HIM 215 Test 2 Part 2

rad2329's version from 2017-03-02 16:44

Section 1

Question Answer
What are the repair factors in wound repair?length, complexity (listed in description, i.e. simple, intermediate, complex), and site
**What is a simple wound repair?Requires only one-layer of suturing, it is superficial, epidermis, dermis, and subcutaneous tissue, measured prior to closure (end to end)
*Dermabond codes to repair for ?Third Party Payers
Only closures that use ____, ____, and _____ are documented with codes. Closure using _____ would not result in the use of a repair code.sutures, staples, tissue adhesive, adhesive tape
**What is an intermediate repair?layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia with skin closure. Single-layer closure can be coded as intermediate if extensive debridement required
**What is a complex wound repair?Greater than layers (exp. scar revision, complicated debridement, extensive undermining, stents, extensive retention sutures)
Wound repair codes include what three main components of a repair:Simple ligation of vessels in an open wound - Simple exploration of nerves, blood vessels, and exposed tendons - Normal debridement
When are additional codes for debridement reported?Gross contamination - Appreciable devitalized/contaminated tissue must be removed to expose healthy tissue
Wound repairs should be grouped by ?Complexity (simple, intermediate, complex) and location/anatomical site (face, ears, nose, etc).
1 inch = 2.54 cm

Section 2

Question Answer
Correct coding of grafts requires knowledge of the ?type of graft (adjacent, free, flap, etc) - donor site - recipient site - any repair to donor site - size - material used (any extra material, i.e. mesh, anything man made)
Split-thickness graft:epidermis and some dermis
Full-thickness graft:Epidermis and all dermis
*Graft type skin substitue:Artificial skin (bilaminate skin substitute)
*Graft type Allograft or Autograft: Donor graft - Tissue cultured epidermal grown using donor cells
*Graft type Xenograft:Nonhuman donor (also called heterografts)
Free skin grafts are ?split-thickness or full-thickness (completely freed from donor site - placed on recipient site)
Flaps leave at least _____ side of the flap intact to _____one, retain blood supply to the graft keeping it viable.
What site is used as the basis for coding a transfer of flaps? from the donor to the recipient site, coding is based on the recipient site.
Donor site may be far from recipient site and flaps may be done in ?stages

Section 3

Question Answer
Explain formation of flap -Based on location: trunk, scalp, nose, etc.
Explain transfer of flap -Previously placed flap released from donor site, also known as walking or walk up of flap
Flap repairs made with ?Muscle, muscle and skin, fasica and skin
How are flap codes divided?location (i.e. trunk, extremity)
Treatment for a pressure ulcer (15920-15999) consists of ?excision of the ulcerated area to the depth of unaffected tissue, fascia, or muscle.
Codes for pressure ulcers are categorized in terms of ?location, type, and extent of closure required.
Many pressue ulcers code with ?ostectomy (bone removal)
*List the pressure ulcer locations:Coccygeal (end of spine), Sacral (between hips), Ischial (lower hip), Trochanter (femur)
What is the main cause of a pressure ulcer? Decreased blood flow to the tissue in the area of pressure, which causes the tissue to die
What is the rule of nine?Method to calculate the percentage of body area burned in an adult

Section 4

Question Answer
When documenting burns, report both the ?percentage of the body’s surface area affected by the burn (using the Rule of Nines or the Lund-Browder chart) and the depth of the burn (first/second/third degree) because these two characteristics together reveal the severity of the burn and its recommended treatment.
Rule of Nines for Adults - Small = ?< 5%
Rule of Nines for Adults - Medium = ?5-10%
Rule of Nines for Adults - Large = ?> 10%
Proportions of burns for children are based on ?Lund-Browder scale
Burns often require multiple debridement and redressing, they are based on ?Initial treatment, size and report percent of burn and depth
Destruction of lesions with the use of means other than excision is?Ablation (i.e. laser, electrosurgery, cryosurgery, chemosurgery etc) - benign/premalignant or malignant tissue - based on location and size
What is Mohs micrographic surgery, and how is it used? a procedure in which the surgeon uses a special microscope to view a lesion and, if it is determined to be malignant, to remove it layer by layer until all malignant cells have been removed.
With the Mohs Microscope the surgeon acts as both ?pathologist and surgeon
With the Mohs Microscope codes are based on ?location, stages, and number of specimens stated in report

Section 5

Question Answer
Regarding introduction, Markers are placed preoperatively to identify the ?exact location of the lesion
Breast procedures are divided based on procedure, such as?incision, Excision, Introduction, Mastectomy procedures, Repair and/or reconstruction
What are the four types of masectomy's?Simple - Modified - Radical - Partial
Mastectomies are based on ?Extent of procedure (For bilateral use -50)
Musculoskeletal System subsections reflect _____ , within each anatomical site, subheadings reflect ______anatomical site, procedures performed
Musculoskeletal System most common procedure:Fracture and dislocation treatments - General subheading (i.e. incisions of soft tissue absecesses, wound exploration, biopsies of muscle & bone tissue) - Arthroscopic procedures - Casts and strapping
What questions should you ask when coding fractures?Site of fracture or dislocation - type of treatment (open, closed) - Manipulation performed and documented - Was traction used and if so what type - Was percutaneous fixation, internal fixation, or external fixation applied - Did docuentation support skin closure - What type of anesthesia was used
Fractures treatments are coded by ?Treatment, which may be open, closed, or percutaneous
Fracture treatment Open: Surgically opened to view or remotely opened to place nail across fracture, Open reduction with internal fixation (ORIF)
Fracture treatment Closed:fracture site is not exposed by surgical incision
Fracture treatment Percutaneousneither open or closed. Fixation devices (such as pins) are placed across the fracture site under imaging

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