Musculoskeletal System

A physician designed and prepared prosthesis for palatal lift prosthesis. How should you report the physician’s professional service for this process?

• a. 21083

• b. 21083 - 26

• c. L9900

• d. L8699-26

Answer explanation

Palatal lift prosthesis ke design aur preparation ke liye CPT code 21083 use hota hai.
Ye code physician ke professional service ko represent karta hai – impression, model making, try-in, adjustment, aur fitting included hote hain.

• CPT Professional Edition ke Index me agar aap “Impression” > “Maxillofacial” > “Palatal Lift Prosthesis” search karte ho, to aapko 21083 milta hai.

• Code 21076–21089 range ke under aate hain maxillofacial prosthetics, jo already physician’s service cover karte hain, isliye modifier 26 lagane ki zarurat nahi hoti.

Options Breakdown:

• 21083 ✅ = Correct code for full professional service of palatal lift prosthesis.

• 21083-26 ❌ = Modifier 26 unnecessary, kyunki service already physician-based hai.

• L9900 ❌ = HCPCS code for miscellaneous prosthetic services — yahan apply nahi hota.

• L8699-26 ❌ = Also HCPCS for unspecified prosthetic — incorrect for professional service.

The patient presented for medial meniscal tear left knee. Arthroscopy with partial medial menisectomy left knee and arthroscopic picking (drilling pick holes) of the lateral femoral condyle left knee was performed. Code the procedure and diagnosis codes.

• 29880-LT, 29879-51-LT, S89.212A

• 29881-LT, 29879-51-LT, S89.212A

• 29882-LT, 29885-51-LT, S89.219A

• 29881-RT, 29885-51-LT, S89.219A

Answer explanation

The patient presented with a medial meniscus tear in the left knee.
Patient ko left knee me medial meniscus ka tear tha, jo ek common joint injury hai.

Arthroscopy was performed on the left knee.
Left knee par arthroscopy ki gayi — ek minimally invasive procedure jisme camera aur small tools use kiye jaate hain joint ke andar dekhne aur repair karne ke liye.

During the procedure, a partial medial meniscectomy was done.
Procedure ke dauraan medial meniscus ka partially removal kiya gaya — yaani sirf damaged part nikala gaya, pura meniscus nahi.

In addition, arthroscopic picking (drilling of small holes) was done on the lateral femoral condyle.
Iske alawa lateral femoral condyle (ghutne ke outer side femur ka end part) me chhoti chhoti holes drill ki gayi, jise picking ya microfracture technique kehte hain — cartilage healing ke liye kiya jaata hai.

CPT code 29881-LT is assigned for arthroscopic partial meniscectomy on the medial meniscus of the left knee.
29881-LT code diya jaata hai jab medial ya lateral meniscus ka partial removal hota hai — is case me medial side affected thi, aur left knee tha, isliye LT modifier laga.

CPT code 29879-51-LT is used for the arthroscopic drilling/picking of the lateral femoral condyle.
29879 code cartilage drilling ke liye hota hai, aur kyunki ye second procedure tha, isliye modifier -51 lagta hai (multiple procedure indicator). LT lagta hai kyunki side left knee hai.

The diagnosis code is S89.212A, which indicates a partial medial meniscus tear in the left knee, initial encounter.
Diagnosis ke liye S89.212A code lagta hai — jo batata hai ki patient ko left knee me medial meniscus tear hua hai, aur yeh pehla treatment (initial encounter) hai.

Final correct coding combination is: 29881-LT, 29879-51-LT, S89.212A.
Yeh tino codes procedure aur diagnosis ko accurately represent karte hain.

Patient complains of chronic/acute arm and shoulder pain following bilateral carpal tunnel surgery. Patient is followed by pain management for over a year. Physician finally diagnoses patient with reflex dystrophy syndrome (RSD). Physician performs six trigger point injections into four muscle groups. Code the procedure(s).

• 20552

• 20553 x 6

• 20551 x 6

• 20553

Answer explanation

Patient complains of chronic or acute arm and shoulder pain after undergoing bilateral carpal tunnel surgery.
Patient ko dono haathon ke carpal tunnel surgery ke baad se arm aur shoulder me lagataar ya kabhi kabhi teekhi pain ho rahi thi.

Pain management specialist has been following the patient for over a year.
Patient pain management ke under 1 saal se regular follow-up me tha, jo chronic pain condition indicate karta hai.

Eventually, the physician diagnoses the patient with Reflex Sympathetic Dystrophy (RSD).
Lambi observation ke baad doctor ne diagnosis diya: Reflex Sympathetic Dystrophy Syndrome (RSD) — jo ek chronic pain condition hoti hai, nerve injury ke baad develop hoti hai.

To treat the pain, the physician performs six trigger point injections into four muscle groups.
Pain relief ke liye doctor ne patient ke sharir ke 4 muscle groups me total 6 injections diye — jise trigger point injections kehte hain. Trigger points wo areas hote hain jahan muscle tight ya spasm me hota hai.

Trigger point injections are coded based on number of muscle groups, not number of injections.
CPT guidelines ke mutabiq, trigger point injection coding muscle groups ke count par hoti hai, na ki injection ke count par.

Since injections were given into 4 or more muscle groups, correct CPT code is 20553.
Jab 3 ya usse zyada muscle groups me trigger point injection diya jaata hai, tab 20553 code lagta hai.

Code Option C (20551 x 6) galat hai kyunki woh tendon origin ke liye hota hai, trigger point ke liye nahi — isliye eliminate kar diya jaata hai.

Final correct CPT code: 20553

Ye code single line me 4+ muscle groups ko represent karta hai, chahe injections kitne bhi hoon.

A Grade I, high velocity open right femur shaft fracture was incurred when a 15-year-old female pedestrian was hit by a car. She was taken to the operating room within four hours of her injury for thorough irrigation and debridement, including excision of devitalized bone. The patient was then reprepped, redraped, and repositioned. Intramedullary rodding was then carried out with proximal and distal locking screws. What are the correct codes for this diagnosis and procedure?

• 27506, 11044-51

• 27506, 11012-51

• 27507, 11012-51

• 27507, 11044-51

Answer explanation

A 15-year-old female pedestrian sustained a Grade I high-velocity open fracture of the right femur shaft after being hit by a car.
(15 saal ki ladki ko car ne takraaya, jisse uske right femur ka Grade I open fracture ho gaya — yani bone skin ke bahar tak exposed thi, par contamination ya soft tissue damage minimal tha.)

She was taken to the operating room within four hours for thorough irrigation and debridement, which included excision of devitalized bone.
(Injury ke 4 ghante ke andar patient ko operation theatre le jaya gaya, jahan zakhm ko achhi tarah se wash (irrigation) aur safai (debridement) ki gayi.
Dead ya damaged bone (devitalized bone) ko bhi nikaala gaya, jo deeper level ka debridement hota hai.)

After initial cleaning, the surgical area was reprepped, redraped, and patient was repositioned.
(Debridement ke baad surgical area ko dubara prep aur sterile drape kiya gaya, aur patient ko nayi surgical position me laya gaya.)

Then, the surgeon performed intramedullary rodding with proximal and distal locking screws.
(Iske baad intramedullary rod (ek metal rod jo femur ke andar daali jaati hai) lagayi gayi, jisme upar (proximal) aur neeche (distal) dono taraf screws se lock kiya gaya )— yeh procedure femur fracture ko stabilize karta hai.

CPT code 27506 is used for open treatment of femoral shaft fracture with intramedullary fixation (with screws/rod).
Yeh code femur shaft ke fracture ke open surgical repair ke liye hai, jisme intramedullary rod aur screws use kiye jaate hain — is case me same procedure hua tha.

CPT code 11012 is the correct code for debridement of open fracture with excision of bone/tissue.
Debridement me bone tak ka kaam kiya gaya tha, isliye superficial debridement ka code (jaise 11044) galat hoga.
11012 open fracture ke saath extensive cleaning aur bone removal ko represent karta hai.

Modifier -51 is applied on the second code to indicate multiple procedures.
Do procedure ek hi session me perform kiye gaye, isliye second CPT code pe -51 modifier lagta hai.

Final Correct Answer: 27506, 11012-51

Yeh dono codes is surgical scenario ko accurately represent karte hain.

https://www.youtube.com/watch?v=OuPecrbui3M

Dr. Roy completed a deep transfer of the anterior tibial and flexor digitorum tendons. Which codes should be used to report this procedure?

• a. 27658 x2

• b. 27690, 27692-51

• c. 27691, 27692

• d. 27691, 27692 x2

Answer explanation

Dr. Roy performed a deep tendon transfer of two tendons: the anterior tibial tendon and the flexor digitorum tendon.
(Dr. Roy ne patient ke anterior tibial aur flexor digitorum tendons ka deep transfer surgery kiya — iska matlab hai tendons ko unki original jagah se hata kar naye functional position me shift karna to restore movement or strength.)

For coding purposes, CPT code 27691 is used for tendon transfer of the anterior tibial tendon, which is a primary deep tendon transfer procedure.
(Anterior tibial tendon ka deep transfer primary tendon transfer maana jaata hai, jiska code hota hai 27691.)

CPT code 27692 is an add-on code used for each additional tendon transfer in the same surgical field, such as the flexor digitorum tendon in this case.
(Flexor digitorum tendon bhi transfer hua, jo ek additional tendon hai, isliye 27692 code lagega. Ye ek add-on code hai jo primary code ke saath hi lagta hai, alag nahi.)

Add-on codes like 27692 never use modifier -51, because they are inherently linked to the primary procedure and are not separately reportable or reduced services.
(Modifier -51 (multiple procedures) add-on codes par nahi lagta — kyunki unka use tab hota hai jab ek se zyada major procedures kiye jaate hain. Add-on codes already dependent hote hain primary code par.)

(Is case me sirf ek primary tendon transfer hua (anterior tibial) aur ek additional tendon transfer hua (flexor digitorum). Isliye ek 27691 aur ek 27692 ka use sahi coding hai.)

Final Correct Answer: c. 27691, 27692

Yeh combination accurately represent karta hai ki ek primary aur ek additional deep tendon transfer kiy

26 yr old female suffered a burst fracture to her lumbar spine during a skiing accident. Dr. Phyllis performed a partial corpectomy to L2 by a transperitoneal approach followed by anterior arthrodesis of L1-L3. She also positioned anterior instrumentation and placed a structural allograft to L1-L3. How would Dr. Phyllis report this procedure?

• 63090, 22558-51, 22585, 22845, 20931

• 63085, 22533, 22585-51, 22808-59

• 22612 x 2, 22808, 22840-51, 20931

• 22558, 22858-51, 22845-51, 20931-59

Answer explanation

A 26-year-old female suffered a burst fracture in her lumbar spine due to a skiing accident.
26 saal ki ek female ko skiing ke dauraan lumbar spine me burst fracture ho gaya — burst fracture ka matlab hota hai vertebra ka explode ya compress ho jaana due to trauma.

Dr. Phyllis performed a partial corpectomy at L2 using a transperitoneal (anterior) approach.
Dr. Phyllis ne L2 vertebra par partial corpectomy ki — yani vertebra ka ek hissa surgically nikaala gaya. Yeh approach anterior se tha, yani pait ke raste se (transperitoneal).

She then performed anterior arthrodesis of L1-L3.
Iske baad unhone L1 se L3 tak anterior arthrodesis kiya — arthrodesis ka matlab hai do ya zyada vertebrae ko fuse kar dena taaki movement na ho aur stability mile.

She also placed anterior instrumentation and a structural allograft from L1 to L3.
Uske baad unhone metal rods/screws (instrumentation) ko spine ke samne ke hisson me lagaya, aur ek structural allograft (donor bone) bhi place kiya spinal fusion ke liye.

Now let’s decode the correct coding step-by-step.

Option A:

• 63090 = Corpectomy (partial) of lumbar vertebra via anterior approach

• 22558-51 = Anterior spinal fusion (arthrodesis), lumbar

• 22585 = Add-on code for additional level of fusion (L3)

• 22845 = Anterior instrumentation

• 20931 = Structural allograft

All components match the operative procedure:

• Corpectomy (primary procedure)

• Anterior arthrodesis from L1–L3

• Instrumentation

• Structural allograft

• All done via anterior (transperitoneal) approach

Why not other options?

• Option B: Uses code 22533, which is for extra-cavitary (lateral) approach, not anterior — so incorrect.

• Option C: Uses 22612, which is for posterior approach, while our approach was clearly anterior — also incorrect.

• Option D: Includes 22858, which is for total disc arthroplasty, not applicable here. Also, 22558 and 22858 are bundled codes, and modifier -51 shouldn’t be applied to add-on codes like 22845 and 20931.

Therefore, based on procedural accuracy and correct coding guidelines:

A patient suffered a fracture of the femur head. He had a Hemiarthroplasty of left femur had with a replacement using a Medicon alloy femoral head and methyl methacrylate cement. How would you report this procedure?

• 27236-LT

• 27235-LT

• 27125-LT

• 27130-LT

Answer explanation

A patient suffered a fracture of the femoral head.
(Patient ko femur ke head (upper end of thigh bone) ka fracture hua — jo hip joint ka part hota hai.)

He underwent hemiarthroplasty of the left femoral head, with replacement using a Medicon alloy femoral head and methyl methacrylate cement.
(Uska treatment hemiarthroplasty se kiya gaya — yaani femur head ko remove karke artificial prosthesis (Medicon alloy) se replace kiya gaya.
Is prosthetic ko cement (methyl methacrylate) se fix kiya gaya — jo surgical fixation technique hai.)

Now, let’s evaluate CPT coding logic.

CPT code 27125 is defined as: Hemiarthroplasty, hip, partial (femoral head only) — generally used for non-fracture indications, such as arthritis or necrosis.
27125 tab use hota hai jab fracture nahi ho, aur sirf joint disease ya damage ke wajah se hip replacement kiya jaye.

But this case involves a fracture of the femoral head — and CPT guidelines clearly state that if hemiarthroplasty is done due to fracture, then you should use CPT 27236 instead.

CPT 27236 includes both open treatment of femoral fracture and prosthetic replacement.
Yeh code specifically fracture ke cases ke liye bana hai jisme joint replacement bhi kiya jaata hai.

Modifier -LT is applied since the procedure was done on the left femur.

So, even though 27125 describes "femoral head replacement," CPT directs us to use 27236 when the replacement follows a fracture — which is the exact scenario here.

Correct Answer: A) 27236-LT

Yeh code fracture ke baad ki gayi hemiarthroplasty with prosthesis ko properly represent karta hai.

What CPT and modifier should you report when the same physician provided a re-reduction of ulnar styloid fractur without incision?

• 25650-76

• 25650-78

•  25651-77

• 25651-58

Answer explanation

The patient had a fracture of the ulnar styloid and needed a re-reduction performed by the same physician.
Patient ke ulnar styloid bone (jo wrist ke paas hoti hai) ka fracture tha. Is fracture ka dobara reduction (re-reduction) kiya gaya — aur ye procedure same doctor ne kiya.

The procedure was done without an incision, which means it was a closed reduction.
Kyuki procedure bina incision ke hua, iska matlab yeh closed technique thi — yaani andar se haddi ko sahi position me laaya gaya, bina cut kiye.

CPT code 25650 represents: Closed treatment of distal ulnar fracture (e.g., styloid),
Lekin jab manipulation (reduction) hota hai, sahi code hota hai 25651: Percutaneous skeletal fixation of ulnar styloid fracture 

In this case, re-reduction indicates manipulation was done, so 25650 is correct base code.

Now let’s understand which modifier to use.

Modifier -76 is used when the same physician repeats the same procedure on the same patient.
Yahan same doctor ne dobara wahi procedure kiya (reduction), isliye modifier -76 lagta hai.

Other modifiers:

• -77 = Repeat procedure by another physician → not applicable here

• -78 = Return to OR for related procedure → not relevant as this was closed, not operative

• -58 = Staged or related procedure during post-op period → not suitable as this wasn’t staged or planned in advance

So based on CPT guidelines for musculoskeletal system (introductory notes in the CPT book), re-reduction by same physician without incision is coded with:

Correct Answer: A) 25650-76

Yeh code re-reduction ko represent karta hai jab same physician bina incision ke dubara reduction karta hai — aur CPT officially is situation me modifier -76 recommend karta hai.

While playing at home, Riley dislocated his right patella, when he fell from a tree. The surgeon documented an open dislocation. Riley underwent a closed treatment under anesthesia. How would you report the treatment?

• 27420-RT

• 27562-RT

• 27842-RT, 27562-RT,51

• 27566-RT

Answer explanation

Riley dislocated his right patella (kneecap) after falling from a tree while playing.
(Riley ped se girne ke baad uske right side patella (ghutne ki haddi) ka dislocation ho gaya — yaani haddi apni jagah se hil gayi thi.)

The surgeon documented that it was an open dislocation.
(Surgeon ne document kiya ki yeh open dislocation tha — yaani joint dislocate hone ke saath skin bhi phat gayi thi ya andar ke structures visible the.)

However, Riley underwent a closed treatment under anesthesia.
Lekin treatment closed method se kiya gaya — yani bina incision ke, under anesthesia, patella ko wapas apni jagah par set kiya gaya.

Now based on CPT coding logic:

The dislocation was in the patella, not in the ankle — so Option C, which includes 27842 (ankle dislocation treatment), is incorrect.

Option A (27420) is for open surgical repair or reconstruction of patella dislocation, which wasn’t done — so this is also incorrect.

Option D (27566) is for open treatment of patella dislocation — but again, procedure yahan closed treatment tha, so this too is eliminated.

CPT code 27562 represents:
Closed treatment of patellar dislocation; requiring anesthesia
This matches exactly with Riley’s case — the treatment was closed and done under anesthesia.

Modifier -RT is applied to indicate the right knee.

Correct Answer: B) 27562-RT

Mike had a bicycle accident and suffered deep hematomas in both knees. He underwent a bilateral incision and drainage. How would you report the procedure?

• 27301-50

• 10040

• 10040

• 27301-RT, 27301-LT

Answer explanation

Mike had a bicycle accident and developed deep hematomas in both knees.
(Mike ko cycle se girne par dono ghutnon me deep hematomas ho gaye — yaani andar ke tissue me blood collect ho gaya tha (internal bruising or blood pooling).

He underwent a bilateral incision and drainage.
(Uska treatment incision and drainage (I&D) procedure se hua — yaani doctor ne cut laga kar andar ka blood ya pus drain kiya.
Bilateral ka matlab hai — yeh procedure dono knees par perform kiya gaya.)

CPT code 10040 is for superficial I&D of acne-like lesions, not deep tissue — so it is inappropriate here.
(10040 code sirf superficial ya surface-level lesions ke liye hota hai, jaise acne — lekin yahan deep hematoma tha, isliye Option B galat hai.)

CPT code 27303 is for incision and drainage at the bone level — which is not mentioned in the scenario.
Is case me sirf soft tissue (hematoma) mention kiya gaya hai, bone involvement nahi hai, isliye Option C bhi galat hai.

CPT code 27301 is correct for incision and drainage of deep abscess or hematoma in the soft tissues of the thigh or knee region.
27301 code deep I&D ke liye hota hai, jab hematoma ghutne ke andar ya surrounding soft tissue me ho.

Since procedure was done on both knees, we apply modifier -50 to indicate a bilateral procedure.
Dono sides par same procedure hua hai, isliye modifier -50 lagate hain instead of repeating the code for each side.

Using 27301-50 is more accurate and efficient than writing 27301-RT + 27301-LT, and is preferred when both sides are treated in the same session.

Correct Answer: A) 27301-50