Posted: May 1st, 2025

Ancillary Coding Exercises – Medical Coding Advance Lab

HINT294L Ancillary Charts
(Each chart is worth 5 points for a total of 100 points)
Ancillary Chart 1
Intravenous Pyelogram
Reason for exam: Fever of unknown origin
Technical data: no-known allergies. 100 milliliter infusion through iv. No reaction noted.
Intravenous Pyelogram: Following the intravenous injection of contrast material, several
films were taken including anterior-posterior and oblique views showing that both
kidneys are normal in size and configuration. The visualized course of the distal ureters
are both normal. The bladder is well visualized on a delayed film and is within normal
limits. There is a small amount of urinary residual on the post voiding film.
Conclusion: Essentially normal intravenous pyelogram.
Answer:
Ancillary Chart 2
Chest X-Ray
Reason for exam: Chest pain
Portable chest, AP, One View: Comparisons are made with previous study. The
cardiac silhouette is not grossly enlarged. The mediastinum is not widened. Lung fields
are clear. Cardiac monitors do superimpose the chest.
Conclusion: Generally stable appearance of the chest.
Answer:
Ancillary Chart 3
CT scan of Orbits
Reason for Exam: Left eye pain
CT of Orbits: CT of orbits in axial and coronal planes without contrast.
Conclusion: Complete opacification of right aspect of sphenoid sinus. Near complete
opacification of right maxillary antrum. Polypoid membrane thickening left maxillary antrum.
Scattered membrane thickening throughout a few ethmoidal air cells. Remainder negative.
Answer:
Ancillary Chart 4
Abdominal X-ray
Reason for exam: Malnutrition
X-ray Abdomen, Single View: A single supine view of the abdomen is submitted for
interpretation. The majority of the pelvis and a portion of the left side of the abdomen are
excluded from this examination. Air is present with both the small and large bowel, which does
not appear distended.
Answer:
Ancillary Chart 5
Left Foot X-ray
Reason for exam: Severe foot pain
Two views, Left Foot: Comparison is made with the most recent films available. There
is diffuse demineralization of the osseous structures of the foot. Soft-tissue swelling is
seen. The differential is not significantly changed compared with the previous
examination.
Conclusion: Overall, no significant change from previous examination. Diffuse softtissue swelling and inferior left calcaneal spur.
Answer:
Ancillary Chart 6
MRI
Reason for exam: Chest pain, shortness of breath
Myocardial Perfusion Imaging: Cardiolite Heart: SPECT left ventricular myocardial
perfusion imaging study was performed in this patient. 29.5 millicuries of technetium99m sestamibi was injected intravenously at peak stress. The patient had a maximal
heart rate of 88%.
Findings: normal cardiolite heart imaging as noted.
Answer:
Ancillary Chart 7
Lung Scan
Reason for exam: Shortness of breath
Ventilation Perfusion Lung Scan: There is inhomogeneity regarding ventilator scan.
This is seen bilaterally. There appears to be elevation of the right hemidiaphragm.
Small area of decreased perfusion and ventilation is noted along the posterior aspect of
the left upper lobe.
Findings: Pulmonary embolus
Answer:
Ancillary Chart 8
CT of Abdomen
Reason for exam: Increased liver enzyme
CT of Abdomen: the patient was scanned from the dome of the diaphragm through the
iliac crest after administration of oral and intravenous contrast. Evaluation of the liver
demonstrates mildly decreased attenuation to be present throughout the liver diffusely.
No focal abnormalities are present within the liver. The remainder of the CT scan
appears unremarkable.
Answer:
Ancillary Chart 9
Chest x-ray
Reason for exam: Parkinson’s disease
Chest: Posterior and anterior views of the chest reveal the heart and lungs to be
normal. Essentially normal chest x-ray.
Answer:
Ancillary Chart 10
Ultrasound
Reason for exam: Right upper quadrant abdominal pain
Gallbladder ultrasound: Multiple B mode scans reveals poor visualization of the
gallbladder. There are several tiny echoes within the lumen of the gallbladder
suggestive of stones, however, there are no acoustic shadowing defects present to
confirm.
Answer:
Ancillary Chart 11
Reason for exam: Type 2 Diabetes, long term insulin use
Physician Order: A1C, glycohemoglobin
Answer:
Ancillary Chart 12
Reason for exam: Hypertension
Physician Order: Lipid panel
Answer:
Ancillary Chart 13
Reason for exam: Routine Physical Exam
Physician order: CBC, CMP, UA
Answer:
Ancillary Chart 14
Reason for exam: Anemia
Physician order: CBC
Answer:
Ancillary Chart 15
Reason for exam: Urinary Tract Infection
Physician order: Urinalysis, urine culture
Answer:
Ancillary Chart 16
Reason for exam: Routine gynecological exam
Physician order: Pap smear
Answer:
Ancillary Chart 17
Reason for surgery: Abdominal Pain
Specimen Received: gallstones
Pathology Diagnosis: Calculus of gallbladder with acute cholecystitis without obstruction
Answer:
Ancillary Chart 18
Reason for surgery: Abdominal pain, fever
Specimen Received: appendix
Pathology Diagnosis: Acute appendicitis with rupture
Answer:
Ancillary Chart 19
Reason for surgery: Anemia
Specimen Received: Bone marrow aspiration
Pathology Diagnosis: Iron deficiency anemia
Answer:
88307, 20220
Ancillary Chart 20
Reason for surgery: Abnormal mole, left arm
Specimen Received: skin lesion
Pathology Diagnosis: Melanoma
Answer:
11606