: The patient was brought to the operating room and placed in supine position. Myself, the operating surgeon was scrubbed throughout the entire operation. After the patient was prepared, median sternotomy incision was carried out and conduits were taken from the left arm as well as the right thigh. The patient weighs almost three hundred pounds and with her obesity there was some concern as to taking down the left internal mammary artery. Because the radial artery appeared to be a good conduit, she should have an arterial graft to the left anterior descending artery territory. She was cannulated after the aorta and atrium were exposed and after full heparinization.Attention was turned to the coronary arteries. The first obtuse marginal artery was a very large target and the vein graft to this target indeed produced an excellent amount of flow. Proximal anastomosis was then carried out to the foot of the aorta. The left anterior descending artery does not have severe disease but is also a very good target, and the radial artery was anastomosed to this target, and the proximal anastomosis was then carried out to the root of the aorta.Sternal closure was then done using wires. The subcutaneous layers were closed using Vicryl suture. The skin was approximated using staples. What CPT® coding is reported?

Restriction of blood supply, commonly due to factors in the blood vessel, that can result in damage or dysfunction of tissue is known as:

When coding for an ambulatory surgical procedure, how is the diagnosis determined?

A 25-year-old female in her last trimester of her pregnancy comes into her obstetrician’s office for a fetal biophysical profile (BPP). An ultrasound is used to first monitor the fetus’ movements showing three movements of the legs and arms (normal). There are two breathing movements lasting 30 seconds (normal). Non-stress test (NST) of 30 minutes showed the heartbeat at 120 beats per minute that increased with movement (normal or reactive). Arms and legs were flexed with fetus’ head on its chest, opening and closing of a hand. Two pockets of amniotic fluid at 3 cm were seen in the uterine cavity (normal). Biophysical profile scored 9 out of 10 points (normal or reassuring). What CPT® code is reported by the obstetrician?

A new patient visits the internal medicine clinic today for diabetes, hypertension, arthritis, and a history of cardiac disease. The provider performs a medically appropriate history and exam. Blood pressure is high. All other conditions are stable. Labs ordered are HbA1c and complete blood count (CBC). The dosage for the blood pressure medication is reviewed and changed. The patient will follow up in three months. What CPT® code is reported?

What is the purpose of National Coverage Determinations?

A 25-year-old male is brought by EMS to the Emergency Department for nausea and vomiting. Patient has elevated blood sugars and the ED provider is unable to get a history due to patient’s altered mental status. A medically appropriate exam is performed and the MDM is high. The patient was stabilized and transferred to ICU under a different provider. The ED provider documents total critical care time 25 minutes. What CPT® coding is reported?

A physician places a centrally inserted, tunneled central venous access device with a subcutaneous pump in a 7-year-old patient.

A surgeon performed a transthoracic median sternotomy for exploration of the space around the lung sacs and for drainage of fluid, caused by pneumonia. What is/are the appropriate code(s) for this scenario?

The patient is here because the cyst in her chest has come to a head and is still painful even though she has been on antibiotics for a week.  I offered to drain it for her. After obtaining consent, we infiltrated the area with 1 cc of 1% lidocaine with epinephrine, prepped the area with Betadine and incised and opened the cyst in the relaxed skin tension lines of her chest, and removed the cystic material. There was no obvious purulence. We are going to have her clean this with a Q-tip. We will let it heal on its own and eventually excise it. I will have her come back a week from Tuesday to reschedule surgery. What CPT® and ICD-10-CM codes are reported?