CCEP Lesson 13 Homework – Musculoskeletal System Overview

Coding for the musculoskeletal section requires a professional understanding of ICD-10-CM Section I Guidelines for Chapter 13 (Musculoskeletal) and Chapter 19 (Injury and Poisoning). The coder must develop a clear understanding of:

1. Bone and joint anatomy and terminology 
2. The anatomical position of the human body 
3. Fracture and disease terminology
4. An understanding of CPT guidelines
5. Layout of the dense 20000 Musculoskeletal Section and the Spine codes in the 60000 Section
6. An understanding of similarities and differences between Surgical Package & Medicare’s Global Package
7. Understanding of NCCI (CCI) Edits
8. Understanding of NCCI/CCI Chapter pages
9. Understanding of RVUs
10. Understanding of the endoscopy coding (diagnostic versus surgical codes) and 
11. A commanding understanding of CPT/HCPCS modifiers.

Assign the diagnosis code(s) for a closed, traumatic non-displaced shaft fracture of the left and right humerus.

A 12-year-old boy fell out of a tree four hours ago, he was brought to the clinic, the physician reviewed the x-rays, and examined the boy.  The diagnosis is a transverse fracture, shaft of the right humerus.  The alignment was perfect, and the clinician will treat this fracture with an appropriate fiberglass immobilizer.  He will come back in 7 days for an x-ray and exam.  

Choose today’s service code from the list provided.

Consider the code you selected for the previous question and select all that apply from below.

The 12-year-old child returns to the clinic seven days after diagnosis and initial treatment of the right humerus fracture.  An x-ray is taken in this clinic and the humerus fracture remains in perfect alignment. A long-arm fiberglass cast is fitted from the shoulder, goes over the wrist, and stops at the end of the distal metacarpals.  He is to return in two weeks for a FU visit. This clinic is a private practice clinic and is not an FQHC clinic.  Select all that apply from the list below.

When a patient has a displaced fracture at the neck of 5th metacarpal of the left hand, which statement best describes where this fracture is located? 

An 18-year-old patient punched the wall 24 hours ago and presents to the clinic with pain and swelling of the left hand. X-ray and exam reveal a displaced fracture at the neck of the fifth metacarpal, left hand.   Assign the diagnosis code(s) for this initial visit.

This patient with a displaced fracture at the neck of the fifth metacarpal was seen by the orthopedic surgeon and underwent a closed reduction and casting of the fracture.  Assign the CPT code(s) for this service.

A 20-year-old patient had a displaced fracture at the neck of the fifth metacarpal, but closed reduction would not hold the fracture in place, so the surgeon did a percutaneous pinning of the fifth metacarpal fracture.  Assign the CPT code(s) for this service. 

The 20-year-old in the above story was seen in follow-up by the orthopedic surgeon five days after his percutaneous pinning of the fifth metacarpal fracture.  The reduction has slipped and was not acceptable. The surgeon had explained preoperatively that this was a risk with this fracture.  The patient was taken to the operating room where an open reduction and internal fixation (ORIF) using a short plate and screws was accomplished.  The patient was put in a posterior splint.  Will recheck with exam and x-ray in two days.

Assign today’s surgical service code(s) and any needed modifier(s).

A 44-year-old woman has right knee pain and intermittent swelling; she describes a type of locking in the right knee.  After x-rays and examination, the surgeon scheduled a diagnostic arthroscopy so that an exact diagnosis could be made.

Today’s surgical finding after the knee arthroscopy: No findings, knee joint completely normal.  

Assign the surgical service code(s). 

A 44-year-old woman has right knee pain and intermittent swelling; she describes a type of locking in the right knee.  After x-rays and examination, the surgeon scheduled a diagnostic arthroscopy so that an exact diagnosis could be made.

Today’s surgical finding after the knee arthroscopy: Medial meniscus tear; meniscectomy performed. 

Assign the service code(s).

A 44-year-old woman has right knee pain and intermittent swelling; she describes a type of locking in the right knee.  After x-rays and examination, the surgeon scheduled a diagnostic arthroscopy so that an exact diagnosis could be made.

Today’s surgical finding after the knee arthroscopy: Medial and Lateral meniscus tears; Articular cartilage debridement and repair of both meniscus performed.

Assign the service code(s).

A 68-year-old with degenerative osteoarthritis underwent a right total knee arthroplasty.  He signed a consent for a total knee arthroplasty to include both sides and the patella.  Code the service performed.

A 77-year-old had a total hip replacement ten years ago.  It has loosened and is painful.  Today we performed a revision of total hip arthroplasty and replaced both the acetabular and femoral component.  Bone graft was used. Assign the CPT code(s).