Pearson CPC New Attempt

A tympanoplasty repairs aperforated tympanic membrane. The key phrase “doesnotremove the mastoid” means this istympanoplasty without mastoidectomy, which is correctly represented by69631in the answer set. Codes that include mastoid work (or represent different tympanoplasty variants) are incorrect because the documentation explicitly states the mastoid was not removed. Diagnosis coding should reflect both thechronic otitis mediaand theperforation. In the options,H66.92represents otitis media (as offered) andH72.92represents perforation of the tympanic membrane (as offered). Although the clinical story specifies the left ear, the provided diagnosis options do not include laterality; on CPC-style questions, you choose the best match among the answer choices. Therefore, the correct combination within this question’s choices is69631 with H66.92 and H72.92, matching tympanoplasty without mastoidectomy plus the documented conditions.

1. Procedure and CPT® Code Selection:

The patient requires a surgical nasal sinus endoscopy to repair a cerebrospinal fluid (CSF) leak caused by a skull fracture that resulted in CSF draining into the nasal passage.

Code 31291 is the correct CPT® code for an endoscopic repair of a cerebrospinal fluid leak in the sphenoid sinus. This procedure code is appropriate because it specifically addresses surgical endoscopy for CSF leak repair in the sinus region.

Other codes provided, such as 31287 (nasal/sinus endoscopy with balloon dilation) and 31235 (nasal endoscopy with biopsy), do not match the description for surgical repair of a CSF leak and are therefore inappropriate for this case.

2. Diagnosis and ICD-10-CM Code Selection:

ICD-10-CM Code S02.19XA is used to describe a fracture of the anterior cranial base, which fits the described injury of the skull with cerebrospinal fluid leakage.

External cause code V47.5XXA is used for motor vehicle accidents involving a car hitting a stationary object.

Y92.411 is the appropriate code to describe the location of the accident as a highway.

3. Exclusion of Additional Procedure Codes:

There is no need for a second endoscopy code or a modifier, as 31291 fully describes the endoscopic repair procedure for the CSF leak.

4. AAPC and CPT® Coding Guidelines:

Per AAPC guidelines, procedure codes for sinus endoscopy are chosen based on the specific type of intervention (e.g., CSF leak repair). The guidelines for ICD-10-CM stress including external cause codes and location codes for trauma cases related to motor vehicle accidents.

Thus, the correct answer based on CPT® and ICD-10-CM coding standards is B. 31291, S02.19XA, V47.5XXA, Y92.411.

The clinical scenario involves a diagnostic angiography (not separately reportable in this case as the therapeutic intervention occurs in the same session and the diagnosis is already known) and a percutaneous transluminal angioplasty (PTA) with stent placement in the left iliac artery.

To code this correctly:

CPT Code 37267: Transluminal stent placement(s), includes angioplasty within the same vessel, when performed; iliac artery.

This code includes the angioplasty if it is performed in the same vessel as the stent (which is true here — both procedures are done in the left iliac artery).

Since angioplasty is inherent to the stenting (to open the narrowed vessel before stent placement), only the stent code is reported.

No need to report angioplasty separately (e.g., 37263) when performed in the same vessel as the stent.

Other options explained:

A. 37267, 37263 – Incorrect. 37263 (angioplasty in the iliac artery) would only be reported if angioplasty was done in a separate iliac artery segment without stenting. Reporting both codes for the same vessel would be unbundling and against CPT/NCCI guidelines.

B. 37258, 37254 – Incorrect. These codes relate to renal artery procedures, not iliac artery.

C. 37258 – Also incorrect, as this refers to renal stent placement, not iliac.

Official CPT® Guideline Reference:

In the CPT® manual (Category I codes, 37220–37235), specific instructions state that angioplasty is included when performed in the same vessel as a stent and should not be reported separately.

For a follow-up examination after the removal of polyps with no new polyps found, the appropriate diagnosis codes are:

Z09: Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm.

Z86.010: Personal history of colonic polyps.

Using Z09 indicates that the follow-up exam is to check the patient after treatment, and Z86.010 indicates a history of colonic polyps, which is relevant to the patient's medical history.

ICD-10-CM guidelines

AMA's CPT® Professional Edition (current year)