AAPC - Chapter 13 Practical Applications Test with Verified Answers
1 view 0 purchase
Course
AAPC - Chapter 13
Institution
AAPC - Chapter 13
AAPC - Chapter 13 Practical Applications Test with Verified Answers
1. 57160
N81.3
CASE 1
DIAGNOSES: Stage III cystocele, stage II uterine pro-
lapse. (Do not code the cystocele separately as it is in-
cluded in the diagnosis code for the uterine prolapse.)
PROCEDURE: Pessary fitting.
INDIC...
AAPC - Chapter 13 Practical Applications Test with Verified Answers
1. 57160 CASE 1
N81.3
DIAGNOSES: Stage III cystocele, stage II uterine pro-
lapse. (Do not code the cystocele separately as it is in-
cluded in the diagnosis code for the uterine prolapse.)
PROCEDURE: Pessary fitting.
INDICATIONS: A 75 year-old, gravida 4, para 4,(This infor-
mation indicates that the patient has had four pregnancies
with four term births and the last two babies were quite
large.) female with pelvic organ prolapse. She had atroph-
ic vaginitis so we had her use Premarin vaginal cream
twice a week for six weeks. She is back for a pessary fitting
today.
FINDINGS: She has a third-degree cystocele, and after
examination we've determined she actually has a third-de-
gree uterine prolapse.(The diagnosis is cystocele with
uterine prolapse. Stage III uterine prolapse is considered
a complete prolapsed.) Her vaginal tissues are improved,
although still atrophic, but much less thin than prior ap-
pointment.
DESCRIPTION OF PROCEDURE: After her exam, I start-
ed with a #4 ring pessary with support. This was clearly
not large enough and the cystocele was coming around
it. I then went to a #5 ring pessary with support with
the same problem. I went to the #6 ring pessary with
support.(The provider indicates the size of the pessary
that he is fitting.) It did not lodge behind her pubic bone
very well, but it definitely reduced all of her prolapse. She
mentioned earlier in the appointment that she could not
void when she came in today. She has not tried reducing
it. I am hopeful that the pessary may help with that. The #6
was comfortable for her. I stood her up and put her through
some maneuvers and it stayed nicely in place. Then she
went walking with the pessary in place for 10 or 15 minutes
and went up and down the stairs. She definitely was able
,AAPC - Chapter 13 Practical Applications Test with Verified Answers
to void more easily with it in. It was comfortable and she
did not really notice it was in.
On recheck it still seemed like she had a little more room
in the pelvis. I removed the #6 and went up to a #7 size.
This seemed to reduce the prolapse a bit better, but was
a little uncomfortable for her. We went back to the #6 ring
pessary with support. She was able to remove it and place
it with instruction in our clinic today.
DISPOSITION: We have ordered the #6 ring pessary (If
the provider supplied the pessary, a HCPCS Level II code
would be reported.) with support and it will be sent to her.
After she gets the pessary, she will remove it once a week
and leave it out overnight. She will continue to use the
Premarin vaginal cream twice a week. She will return to
clinic after she has used the pessary for 2 or 3 weeks,
so we can check her tissues. She is to report if she has
vaginal discharge or bleeding, as she is at risk for getting
ulceration from the pessary.
I answered all of her questions about her condition of
pelvic organ prolapse and treatment with estrogen and
pessary. She will call if she has any bleeding.
What are the CPT and ICD-10-CM codes reported?
2. 57260 CASE 2
58260-51
57283-59 DIAGNOSES:
N81.3
N95.0 1. Complete procidentia (The stated diagnosis is Com-
N32.89 plete Procidentia, and this is well supported in the body of
the operative note. A review of several medical dictionaries
shows the definition of Procidentia, prolapse of an organ
or part.)
2. Recurrent urinary tract infections (A history of post-
menopausal vaginal bleeding, anemia and recurrent uri-
, AAPC - Chapter 13 Practical Applications Test with Verified Answers
nary tract infection (UTI).)
3. Postmenopausal vaginal bleeding (Select codes for the
definitive diagnoses.)
PROCEDURES:
1. Vaginal hysterectomy
2. Anterior and posterior colporrhaphy
3. Cystoscopy
4. Vaginal vault suspension
SPECIMENS: Uterus and cervix.
FINDINGS: A thick hypertophic ulcerated cervix was not-
ed. The adnexa were small and atrophic. Complete pro-
cidentia with cystocele and rectocele. (All of these prob-
lems are addressed in the body of the note below.) Cys-
toscopy done after indigo carmine was administered,(In-
digo carmine is a dye injected during urogynecologic pro-
cedures for better visualization of structures/fluids etc. by
turning the urine red.) at the end of the case, revealed
bilateral strong ureteral jets.
INDICATIONS: Pt. with history of postmenopausal vagi-
nal bleeding, anemia and recurrent urinary tract infec-
tions, although she denied any urinary incontinence. Her
cervix was found to be ulcerated, erythematous and hy-
pertrophic. Cervical biopsy was negative for neoplasia.
She desires surgical management of these problems.
OPERATION: The patient was taken to the operating room
and placed in lithotomy position while awake. The patient
has a history of bilateral knee replacements and cannot
bend her legs. We put her in lithotomy position using
Yellofin stirrups, keeping her legs without any bend and
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller MERCYTRISHIA. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.99. You're not tied to anything after your purchase.
