Ch 7 Skin, Subcutaneous Tissue and Breast DIsorders Flashcards
(112 cards)
1
Q
What chapter is localized, noncontagious skin and subcutaneous infections classified to?
A
Chapter XII (12)
2
Q
Diffuse spreading infection of the skin; organisms usually gram-positive cocci and staph aureus
A
cellulitis
3
Q
T or F. Cellulitis infection by gram-negative bacteria is rare
A
T
4
Q
Usually results from a break in the skin such as a puncture wound, laceration or ulcer; presents as an abrupt onset of redness, edema, pain, and heat in the infected area
A
cellulitis
5
Q
If cellulitis isn’t explicitly diagnosed, is a code from category L03 still assigned?
A
No. Only assigned if cellulitis diagnosis is stated by the physician
6
Q
What 2 codes are included when coding cellulitis?
A
- cellulitis code
2. additional option code if causative organism when known
7
Q
What 2 codes are included when cellulitis is present in an open wound/wound management is applied?
A
- cellulitis code
2. code for open wound, complicated fifth character
8
Q
Sequencing of the code for cellulitis depends on the _____
A
course of treatment
9
Q
If cellulitis treatment involves oral antibiotics, sequence the ___ as the MRDx and add ___ as type 1/2
A
laceration MRDx
cellulitis type 1/2
10
Q
If cellulitis treatment involves IV antibiotics, the ____ is sequenced as the MRDx and the ____ is added as a type 3
A
cellulitis MRDx
laceration type 3
11
Q
If the laceration requires repair in the ____, standard diagnosis typing rules apply
A
operating room
12
Q
If wound management isn’t applied, how is it typed?
A
type 3
13
Q
When is T79.3 /Post traumatic wound infection, not elsewhere classified/ coded?
A
when an injury code does not indicate an infection at the site of injury
14
Q
What 2 codes are included when cellulitis occurs with a skin ulce?
A
- ulcer
- cellulitis
sequenced according to circumstances
15
Q
Red lines streaking away from a cellulitic area signifying streptococcus has infected the subcutaneous lymphatic channels
A
lymphangiitis
16
Q
Lymphangiitis is included in the codes for ____
A
cellulitis
17
Q
When cellulitis occurs with an abscess, only the code for ___ is assigned
A
abscess
18
Q
Is gangrenous cellulitis classified to cellulitis?
A
No. classified to /Gangrene, not elsewhere classified)
19
Q
How are gangrenous cellulitis codes sequenced?
A
- injury
2. gangrene
20
Q
T or F. Cellulitis can also describe conditions in other anatomical sites.
A
T
21
Q
Viral skin infections such as herpes simplex, herpes zoster, mycoses and parasitic skin orders are coded to which code range?
A
A00-B99 /Certain infectious and parasitic diseases/
22
Q
Decubitus ulcers are coded with the __ digit identifying the stage of the ulcer
A
4th digit
23
Q
How are infected decubitus ulcer codes sequenced?
A
- decubitus ulcer code
2. drug resistant organism, clustered
24
Q
On which forms does one find decubitus ulcer stage?
A
nurses notes; forms designed to record wound information
25
Type of decubitus ulcer in which eschar prevents determination of the depth of the ulcer
unstageable
26
Unstageable ulcers are more typically documented in the case of a ___ or ___ encounter
short stay; ER encounter
27
Ulcers due to varicose veins of the lower extremities
stasis ulcers
28
Ulcers classified to the circulatory system chapter rather than to the categories for conditions of the skin
stasis ulcers; coded to /Varicose veins of lower extremities/
29
Stasis ulcers having different course than varicose veins are classified to ___
L97.- /Ulcer of lower limb, NEC/; ignore index
30
T or F. Dermatitis and eczema are used interchangeably
T
31
T or F. Dermatitis caused by substances taken internally and dermatitis caused by substances in contact with skin are coded to different categories
T
32
When dermatitis is due to pharmaceutical substances/drugs, it must be determined if there was an ___ or ___
adverse effect (drug taken as directed) or as poisoning (incorrect use of drug)
33
How are codes sequenced if drugs presented an adverse effect?
1. dermatitis
| 2. external cause code to indicate medication responsible
34
Where are external cause codes found?
last column of the drug table, binocular #3, /Adverse effect in therapeutic use/
35
Begins as a cyst in the sacrococcygeal region; presents as either an acute abscess or a chronic draining sinus
pilonidal disease
36
Treatment of an abscess includes ____ and ___
1. drainage
| 2. removal of hair and skin debris
37
Marsupialization is a surgical abscess intervention classified to ___
1.YS.80.^^ /Repair, skin of abdomen and trunk/
38
Drainage in an abscess intervention is classified to
1.YS.52^^ /Drainage, skin of abdomen and trunk/
39
T or F. Dressing changes following marsupialization are coded.
T. Coded to Z48.0 /Attention to surgical dressings and sutures/
40
Cutaneous lupus is classified to which category?
L93 /Lupus erythematosus/, not /Systemic lupus erythematosus/
41
Although often described as a tumor, ___ and ___ are not classified as a neoplasm.
seborrheic and actinic keratosis
42
When is actinic keratosis classified to a neoplasm chapter?
When described as having "uncertain behaviour" or "intraepidermal squamous cell carcinoma"
43
What are one of two choices for coding cosmetic surgery?
Z41.1 /Unacceptable cosmetic appearance/
| Z41.2 /Correction of previous surgery or trauma/
44
Occurs in patients with sagging abdominal tissue due to aging, pregnancies, weight loss etc; may seek services to remove excess skin and fat
abdominal laxity/panniculus
45
How is abdominal laxity performed for cosmetic reasons coded?
1. MRDx Z41.1
| 2. Type 3 Cause (skin/fat/muscle)
46
What is the difference between abdominal panniculus and abdominal laxity?
abdominal laxity is only for when skin and subcutaneous tissues are involved in interventions
47
Removal of abdominal skin and fat only is coded to ____
1. YS.78.^^ /Repair by decreasing size, skin of abdomen and trunk/, also described as liposuction/abdominoplasty/
panniculectomy
48
How is abdominal laxity in which abdominal muscles are weakened coded?
M62.88 /Other specified disorders of muscle, other site/
49
Repair involving abdominal muscles, or panniculectomy, is classified to ___
1.SY.80^^ /Repair, muscles of the chest and abdomen/
50
It is assumed on CCI that whenever tissue is removed, a ____ will be required
repair of the operative site
51
The type of repair is determined by the ____ created by the tissue removal
size of the defect
52
A separate code for repair is not required because the type of repair is identified in the ___ of the CCI code for the excision
qualifier fields
53
T or F. Since repair is identified in the qualifier fields of CCI codes, do not assign a separate intervention code for the repair
T
54
Operations on skin and subcutaneous tissue *only* with no mention of muscle or fascia is coded to ____
excision of skin, by site
55
Excisions mentioning tendons, fascia or muscle is coded to ___
excision of soft tissue, by site
56
Closure of traumatic or surgical wounds may be described as ___, ___, and ___
primary
delayed primary
secondary intention
57
Immediate closure
primary closure
58
Closure carried out for wounds too old for primary closure, particularly if infected, significantly contaminated, organic debris + animal bites involved
delayed primary closure
59
Closure where wound is left to heal on its own
secondary intention
60
An excision that goes deep enough to include bone is classified to ___
radical excision of bone
61
Intervention used when a vascular supply is retained within the tissue being re-positioned
flap
62
Type of graft where tissue is taken from one's own body for placement into a new position on the body; has no vascular supply and is fully excised from procurement site
autograft or autologous tissue
63
Autografts include what type of skin grafts?
1. split thickness (STSG)
| 2. full thickness (STSG)
64
Thin skin graft involving epidermis and none of the dermis or thick/immediate skin graft involving epidermis and some dermis
split thickness (STSG)
65
Autograft involving entire thickness of the epidermis and all of the dermis
full thickness (STSG)
66
For autografts, assign an additional code for ___ unless minor or from the same operative wound
procurement of the tissue
67
Type of graft involving organ or tissue procured from another person (dead or alive); may or may not have vascular supply
homograft or allograft/allogenic organ/homologous tissue
68
Type of graft involving organ or tissue procured from an animal source
xenograft or heterograft/heterologous graft/heteroplastic graft
69
Type of flap where tissue is taken from patient from the immediate vicinity where repair is needed; has nerve and vascular supply
local flap or advancement flap/rotation flap/transposition flap/V-Y advancement flap/Z-plasty
70
Local flaps are cut on three sides, leaving fourth side attached to its ___ and ___ supply
blood and nerve supply
71
Do you assign additional codes to describe procurement for local flaps?
no
72
Type of flap prepared like a local one but is procured from a site distant to where the repair is needed; may need to be split or tunnelled to the application site; fairly large defect left at procurement site
pedicled flap or distant/regional/composite/myocutaneou/
| muscle rotation/muscle transposition/lastissimus dorsi myocutaneous/trans-rectus/abdominis muscle/TRAM
73
For pedicled flap, a code is assigned to describe procurement of any ___ segments
intestinal
74
Type of flap similar to pedicled flap but tissue is completely excised from procurement site; requires microscopic anastomosis of blood vessels and nerves
free flap or composite free/fasciocutaneous/fibular/ interpositional intestinal/random
75
What are the coding rules for free flaps?
1. assign procurement code
| 2. assign code if operating microscope is used /Imaging intervention/
76
Assume that a composite tissue flap is ___ when not specified as free or pedicled by the health care provider
pedicled
77
Type of graft/flap involving man-made materials to replace tissue in body; often encourage tissue regeneration and healing
synthetic tissue
78
Type of graft/flap where tissue is derived from cultivation of cells (autologous) in the laboratory
cultured tissue
79
A code for procurement of tissue must always be assigned when a separate incision is required to obtain tissue for a __ flap or an __ graft
free flap or an autograft
80
Why are procurement of tissue codes mandatory for free flaps/autografts?
Important to track outcomes in relation to the donor and recipient site
81
It is usually unnecessary to code procurement of ___ or ___ flaps since these interventions are considered enlargement of the surgical defect already created
local flap or pedicled flap
82
Whenever an ___ segment is harvested, a procurement code must always be assigned
intestinal
83
Tissue qualifier "__" means procurement code isn't required
E
84
When two or more tissue types are used in the same intervention, the qualifier selected is ____
combined sources of tissue
85
When new skin is needed for reconstruction, the most common method used is a ___ or ___
skin graft or flap
86
Method to grow new skin with a better match usually used in breast reconstruction, hair transplantation and scar revision
tissue expansion
87
Procedure where balloon is placed under the skin next to the area where new tissue is needed; balloon gradually expands via saline/silicone injections until skin is stretched
tissue expansion
88
Advantages of tissue expansion
same skin color, texture, small risk factor
89
Disadvantages of tissue expansion
prolonged time, more than one operation, temporary deformity while expander in place
90
When expanders are initially placed, search for ____ for CCI code
/implantation, device, skin/
91
When returning for injections into the expander, search for ___ for CCI code
/management, device, skin/
92
For returning patients needing expander injections, the MRDX would be ____
Z45.8 /Adjustment and management of other implanted devices/
93
T or F. Growth, cyst and lump don't necessarily refer to neoplastic disease.
T
94
Cystic papillomatosis, adenosis or fibrosis are classified to ___
Benign mammary dysplasia
95
The most common benign neoplastic lesion found in the breast
fibroadenoma, /Benign neoplasm of breast/
96
This report provides specific info about the morphology of excised breast tissue and must be read carefully to ensure accurate code assignment
pathology report
97
Breast cancer arising from the epithelial lining of the large or intermediate-sized ducts
ductal
98
Breast cancer arising from the epithelium of the terminal ducts of the lobules
lobular
99
Noninvasive intraductal, noninfiltrating intraductal, ductal carcinoma in situ and lobular in situ are classified to ___
carcinoma in situ
100
If pathology report indicates both infiltrating carcinoma and ca in situ of ___ sites, separate codes are assigned
noncontiguous
101
Lower inner quadrant of right breast
4: 00
5: 00
102
Lower inner quadrant of left breast
7: 00
8: 00
103
Primary malignancy in which there is more than one tumor of non-contiguous sites all of which have formed separately from one another; tumors likely to be in different quadrants of breast
multicentric
104
Primary malignancy when more than one tumor arises from one original tumor; same quadrant of breast
multifocal
105
T or F. Multicentric/multifocal tumors are classified separately
T
106
What codes are mandatory when a patient has had a previous mastectomy and now has a new malignancy in their other breast?
1. /Acquired absence of breast/
| 2. /Personal history of malignant neoplasm/
107
For mastectomies, add a code for axillary node excision only if there is a _____
separate incision
108
Tattoing of areola/nipple is found under ____
repair, nipple
109
"Raised skin flaps" mean there was enough skin left to close the incision
T
110
What is the MRDx for breast reductions?
N62, with functional pain coded as type 3
111
If there is an abnormality that requires breast augmentation, what is the MRDx?
code for the abnormality
112
Free flaps are also know as ___
TRAM flaps
