27 Oct This 72-year-old female presented to the hospital-based urgent care clinic with a chief complaint of recurrent epistaxis for three days prior to admission.

This 72-year-old female presented to the hospital-based urgent care clinic with a chief complaint of recurrent epistaxis for three days prior to admission. The bleeding occurred in the right nostril. She also complained of weakness and dizziness when standing. At the last clinic visit, hematocrit was 35, and this morning it is 27. Her past medical history is positive for COPD with a negative surgical history. A right anterior limited nasal pack was placed in the clinic treatment room. Because of the weakness and dizziness, we decided to admit the patient to an observation bed. In the evening, the anterior pack required replacement with extensive cauterization in the right nares because of refractory bleeding. Due to falling hematocrit, two units of packed red cells were transfused for the acute blood-loss anemia resulting. The next morning, the patient was still experiencing some bleeding around the anterior nasal pack. For this reason, she was taken back to the treatment room, and a posterior nasopharyngeal pack in the right nares was placed by another physician. No further bleeding occurred throughout the day, and the patient was discharged to home healthcare follow-up following pack removal. 

Which of the following ICD-10-CM, CPT, and HCPCS codes should appear on the healthcare transaction claim for the outpatient services rendered to this Medicare patient?

a) R04.0, 30901-RT, 30903-RT, 30905-RT, 36430

b) R04.0, D62, J44.9, 30901-RT, 30901-RT-76, 30905-RT-77, P9021

c) R04.0, D64.9, 30901-RT, 30903-RT-59, 30905-RT-77, 36430, P9021(2 units)

d) R04.0, D62, J44.9, 30901-RT, 30903-RT-XE, 30905-RT-XE, 36430, P9021-BL(2 units)

8.61.  The patient is a 66-year-old male who presented to the emergency department with a two-day history of severe shortness of breath, nonproductive cough, and slight fever. His medical history includes non-small cell lung cancer in the right middle lobe, two months post-completion of radiation therapy. Surgery was contraindicated because of atrial fibrillation and the long-term use of Coumadin. The Oncologist documented that chemotherapy was not indicated in this case and felt that the tumor was eradicated. The patient also has been plagued with chronic dermatitis over the radiation port area on the right lateral chest wall following the 2nd radiation treatment. The skin continues to show the infection on an exam. A two-view chest x-ray showed consolidation in the right lower lobe of the lung. The physician diagnosed pneumonitis as an aftereffect of radiation therapy and prescribed inhaled corticosteroid. Beclomethasone Diproprionate, and long-term oral corticosteroids on a tapering dose. Which of the following is the correct coding for the diagnosis and ancillary procedures provided? 

a) J18.9, L25.1, Z85.118, W88.8XXA, 71045

b) J70.0, L59.8, I48.91, Z85.118, Z79.01, W88.8XXA, 71046

c) J70.0, L59.8, I48.91, W88.8XXA, 71048

d) J70.0, L59.8, I48.91, C34.2, Z79.01, W88.8XXA, 71047

8.62.  Preoperative Diagnosis: Chronic sinusitis

          Postoperative Diagnosis: Chronic sinusitis of the maxillary, ethmoid, and sphenoid sinuses

          Procedure: Bilateral endoscopic sinusotomies, anterior and posterior ethmoidecto-mies, and sphenoidotomy, with debris removal in all sites

Description of Operation: The patient was placed in the supine position after appropriate preparation, draping, and induction of endotracheal anesthesia. The nose was cocainized and injected with Xylocaine 2 percent with 1:100,000 epinephrine. The endoscope was then used to examine the maxillary sinus structures on the left side. There were several polyps present, and these were carefully injected with Xylocaine 0.5 percent with 1:200,000 epinephrine and removed. The maxillary sinus opening was identified by blunt dissection and was then opened, and with various rongeurs, the tissue was debrided. We then started through the posterior of the middle meatus region involving the ethmoid floors. Care was taken to preserve the parietal mucosa while performing the ethmoidectomies; the n we proceeded posteriorly and entered into the sphenoid posteriorly and inferiorly. Gelfilm was folded and placed in the areas involved. Attention was then directed to the right side in a similar fashion. Again, polyps were removed from the maxillary sinus. The uncinate was prominent and was resected, and more polyps were debrided. We then identified the maxillary sinus opening on the right and opened it in a satisfactory manner. We then proceeded anteriorly through posterior ethmoidal cells into the sphenoid cavity posteriorly, opening and removing large amounts of polyploid mucosa, polyps, and some mild purulence. When this was completed to our satisfaction, Gelfilm was folded and placed. The posterior throat was suctioned clear, and the patient was awakened and taken to recovery in good condition. 

Which of the following ICD-10-CM and CPT codes will be reported for this ambulatory surgery service?

a) J32.9, 31256-50, 31287

b) J32.0, J32.2, J32.3, J33.8, 31256-50, 31287-50

c) J32.8, J33.8, 31255-50, 31267-50, 31288-50

d) J32.8, J33.8, 31255, 31267