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Exam 14: Respiratory System

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Question 1

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Surgical thoracoscopy with pleurodesis. CPT Code: ____________________

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Excision of a cervical tracheal tumor. CPT Code: ____________________

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Match each term with the correct phrase below. -Lavage

Irrigation of the sphenoid sinus. CPT Code: ____________________

In what Surgery subsection would you find the code for the incision and drainage of a nasal abscess using an external approach to the abscess?

Location: Outpatient Hospital BRONCHOSCOPY REPORT INDICATION FOR THE PROCEDURE: Patient with chronic emphysema and chronic obstructive pulmonary disease and a significant smoking history. PROCEDURE: Bronchoscopy procedure PREPROCEDURE MEDICATIONS: Atropine 0.5 mg and codeine 60 mg intramuscularly, and then also hydroxyzine. Topical anesthesia was applied with cocaine mix along with the Lidocaine topically into the throat. He was lying supine in the fluoroscope unit and with video monitoring, the bronchoscope was introduced through the nose and into the upper airway. The vocal cords were visualized. There were no endobronchial lesions noted. The vocal cords were moving equally with phonation and respiration. The bronchoscope was introduced through the vocal cords and negotiated into the trachea; the left upper lingula and lower lobe branches were visualized. No endobronchial lesions were noted. The right main, middle, lower, and upper lobe bronchi up to subsegmental branches were visualized; no endobronchial lesions were noted either. The procedure was uneventful. He did not have any significant cough during the procedure. CPT Code: ____________________

A chest tube may be used as an indwelling method of draining the accumulated fluid in the pleural space.

Using an existing tracheostomy incision, the physician places a bronchoscope through the incision to view the airway (tracheobronchoscopy). CPT Code: ____________________

The name of the procedure in which mucus is removed from the sinuses by flushing a saline solution through the sinus cavities is ____ therapy. For example, the Proetz procedure (saline irrigation combined with suction) .

The term that describes obtaining a tissue sample is:

Match each term with the correct phrase below. -Tracheoplasty

Surgical thoracoscopy with excision of pericardial tumor. CPT Code: ____________________

Percutaneous introduction of a needle wire dilator to provide for insertion of an indwelling oxygen tube. CPT Code: ____________________

Location: Outpatient Hospital OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Septal deviation. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Septoplasty. OPERATIVE NOTE: The patient was admitted through the same-day surgery department and taken to the operating room and was administered general anesthetic by intravenous injection and was intubated endotracheally. His nose was decongested with 4 cc of 4% cocaine solution on nasal pledgets. A small amount of Afrin was also used. The patient was draped in the usual fashion. The packing was then removed and the left septum was injected with 1% lidocaine with epinephrine. A left hemitransfixion incision was created with a Beaver blade and a mucoperichondrial flap was elevated on this side; this was extended posteriorly over the perpendicular plate of ethmoid and vomer, extended inferiorly over a septal spur. We then separated the bony and cartilaginous septum to elevate it on the opposite side. We elevated on either side of the maxillary crest. A 4-mm osteotome was used to remove this. A portion of inferior cartilage was also removed. Once this was completed we laid the mucosa back into position and the septum was nicely reduced. We closed the caudal hemitransfixion incision with interrupted 3-0 Chromic suture. The septum was closed with 4-0 plain gut suture. Doyle splints were then placed on either side of the nose. The patient was then allowed to recover from the anesthetic and taken to the postanesthesia care unit in stable condition. There were no complications during this procedure. CPT Code: ____________________

Location: Inpatient Hospital OPERATIVE REPORT INDICATION: Cardiogenic shock and the need to initiate mechanical ventilation. PROCEDURE PERFORMED: Intubation. ANESTHESIA: Versed and fentanyl. PROCEDURE: After the procedure was explained and consent was obtained from the patient's family, the patient was prepped for an endotracheal intubation. The patient was premedicated with Versed and fentanyl. After adequate anesthesia and analgesia was achieved, the patient's vocal cords were directly visualized with the aid of a laryngoscope using a Miller 3 blade. A size 8.5 endotracheal tube was then inserted and passed through the vocal cords atraumatically and without any difficulty. The CO₂ monitor did confirm correct placement of the tube. The cuff was then inflated and the tube secured around 22 cm at the lips. The patient tolerated the procedure well. There were no acute complications. A chest x-ray had been ordered to confirm correct placement of the endotracheal tube. CPT Code: ____________________

Which of the following terms does not describe the nasal turbinates?

Total pulmonary decortication. CPT Code: ____________________

A surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy.

Three-year-old Hannah is playing with a marble and sticks it in her nose. Her mother is unable to dislodge the marble so she takes Hannah to the physician's office. The physician removes the marble with hemostats. CPT Code: ____________________

Match each term with the correct phrase below. -Tracheostomy