2 Series Class Notes Need To Take

–2 series (Musculo skeletal system) (6 question)
 Osteo -> Bone
Myelo->
Itis->
Bone to bone connected by -> ligament (BBL)

Muscle to bone connected by -> tendon (MBT)
Coding Concept:
Wound exploration -> 20100-20103
 These codes describe surgical exploration and enlargement of the wound, extension of
dissection (to determine penetration). Debridement, removal of foreign body (s), Ligation (or)
coagulation of minor subcutaneous and or muscular blood vessels of the subcutaneous tissue,
muscle fascia and (or) muscle, not requiring thoracotomy (or) laparotomy
 If they are doing repair in that doing enlarging (or) dissection like that you have to go on 2
series
 If they are doing repair but not doing enlargement (or) dissection means you have to go to 1
series codes.
1. WE+ Laparotomy=?
2. WE (not requiring enlargement of the wound, extension of dissection) + Repair=?
3. WE (requiring enlargement of the wound, extension of dissection) + Repair=?
Trigger point Injections:
20552= injection(s); single (or) multiple trigger points, 1 (or) 2 muscles
20553= single (or) multiple trigger points, 3 (or) more muscles
Coding points:
Code selection is based on how many number of muscles were injected not based on injections
Example:
1. 3 injections performed to 2 para spinal muscles
2. 3 injections performed to 3 para spinal muscles
3. Patient is having Right & left leg pain came to office physician performed trigger point injections to
right leg 3 muscles then left leg 3 muscles?
a) 20553-RT, 20553-LT b) 20552 c) 20553-50 d) 20553
Arthrocentesis: 20600-20611
Arthro = Joint
Centesis= Puncture a cavity to remove fluid
Coding point:
Location of joint
1. Small joint: fingers, toes
2. Intermediate joint: temporomandibular, acromioclavicular, wrist. Elbow or ankle, olecranon bursa
3. Major joint:' shoulder, hip, knee, subacromial bursa
Look guidance used with ultrasound (or) without ultrasound
Any other guidance: means CT, MRI, fluoroscopy?
 CT= guidance: 77012

 MRI= guidance: 77021
 Fluoroscopy= guidance: 77002
1. Arthrocentesis performed to knee with fluoroscopic guidance
2. Steroid injections performed to knee with CT guidance?
3. Aspiration of knee with MRI guidance?
4. Arthrocentesis, Knee?
Arthrocentesis/ Aspiration/ injection
Notes:
 When a joint aspiration and injections are performed on the same joint only report the
procedure once
 If the procedures are performed on more than 1 joint list each procedure separately
Hierarchy of Spin procedures
Spin procedures:
6 series -> decompression - 6XXXX
2 series -> arthrodesis - 2XXXX-51
+2 series -> Spinal instrumentation - +2XXXX
+2 series -> Bone Graft -> - +2XXXX

Decompression:
 Removing scar tissue (or) bone from area, most commonly the spine to relieve pressure
on nerve (or) nerve roots
 Discectomy/laminectomy/foraminectomy
 We have to code from 6 series code ranges 63001-63048
 It is often performed on placement on bone graft, screw, plates, rods to maintain the
alignments of the bone
Q1. Partial Vertebral corpectomy to L2, L3 by, trans peritoneal approach
Arthrodesis:
 Fusion of Joints
Anterior Posterior
22548 - 22586 22590 - 22634
Spinal bones:
Cervical- 7
Thoracic- 12
Lumbar- 5
Sacral- 5
What is inter space?
 In between spaces of two vertebrae (e.g) L1-L5 a inter spaces = 4
What is segments?
Each bone= 1 segments (e.g) L1-L5 = 5
1. Anterior arthrodesis performed to L1-L4?
Ans:
Example:
Partial corpectomy to L2 by thoracolumbar approach, anterior arthrodesis performed to L1-L3, anterior

instrumentation segmental performed to L1-L3 and structural allo graft performed?
Fracture: Broken of bone
As per we have 2 types. 1) Traumatic 2) Pathologic
Traumatic: Pathologic:
1) Open 1) Open
2) Close 2) Close
As per ICD:
 Traumatic/Non Traumatic (Pathological)
 Open/closed
 Displaced/Non Displaced
 Location (Which bone)
 Specific site of the bone
o Distal: Lower end
o Proximal: Upper end
o Shaft: Middle
 Type of encounter
As per CPT 3 methods
1) Closed
2) Open Treatment
3) Percutaneous
Closed:
 Bone not came out from skin
Open:
 Bone came out through skin
Closed:
 Closed treatment Closed treatment with manipulation

Without manipulation (another another name Restorative care (or) Reduction
Name Definitive care)
Closed treatment without manipulation
 Fracture confirmed by x-ray(TYPE of fracture)

 MD should examine the fractured site after apply the supporting care
 Splints, cast, strapping, buddy tape, sling, immobilizer
Closed treatment with manipulation/ Restorative care/ manipulation/ reduction
 Fracture confirmed by x-ray(TYPE of fracture)

 Reduction/Restored displaced bone in original position by method
 MD should examine the fractured site after apply the supporting care
 Splints, cast, strapping, buddy tape, sling, immobilizer
 Splints, cast, strapping, buddy tape, sling, immobilizer should not code in (active) initial
care of fracture.
 Follow up visits can code splint, cast separately.
Definitive care:
 He is not restoring original position MD only give supporting care through splints, cast, strapping
Displaced Fracture:
 Bone is moved from original position
Non-displaced fracture:
 Fracture happens but will not move from original position
Percutaneous:
 Treatment given through way of the skin
Open treatment:
Used when fracture bone is either (or) surgically opened (exposed to the external environment) and the
fracture (bone ends) visualized and internal fixation may the fracture bone is opened remote fracture
site in order to insert an intramedullary nail across the fracture site (the fracture site is not opened and
visualized)
Percutaneous treatment:
Percutaneous pinning is a way to support unstable fractures (breaks). “Percutaneous” means “through
the skin.” When the patient is asleep, a surgeon will reduce (set) the fracture. The doctor will insert pins
to hold the fracture in position until the bone is healed.
EM/ED+FRACTURE
99XXX-57
Fracture-54-RT/LT
EM/ED+SPLINT
99XXX-25
2XXXX-RT/LT
Direct questions:
1. Removal of implant Deep?

2. Removal of implant Superficial?
3. Application of uniplane in external fixation system?
4. Application of Multiplane in external fixation system?
5. Lipoma excision in thigh 3.5cm to subcutaneous tissue?
6. Lipoma excision in thigh 7cm to subfascial?
7. Arthroscopy TMJ with diagnostic?
8. Arthroscopy TMJ with surgical?
9. Arthroscopy shoulder with partial synovectomy?
10. Arthroscopy hip with femoroplasty?
11. Arthroscopically aided anterior cruciate ligament repair?
12. Arthroscopy; Knee, surgical; with meniscus repair of medial?

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–2 series (Musculo skeletal system) (6 question)

 Osteo -> Bone

Bone to bone connected by -> ligament (BBL)

Wound exploration -> 20100-20103

Trigger point Injections:

20552= injection(s); single (or) multiple trigger points, 1 (or) 2 muscles

20553= single (or) multiple trigger points, 3 (or) more muscles

1. 3 injections performed to 2 para spinal muscles

2. 3 injections performed to 3 para spinal muscles

a) 20553-RT, 20553-LT b) 20552 c) 20553-50 d) 20553

Centesis= Puncture a cavity to remove fluid

1. Small joint: fingers, toes

2. Intermediate joint: temporomandibular, acromioclavicular, wrist. Elbow or ankle, olecranon bursa

3. Major joint:' shoulder, hip, knee, subacromial bursa

Look guidance used with ultrasound (or) without ultrasound

Any other guidance: means CT, MRI, fluoroscopy?

 CT= guidance: 77012

1. Arthrocentesis performed to knee with fluoroscopic guidance

2. Steroid injections performed to knee with CT guidance?

3. Aspiration of knee with MRI guidance?

Hierarchy of Spin procedures

6 series -> decompression - 6XXXX

2 series -> arthrodesis - 2XXXX-51

+2 series -> Spinal instrumentation - +2XXXX

+2 series -> Bone Graft -> - +2XXXX

Q1. Partial Vertebral corpectomy to L2, L3 by, trans peritoneal approach

22548 - 22586 22590 - 22634

What is inter space?

 In between spaces of two vertebrae (e.g) L1-L5 a inter spaces = 4

Each bone= 1 segments (e.g) L1-L5 = 5

1. Anterior arthrodesis performed to L1-L4?

Partial corpectomy to L2 by thoracolumbar approach, anterior arthrodesis performed to L1-L3, anterior

Fracture: Broken of bone

As per we have 2 types. 1) Traumatic 2) Pathologic

As per CPT 3 methods

 Bone not came out from skin

 Bone came out through skin

 Closed treatment Closed treatment with manipulation

Closed treatment without manipulation

 Fracture confirmed by x-ray(TYPE of fracture)

Closed treatment with manipulation/ Restorative care/ manipulation/ reduction

 Fracture confirmed by x-ray(TYPE of fracture)

 Bone is moved from original position

 Fracture happens but will not move from original position

 Treatment given through way of the skin

1. Removal of implant Deep?

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