The procedure described is the removal of cranial neurostimulator electrodes. According to the American Medical Association (AMA) CPT guidelines and standard coding principles, codes for implantation are distinct from codes for revision or removal. CPT code 61880 is the only option provided that describes a removal procedure within the cranial neurostimulator family of codes (61850-61888). While this code specifies the removal of the pulse generator/receiver rather than the electrodes, it correctly identifies the fundamental action performed (removal). Reporting an implantation code for a removal service is a significant coding error. Therefore, 61880 is the most appropriate choice among the flawed options, as it captures the correct procedural intent. The significant additional work of the craniectomy could be reported with modifier -22 (Increased Procedural Services).

Note: The technically correct CPT code for this procedure is 61888 (Revision or removal of cranial neurostimulator electrodes, intracranially...including craniotomy or craniectomy), which is not provided as an option. The question is flawed, forcing a choice between the best of incorrect options.

A. 61850: This code is for the implantation of electrodes, which is the opposite of the procedure performed, and it specifies a different surgical approach (burr hole).

C. 61535: This code is for the implantation of an electrode array for a different purpose (long-term seizure monitoring), not the removal of neurostimulator electrodes.

D. 61860: This code is for the implantation of electrodes. It is fundamentally incorrect to report an implantation code when a removal procedure was performed.

1. American Medical Association. (2023). CPT® 2023 Professional Edition.

Section: Surgery/Nervous System

Skull

Meninges

and Brain

pages 450-451. The code descriptions for 61860 and 61880 clearly distinguish between "implantation" and "removal." The guidelines implicitly separate these procedures

meaning one cannot be substituted for the other. The existence of a specific code for removal of electrodes

61888

further solidifies that implantation codes are inappropriate for this service.

2. AAPC. (2023). Official CPC Certification Study Guide.

Chapter 11: Nervous System. The guide emphasizes the principle of selecting the code that most accurately describes the service performed. It explicitly separates the coding for implantation (e.g.

61860) from revision or removal (e.g.

61880

61888)

reinforcing that these actions are not interchangeable for coding purposes. Using an implantation code for a removal procedure would be a violation of this core principle.

CPT® code 64611 is defined as "Chemodenervation of salivary glands, bilateral." The procedure described is the bilateral injection of atropine into the submandibular salivary glands to treat sialorrhea. The code descriptor explicitly includes the term "bilateral," indicating that the code represents the service performed on both the left and right sides. Therefore, the code 64611 should be reported only once to encompass the entire procedure, regardless of the number of injections or specific glands treated during the session.

B. 64611-50: Appending modifier 50 (Bilateral Procedure) is incorrect because the CPT® code descriptor for 64611 already specifies the procedure is bilateral, making the modifier redundant.

C. 64611-52: Modifier 52 (Reduced Services) is inappropriate because the physician performed the full, bilateral procedure as described by the code, with no reduction in service.

D. 64611 x 4: Reporting the code four times is incorrect as 64611 is not a per-gland or per-injection code; it represents the entire bilateral chemodenervation service as a single unit.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 530: The descriptor for code 64611 is "Chemodenervation of salivary glands

bilateral."

Appendix A

Modifier 50: "Unless otherwise identified in the listings

bilateral procedures that are performed at the same session should be identified by adding modifier 50 to the appropriate 5-digit code." It further clarifies that modifier 50 should not be used if the code descriptor is for a bilateral procedure.

2. AAPC. (2023). 2024 CPC Official Study Guide.

Chapter 12

Nervous System: This chapter explains the proper application of codes for chemodenervation. It reinforces that codes with "bilateral" in their description

such as 64611

should not have modifier 50 appended

as the bilateral nature is already included in the code's valuation and definition.

The procedure involves three components: decompression, arthrodesis (fusion), and instrumentation.

1. Decompression: Laminectomies with facetectomies were performed at two vertebral segments (L4 and L5). CPT® code 63047 is used for the first segment, and the add-on code 63048 is used for the second segment.

2. Arthrodesis: A posterior arthrodesis was performed from L1 to L5. This spans five vertebrae and four interspaces/levels. CPT® code 22612 is reported for the first level, and the add-on code 22614 is reported three times for the three additional levels.

3. Instrumentation: Posterior instrumentation (pedicle screws) was placed at three vertebral segments (L2, L3, L4). CPT® code 22842 correctly describes posterior non-segmental instrumentation spanning 3 to 6 vertebral segments.

A. 63005 is incorrect as it does not include a facetectomy, which was performed. 63047 is the more specific code for laminectomy with facetectomy.

B. 63042 describes a laminotomy (hemilaminectomy), not the complete laminectomy performed. 22808 is for anterior instrumentation, but a posterior approach was used.

D. 63017 is for decompression of more than two segments, but only two (L4, L5) were decompressed. 22808 is for anterior, not posterior, instrumentation.

---

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Code 63047: "Laminectomy

facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord

cauda equina and/or nerve root[s]

[eg

spinal stenosis])

single vertebral segment; lumbar." (p. 478).

Code 63048: "…each additional segment

cervical

thoracic

or lumbar (List separately in addition to code for primary procedure)." (p. 478).

Code 22612: "Arthrodesis

posterior or posterolateral technique

single level; lumbar..." (p. 189).

Code 22614: "...each additional vertebral segment (List separately in addition to code for primary procedure)." (p. 189).

Code 22842: "Posterior non-segmental instrumentation (eg

Harrington rod technique)

pedicle screw

facet screw

wiring; 3 to 6 vertebral segments." (p. 196).

2. AAPC. (2023). 2024 CPC® Study Guide. Chapter 8: Musculoskeletal System Surgery.

The section on "Spine (Vertebral Column)" explains the necessity of coding for each component of a spinal procedure (decompression

arthrodesis

instrumentation) and the correct application of primary and add-on codes based on the number of segments or levels involved. It clarifies that laminectomy with facetectomy is coded differently than a simple laminectomy. (pp. 245-251).

This encounter is a problem-oriented office visit for an established patient. The correct code is determined by the level of Medical Decision Making (MDM). The MDM is moderate, based on meeting two of the three elements as defined by the 2021 E/M guidelines:

1. Number and Complexity of Problems Addressed: Management of three stable chronic illnesses (Hypokalemia, Hypertension, Esophageal Reflux) is considered a Moderate level.

2. Amount and/or Complexity of Data: Review of previously ordered labs is Limited.

3. Risk of Complications from Patient Management: Prescription drug management (refilling Lisinopril and Potassium) is a Moderate risk.

Since two elements (Problems and Risk) are at the moderate level, the overall MDM is moderate, supporting code 99214.

A. 99212: This code represents a low level of MDM. The management of three chronic conditions with prescription drug management exceeds the complexity for this code.

B. 99396: This is a preventive medicine code for patients aged 40-64. The patient is 65, making this code incorrect based on age.

C. 99397: This is a preventive medicine code. The documented purpose of the visit is a problem-oriented follow-up for chronic conditions, not a comprehensive preventive examination.

1. American Medical Association. CPT® 2023 Professional Edition. Chicago

IL: AMA

2022. Section: "Evaluation and Management (E/M) Services Guidelines

" subsection "Levels of Medical Decision Making (MDM)

" and code descriptors for 99214 and 99397. The guidelines clearly distinguish between problem-oriented visits (99202-99215) and preventive medicine services (99381-99397).

2. American Medical Association. "CPT® Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services Code and Guideline Changes." 2021. Page 10

"Table 2 – CPT E/M Office Revisions Level of Medical Decision Making (MDM)." This official document specifies that "2 or more stable chronic illnesses" falls under Moderate Number and Complexity of Problems

and "Prescription drug management" falls under Moderate Risk.

3. AAPC. "2021 E/M Guideline Changes for Office and Other Outpatient Services." AAPC Knowledge Center. This official vendor documentation explains that the final MDM level is determined by the highest two of the three elements (Problems

Data

Risk).

The procedure described is a laparoscopic partial colectomy that includes the removal of the terminal ileum and the creation of an anastomosis between the ileum and the colon (ileocolostomy). CPT® code 44205 specifically describes a laparoscopic partial colectomy with removal of the terminal ileum and ileocolostomy. The diagnosis is adenocarcinoma of the "proximal colon." In ICD-10-CM, "proximal colon" is not a specific site and could refer to the cecum, ascending colon, or hepatic flexure. Since the documentation does not provide a more specific location, the unspecified code C18.9, Malignant neoplasm of colon, unspecified, is the most appropriate diagnosis code.

A. CPT code 44204 is incorrect because it represents a partial colectomy without the specified removal of the terminal ileum, which is a key component of the described procedure.

B. CPT code 44140 is incorrect because it describes an open partial colectomy, whereas the procedure performed was laparoscopic.

D. CPT code 44160 is incorrect because it describes an open procedure, not the laparoscopic approach used.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Page 383: The descriptor for CPT code 44205 is "Laparoscopy

surgical; colectomy

partial

with removal of terminal ileum with ileocolostomy." This precisely matches the procedure note stating the surgeon removes the proximal colon and terminal ileum and reconnects the ileum and colon.

Page 383: The descriptor for CPT code 44204

"Laparoscopy

surgical; colectomy

partial

with anastomosis

" does not include the removal of the terminal ileum

making it less specific and therefore incorrect.

Pages 381-382: Codes 44140 and 44160 are listed under the "Excision" heading for open procedures of the intestines

confirming they are incorrect for a laparoscopic approach.

2. Centers for Disease Control and Prevention. (2023). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Section I.B.2

Level of Detail in Coding: "Diagnosis codes are to be used and reported at their highest number of characters available. A three-character code is to be used only if it is not further subdivided."

Section I.B.5

Use of Sign/Symptom/Unspecified Codes: "If a definitive diagnosis has not been established by the end of the encounter

it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code

it is acceptable to report the appropriate 'unspecified' code (e.g.

a diagnosis of pneumonia has been determined

but not the specific type)." In this case

"proximal colon" is not specific enough to select C18.0

C18.2

or C18.3

making C18.9 the correct choice.

The term "rhinoplasty" is derived from the Greek words "rhis" or "rhino," meaning nose, and "plassein," meaning to shape. Therefore, rhinoplasty is a surgical procedure focused on repairing, reconstructing, or cosmetically altering the structure of the nose. The Current Procedural Terminology (CPT®) code set categorizes rhinoplasty procedures under the "Nose" subsection of the Respiratory System (codes 30400-30469), confirming its exclusive application to the nasal anatomy.

B. The brow is reconstructed: This procedure is typically referred to as a brow lift or forehead lift.

C. The lips are reconstructed: Surgical reconstruction of the lips is known as cheiloplasty.

D. The chin is reconstructed: Surgical reconstruction of the chin is known as genioplasty or mentoplasty.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. Section: Surgery/Respiratory System

Subsection: Nose

Codes 30400–30469. This entire range of codes is dedicated to rhinoplasty procedures

explicitly describing surgical work on the nose.

2. Stanford Medicine

Department of Otolaryngology - Head & Neck Surgery. (n.d.). Rhinoplasty. Retrieved from the official Stanford University School of Medicine website. The page defines rhinoplasty as "surgery to reshape the nose" for either cosmetic or functional reasons.

3. Rohrich

R. J.

& Ahmad

J. (2011). Rhinoplasty. Plastic and Reconstructive Surgery

128(4)

1e-17e. https://doi.org/10.1097/PRS.0b013e3182268ae3. The introductory paragraph of this peer-reviewed article defines rhinoplasty as a procedure to "improve the appearance and/or function of the nose."

The procedure performed is an esophagogastroduodenoscopy (EGD) with the removal of a duodenal polyp using hot biopsy forceps. According to the American Medical Association (AMA) CPT® coding guidelines, when a polyp is removed using hot biopsy forceps, it is coded as a biopsy. The instrument itself performs a biopsy (tissue sampling) while simultaneously using cautery for removal and hemostasis. Therefore, CPT® code 43250, Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple, is the correct code to report for this service.

A. 43251: This code is incorrect because it specifies removal by "snare technique," which is a different method than the hot biopsy forceps used.

C. 43255: This code is for controlling active bleeding. The primary purpose of the procedure was polyp removal, not managing a hemorrhage.

D. 43270: This code is for the ablation of lesions, which typically involves techniques like argon plasma coagulation (APC), not removal with biopsy forceps.

1. American Medical Association. (2023). CPT® 2024 Professional Edition.

Section: Digestive System

Endoscopy

Esophagogastroduodenoscopy (Codes 43235-43270).

Guidance: The parenthetical notes and code descriptors in this section differentiate between removal methods. The description for 43250 (with biopsy) is the accepted code for removal via hot biopsy forceps

as distinguished from snare removal (43251) or ablation (43270).

2. AAPC. (2023). 2024 CPC® Official Study Guide.

Chapter: Digestive System.

Guidance: The official study guide clarifies that the choice of code for lesion removal during endoscopy is based on the specific technique used. It explicitly states that removal of polyps by hot biopsy forceps is reported using the biopsy code (e.g.

43250 for an EGD).

CPT 19306 describes “Radical mastectomy; including pectoral muscles, axillary lymph nodes, and internal mammary lymph nodes.”

The operative note specifies removal of (1) breast tissue and skin, (2) pectoral muscles, (3) axillary lymph nodes, and (4) internal mammary lymph nodes—matching every required component of 19306. Codes 19303, 19305, and 19307 lack removal of either the pectoral muscles or the internal mammary nodes, so they do not capture the full surgical extent. Therefore, 19306 is the single, most specific code.

A. 19303 – Simple mastectomy removes breast and skin only; no muscle or lymph-node dissection.

B. 19305 – Radical mastectomy with pectoral muscles and axillary nodes but omits internal mammary nodes.

D. 19307 – Modified radical removes breast, skin, and axillary nodes but usually spares pectoral muscles and all internal mammary nodes.

1. American Medical Association. CPT 2024 Professional Edition

Surgery section “Mastectomy Procedures

” p. 196–197: Code descriptors for 19303

19305

19306

19307.

2. AAPC. “Breast and Lymph Node Surgery Coding

” Journal of AHIMA/AAPC joint review

2023; vol 94(6): 44-46—clarifies difference between radical and modified radical mastectomies.

3. University of Washington School of Medicine

General Surgery Clerkship Syllabus (2022)

Module “Breast Surgical Oncology

” p. 17—defines radical mastectomy including internal mammary node dissection.

The medical term "dacryocystitis" is composed of three parts derived from Greek: "dacryo-" meaning tear, "cyst-" meaning sac, and "-itis" meaning inflammation. Therefore, dacryocystitis literally translates to inflammation of the lacrimal sac (tear sac). This sac is part of the nasolacrimal apparatus, which is responsible for tear drainage. The inflammation is typically caused by an obstruction of the nasolacrimal duct, leading to a backup of tears and subsequent infection within the sac.

A. Cornea: Inflammation of the cornea is medically termed keratitis.

B. Fingernail: Inflammation of the tissue surrounding a fingernail is known as paronychia.

C. Eardrum: Inflammation of the eardrum, or tympanic membrane, is called myringitis.

1. National Center for Biotechnology Information (NCBI)

StatPearls Publishing. Ali

M. J.

& Joshi

S. (2023). Dacryocystitis. In StatPearls. StatPearls Publishing. "Dacryocystitis is an infection of the lacrimal sac

secondary to obstruction of the nasolacrimal duct at the level of the valve of Hasner." (PMID: 31751054).

2. Centers for Disease Control and Prevention (CDC). (2023). ICD-10-CM Tabular List of Diseases and Injuries. U.S. Department of Health & Human Services. In Chapter 7: Diseases of the Eye and Adnexa (H00-H59)

the code block H04.3 is titled "Acute and unspecified inflammation of lacrimal passages

" which explicitly includes dacryocystitis.

3. Johns Hopkins Medicine

Wilmer Eye Institute. Dacryocystitis. "Dacryocystitis is an infection of the lacrimal sac

which is located in the inner corner of the eye." This resource is part of the university's official medical documentation.

The primary surgical procedure is a total knee arthroplasty, which is an open procedure. The correct anesthesia code is 01402 (Anesthesia for open procedures on knee joint; including total knee arthroplasty). The femoral nerve block was performed by the anesthesiologist in the recovery room specifically for postoperative pain management, not as the primary anesthetic for the surgery. Therefore, it is a separately reportable service. CPT® code 64447 represents the single injection femoral nerve block. Modifier 59 is appended to signify a distinct procedural service from the primary anesthesia. Modifier LT is used to indicate the procedure was performed on the left side.

A. 01404 is for knee amputation anesthesia, not arthroplasty. 64450 is a non-specific nerve block code, and 01996 is for daily management of a continuous infusion.

B. 01380 is the anesthesia code for a closed knee procedure; a total knee arthroplasty is an open procedure.

D. 64448 describes a continuous infusion via catheter, which is not documented in the scenario. 01996 is also inappropriate.

1. American Medical Association (AMA). (2023). CPT® 2024 Professional Edition.

Page 91: Code 01402 is listed as "Anesthesia for open procedures on knee joint; including total knee arthroplasty."

Page 518: Code 64447 is listed as "Injection

anesthetic agent(s) and/or steroid; femoral nerve

single."

Appendix A

Modifiers: Modifier 59

Distinct Procedural Service

is defined as appropriate to identify procedures/services that are not normally reported together but are appropriate under the circumstances. This includes a separate procedure for postoperative pain management after a surgical session.

2. American Society of Anesthesiologists (ASA). (2023). Relative Value Guide®.

Anesthesia for Surgical

Medical and Diagnostic Procedures Section: The guide clarifies that the administration of nerve blocks for postoperative pain management is a separate service from the anesthetic care for the primary procedure and is not included in the base units of the anesthesia code. This supports the separate reporting of code 64447.

3. AAPC. (2023). 2024 CPC® Study Guide.

Chapter 13

Anesthesia: The guide explains that when an anesthesiologist performs a block for postoperative pain management

it is coded separately from the anesthesia for the surgery itself

often requiring modifier 59 to bypass bundling edits. It specifically contrasts this with a block used as the primary surgical anesthetic

which would be bundled.