AAPC CPC Chapter 11

B

What is the function of the gall bladder? A) It plays a role in maintaining glucose levels in the blood. B) It conveys and stores bile. C) It breaks down and stores waste products. D) It produces acidic juices for digestion.

B

What is the term that describes the removal of a portion or all of the stomach? A) Gastrotomy B) Gastrectomy C) Gastrostomy D) Gastric bypass

B

Where is the vermilion border located? A) Underneath the tongue B) Upper and lower lips C) Stomach lining D) In the esophagus

A

What is the correct CPT® coding for a partial distal gastrectomy with Roux-en-Y reconstruction with vagotomy? A) 43633, 43635 B) 43634, 43635 C) 43621, 43635 D) 43633, 43640-51

B

A 42-year-old patient visits his doctor for chest pain and a dry cough lasting for two months. After evaluating the patient, the physician states the patient has GERD. What is/are the correct diagnosis code(s)? A) K21.0 B) K21.9 C) K63.9, R05 D) R07.9, R05

D

A patient suffering from cirrhosis of the liver from alcohol abuse presents with a history of coffee ground emesis (bleeding). The surgeon diagnoses the patient with esophageal gastric varices. Two days later, in the hospital GI lab, the surgeon ligates the varices with bands via an UGI endoscopy. What CPT® and ICD-10-CM codes are reported? A) 43400, I85.11, F10.10, K74.60 B) 43235, I83.008, F10.20, K70.30 C) 43205, K74.60, I85.01, F10.20 D) 43244, K70.30, I85.11, F10.10

A

A patient with hypertension is scheduled for same day surgery for removal of her gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery. What ICD-10-CM codes are reported by the cardiologist? A) Z01.810, K80.20, I10 B) I10, Z01.818, K80.20 C) K80.20, I10, Z01.810 D) K80.21, Z01.89, I10

D

A screening colonoscopy is performed on a 50 year-old patient with a family history of colon cancer. Multiple polyps were found during the procedure. Two polyps in the transverse colon were removed with hot forceps cautery. Three polyps in the ascending colon were removed via snare. Portions of all polyp tissues were to be sent to pathology. What are the correct CPT® and ICD-10-CM codes for this patient encounter? A) 48584 x2, 45385 x3, K63.5 B) 45384, 45385-59, K63.5, Z12.11, Z80.0 C) 45384 x2, 45385 x3, Z80.0, K63.5, Z12.11 D) 45384, 45385-59, Z12.11, D12.3, D12.2, Z80.0

B

An 11 year-old patient is seen in the OR for a secondary palatoplasty for complete unilateral cleft palate. Shortly after general anesthesia is administered, the patient begins to seize. The surgeon quickly terminates the surgery in order to stabilize the patient. What CPT® and ICD-10-CM codes are reported for the surgeon? A) 42220-52, Q35.7, R56.9 B) 42220-53, Q35.9, R56.9 C) 42215-76, Q35.7, R56.9 D) 42215-53, Q35.9, R56.9

C

Bile empties into the duodenum through what structure? A) Pyloric sphincter B) Biliary artery C) Common bile duct D) Common hepatic duct

CPT® code(s): 44205 ICD-10-CM code(s): K63.5

CASE 2 Preoperative Diagnosis: Right-sided colonic polyps. Postoperative Diagnosis: Right-sided colonic polyps. Procedure: Laparoscopic right hemicolectomy with ileocolic anastomosis. Description of Procedure: After induction of adequate general endotracheal anesthesia,(General anesthesia.) the patient was carefully positioned in the supine, modified-lithotomy position and Allen stirrups. Great care was taken to carefully pad and protect all areas of potential bodily injury. The abdomen was prepped and draped in the usual sterile manner.(Positioning and draping the patient is standard of care - not billable.) Using a supra-umbilical vertical incision, a Hasson technique(Type of laparoscopic approach. The Hasson technique employs an open type of port insertion site for laparoscopic procedures.) was employed to carefully place a 10 mm cannula. Carbon dioxide pneumoperitoneum of 15 mmHg was achieved, after which a 30-degree telescope was carefully introduced. Under direct vision, two left-sided ports were placed: one in the left lower quadrant, one in the left upper quadrant, each lateral to the epigastric vessels through horizontal stab wounds.(Placement of the trocars for visualization into the abdominal cavity.) With a combination of head up, head down, and right side up, the entire right colon was mobilized from the duodenum, pancreas, and right ureter, using 10 mm diameter Babcock grasping forceps and 5 mm diameter harmonic scalpel.(The colon is freed away from it's attachments to other structures. The Babcock grasper holds the colon in place while the harmonic scalpel cuts away the connections.) After complete mobilization and copious irrigation and verification of meticulous hemostasis, the supraumbilical port was lengthened to 4 cm, through which an Alexis wound protector was placed. The entire right colon was withdrawn.(Pulled to outside the cavity through the extended incision.) High ligation of the ileocolic arcade and the right branch of the middle colic(The division of the colon.) were undertaken using 10 mm diameter LigaSure Atlas.(Device used to seal or divide the circulation to that portion of the bowel slated for removal.) The Atlas was used for the remaining mesentery. The bowel was circumferentially cleared of fat proximally and distally, and each end was divided with a GIA 100 mm stapler with a blue cartridge. The field was draped with blue towels, and the antimesenteric border of each staple line was excised along with the terminal ileum. A side-to-side, functional end-to-end anastomosis was fashioned between the remaining ileum and colon with a GIA 100 mm stapling device with a blue cartridge.(Reattachment of the two ends of the colon: ileocolostomy.) The staple line was verified for hemostasis, after which the afferent limb was secured to the efferent limb with 3-0 PDS II seromuscular Lembert-type sutures. After verification of anastomotic hemostasis, the apical enterotomy was also secured with a GIA 100 mm stapling device with a blue cartridge. The anastomosis was healthy, pink, widely patent, circumferentially intact, and easily returned into the peritoneal cavity.(The externalized colon is reinserted into the abdominal cavity after it is checked for hemostasis and perfusion.) After copious irrigation and verification of meticulous hemostasis, the fascia was closed with interrupted No. 1 Vicryl plus figure-of-eight sutures. The subcutaneous layers were irrigated and meticulous hemostasis was verified. Port sites were closed in a similar manner. The skin was closed and covered by dry dressings,(After the trocars are removed, the stab sites are sutured closed.) and the patient was discharged to the recovery room in stable condition, without having suffered any apparent operative complications. What are the CPT® and ICD-10-CM codes for this service? CPT® code(s): ICD-10-CM code(s):

CPT® code: 47563 ICD-10-CM codes: K80.1, K85.90

CASE 5 Preoperative Diagnosis: Cholelithiasis, chronic cholecystitis, and acute pancreatitis. Postoperative Diagnosis: Cholelithiasis, chronic cholecystitis, and acute pancreatitis, pathology pending. Procedure Performed: Laparoscopic cholecystectomy, with intra-operative fluoroscopic cholangiography. Anesthesia: General anesthesia and 0.5% Marcaine (10 cc/s). Estimated Blood Loss: minimal. Drains: None. Specimen: Gallbaldder. Operative indications: This is a 49 year-old female with the above diagnosis who presents for elective laparoscopy, cholecystectomy and intra-operative cholangiography. Operative Procedure: The patient was brought to the OR suite with PAS stocking(Pneumatic antiembolism stockings—these are compression stockings to help prevent blood clots during and after surgery.) in place. She was transferred to the operative table, given a general anesthetic, positioned supine on the table, and the operative field was sterilely prepped and draped. A vertical incision was made in the base of the umbilicus and deepened through the fascia. Stay sutures of 0-Proline were placed, and the abdomen was entered under direct vision. A Hassan cannula(Brand of laparoscopic instrument.) was anchored in place with the stay sutures and the abdomen was insufflated to 15 mm Hg with CO2 gas. A 10 mm, 30-degree scope was assembled, focused, weight-balanced, and placed into the abdomen. Cursory evaluation revealed no other obvious pathology with the exception of the gallbladder. Under direct vision, 3-5 mm ports were placed in the epigastrium, right upper quadrant, and right lower quadrant. The patient was placed in reverse Trendelenberg position,(Reverse Trendelenburg refers to the patient in the supine position with the head of the bed elevated twenty degrees to help increase the amount of operative work space during upper abdominal surgery.) with the right side up. The fundus of the gallbladder was grasped and retracted over the dome of the liver. Adhesions to the gallbladder were taken down with sharp and blunt dissection while carefully maintaining hemostasis with electrocauterery. The ampulla of the gallbladder was grasped with a second instrument and retracted downward and laterally, displaying the angle of Calot distracted from the portal structures, The cystic duct and artery were dissected circumferentially. A single clip was placed on the distal cystic duct and an opening created just proximal to it. The cholangiogram apparatus was introduced into the abdomen via the 5 mm RUQ port and the 5-French whistle-tip ureteral catheter was threaded into the common bile duct through the opening in the cystic duct. The cholangiogram was performed under fluoroscopy and was normal, demonstrating filling of the duct with defects and prompt flow into the duodenum.(This is a fluoroscopic look at the bile ducts, which shows that the bile duct is unobstructed, because contrast was able to reach the duodenum. This is not an interpretation of the cholangiogram.) The cholangiogram apparatus was withdrawn from the abdomen, and the cystic duct was clipped twice proximally, and divided. The cystic artery was clipped once distally, twice proximally, and divided. The cystic duct and artery were dissected circumferentially, clipped once distally, twice proximally and divided. Care was taken not to encroach upon the common bile duct or portal structures. The gallbladder was taken down from the liver using the hook-dissector and cautery carefully maintaining hemostasis during the process. The right upper quadrant was irrigated with saline and suctioned dry. Hemostasis was confirmed. There was no bile drainage from the gallbladder bed in the liver. A 5 mm, 30-degree scope was assembled, focused, white-balanced, and placed into the epigastric port. The gallbladder was removed under direct vision through the umbilical port. The other ports were removed under direct vision, and hemostasis was achieved. The abdomen was de-insufflated.(Gas is released from the abdomen.) The fascia in the umbilical incision was closed with a figure of eight suture of 0 vicryl. The wounds were infiltrated with a total of 10 cc's of 0.5% marcaine. The skin incisions were closed with subcuticular sutures of 4.0 vicryl. Steri-strips and sterile dressings were applied. After a correct sponge, instrument, and needle count, the patient was awakened, extubated, and taken to the recovery room in good condition. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM codes (2):

A

Code intraoral incision and drainage of hematoma of tongue, submandibular space. What CPT® code is reported? A) 41008 B) 41009 C) 41015 D) 41017

B

Code peritoneoscopy with laparoscopic partial colectomy and anastomosis. What CPT® code(s) is/are reported? A) 44140 B) 44204 C) 49320, 44140 D) 49320, 44204

C

What ICD-10-CM code(s) is reported for ulcerative colitis with rectal bleeding? A) K51.511 B) K52.9, K62.5 C) K51.911 D) K51.90

D

What is the CPT® code for removal of a foreign body from the esophagus via the thoracic area? A) 43215 B) 43020 C) 43500 D) 43045

D

How do you report a screening colonoscopy performed on a 65 year-old Medicare patient with a family history of colon cancer? The physician was able to pass the scope to the cecum. What CPT® and ICD-10-CM codes are reported? A) 45330, Z13.818, Z80.0 B) 45378, Z12.11, Z85.038 C) G0104, Z13.818, Z85.038 D) G0105, Z12.11, Z80.0

A

How many lobes are in the liver? A) 4 lobes B) 3 lobes C) 2 lobes D) 5 lobes

D

In ICD-10-CM, how is Crohn's disease of the small intestine with intestinal obstruction reported? A) Crohn's disease of the small intestine is reported first with intestinal obstruction reported as a secondary diagnosis. B) Intestinal obstruction is reported first with Crohn's disease of the small intestine is reported as a secondary. C) One combination code is reported to indicate Crohn's disease of the small intestine with intestinal obstruction. D) Crohn's disease of the small intestine is reported as regional enteritis of the small intestines.

D

Margaret has a cholecystoenterostomy with a Roux-en-Y. Five hours later, she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and was demonstrating early signs of peritonitis. What is the correct coding for the subsequent services on this date of service? The same surgeon took her back to the OR as the one who performed the original operation. What CPT® code is reported? A) 49000-58 B) 49000-77 C) 49402-77 D) 49402-78

A

Operative Report Indications: This is a third follow-up EGD dilation on this 40 year-old patient for a pyloric channel ulcer which has been slow to heal with resulting pyloric stricture. This is a repeat evaluation and dilation. Medications: Intravenous Versed 2 mg. Posterior pharyngeal Cetacaine spray. Procedure: With the patient in the left lateral decubitus position, the Olympus GIFXQ10 was inserted into the proximal esophagus and advanced to the Z-line. The esophageal mucosa was unremarkable. Stomach was entered revealing normal gastric mucosa. Mild erythema was seen in the antrum. The pyloric channel was again widened. The ulcer, as previously seen, was well healed with a scar. The pyloric stricture was still present. With some probing, the 11 mm endoscope could be introduced into the second portion of the duodenum, revealing normal mucosa. Marked deformity and scarring was seen in the proximal bulb. Following the diagnostic exam, a 15 mm balloon was placed across the stricture, dilated to maximum pressure, and withdrawn. There was minimal bleeding post-op. Much easier access into the duodenum was accomplished after the dilation. Follow-up biopsies were also taken to evaluate Helicobacter noted on a previous exam. The patient tolerated the procedure well. Impressions: Pyloric stricture secondary to healed pyloric channel ulcer, dilated. Plan: Check on biopsy, continue Prilosec for at least another 30 days. At that time, a repeat endoscopy and final dilation will be accomplished. He will almost certainly need chronic H2 blocker therapy to avoid recurrence of this divesting complicated ulcer. What CPT® and ICD-10-CM codes are reported? A) 43245, 43239-51, K31.1, Z87.11 B) 43235, 43239-51, K31.4, Z87.19 C) 43248, 43239-59, K31.5, Z87.19 D) 43236, 43239-59, K31.1, Z87.11

D

Procedure: Colectomy with a take-down of splenic flexure. The patient was taken to the operating room, placed in the dorsal lithotomy position, and then prepped and draped in the usual sterile fashion. A vertical paramedian incision was made along the left side of the umbilicus from the symphysis and taken up to above the umbilicus. This incision was carried down to the rectus muscles, which were separated in the midline. The peritoneal cavity was entered with findings as described. The ascitic fluid was removed and hand-held retractors were used to assist in surgical exposure. The malignant intra-abdominal tumor was resected from the hepatic flexure into the mid transverse colon. The resection was extended into the left upper quadrant and the attachments were also clamped, cut and suture ligated with 2-0 silk sutures in a stepwise fashion until mobilization of the tumor mass could be brought medial and hemostasis was obtained. Attempts to find a dissection plane between the malignant tumor mass and the transverse colon were unsuccessful as it appeared the tumor mass was invading into the wall of the bowel with extrinsic compression and distortion of the bowel lumen. Given the mass could not be resected without removal of bowel, attention was directed to mobilization of the splenic flexure. Retroperitoneal dissection was started in the pelvis and continued along the left paracolic gutter. The ligamentous and peritoneal attachments were taken down with Bovie cautery in a stepwise fashion around the splenic flexure of the colon until the entire left colon was mobilized medially. Similar steps were then carried on the right side as the right colon and hepatic flexure were mobilized. The peritoneal and ligamentous attachments were taken down with Bovie cautery. Vascular attachments were clamped, cut, and suture ligated with 2-0 silk until the right colon was mobilized satisfactorily. The GIA stapler was introduced and fired at both ends to dissect the tumorous bowel free. The bowel was delivered off the operative field. Attention was then directed towards re-anastomosis of the colon. Linen-shod clamps were used to gently clamp the proximal and distal segments of the large bowel. The staple line was removed with Metzenbaum scissors and the colon lumen was irrigated. The silk sutures were used to divide the circumference of the bowel into equal thirds, and the proximal and distal edges of the bowel were reapproximated with silk sutures. The posterior segment of the bowel was then retracted and secured with a TA stapler, ensuring a full thickness bowel wall insertion into the staple line. The additional two-thirds were also isolated and, with the TA stapler, clamped, ensuring that all layers of the bowel wall were incorporated into the anastomosis. A third staple line was fired and the integrity of the anastomosis was checked. First, complete hemostasis was noted. There was well beyond a finger width lumen within the large bowel. The linen-shod clamps were released and gas and bowel fluid were moved through the anastomosis aggressively with intact staple line; no leakage of gas or fluid. The abdomen was then irrigated and water was left over the anastomosis. The anastomosis was manipulated with no extravasation of air. The abdomen and pelvis were then irrigated aggressively. The Mesenteric trap was then re-approximated with interrupted 3-0 silk suture ligatures. All sites were inspected and noted to be hemostatic. Attention was directed towards closing. Pathology report showed intra-abdominal cancer. Transverse colon and hepatic flexure cancer were also indicated. The origin of the cancer could not be determined from the specimen given. What is the correct CPT® and ICD-10-CM coding for this report? A) 44160, C18.8 B) 44140, C79.89, C78.5 C) 44147, 44139, C76.2, C18.8 D) 44140, 44139, C76.2, C18.8

D

What CPT® and ICD-10-CM codes represent the creation of an opening into the stomach to insert a temporary feeding tube for nutritional support in an adult patient with proximal esophageal carcinoma due to alcohol dependence? A gastric tube was not created. A) 43653, C15.9, F10.20 B) 43870, C15.8, F10.99 C) 43831, D49.0, F10.10 D) 43830, C15.3, F10.20

D

The patient is a 65-year-old female with Type 2 diabetes. She is seen today by her primary care physician for extreme abdominal bloating and discomfort after eating. The patient also complains of constant heartburn. This occurrs frequently and is not relieved by anything the patient has tried. The patient recorded her blood sugar this morning as 178. Her A1C taken in the office was 8.2. The physician diagnoses gastroparesis due to the patient's diabetes. Code the ICD-10-CM diagnosis(es). A) E10.43 B) K31.84 C) E11.43 D) E11.43, K31.84

C

The prefix meaning lip A) an/o B) cec/o C) cheil/o D) col/o

B

The suffix meaning artificial or surgical opening A) -ectasis B) -stomy C) -cele D) -lysis

B

What CPT® and ICD-10-CM codes are reported for a gastric restriction by placing a gastric band via laparoscopic surgery for an adult patient diagnosed as morbidly obese having a BMI of 43, type 2 uncontrolled diabetes and elevated blood sugar readings daily? A) 43644, E66.9, Z68.41, E10.9 B) 43770, E66.01, Z68.41, E11.9 C) 43842, E66.01, Z68.41, E11.9 D) 43771, E66.01, Z68.41, E10.9

B

A 12 year-old patient had an adenoidectomy in 2013 and a second adenoidectomy this year. What CPT® code(s) is/are reported for the second adenoidectomy performed this year? A) 42826 B) 42836 C) 42831, 42836 D) 42831

C

A 20 year-old patient presented to the hospital for a sigmoidoscopy due to a history of bloody stools for three weeks' duration. The patient was prepped for the sigmoidoscopy and the sigmoidoscope was passed without difficulty to about 40 cm. The entire mucosal lining was erythematosus. There was no friability of the overlying mucosa and no bleeding noted. No pseudo polyps were identified. Biopsies were taken at about 30 cm; these were thought to be representative of the mucosa in general. The scope was retracted; no other abnormalities were seen. What CPT® and ICD-10-CM codes are reported? A) 45330, 45331, K62.5 B) 45333, Z12.11, K62.5 C) 45331, K92.1 D) 45305, K92.1

C

A 28 year-old female had symptoms of RLQ abdominal pain, fever and vomiting. She was diagnosed with acute appendicitis. The surgeon makes an abdominal incision to remove the appendix. The appendix was not ruptured. The incision is closed. What are the correct CPT® and ICD-10-CM codes for this encounter? A) 44950, R10.31, R50.9, R11.10, K35.80 B) 44970, K35.80 C) 44950, K35.80 D) 44970, K37

D

A 28-year-old female has constant abdominal pain and diarrhea. The provider runs blood tests and takes a stool sample. A colonoscopy with biopsy is performed to rule out ulcerative colitis. The provider determines the patient has IBS. What is/are the correct diagnosis code(s)? A) K22.0 B) K58.0, R10.9, R19.7 C) K51.90, K58.0 D) K58.0

B

A 33 year-old male patient presents to the endoscopy suite to determine if he has an ulcer. The physician performs a diagnostic scope through the esophagus, stomach and into the duodenum and jejunum. During the scope the patient has a severe drop in blood pressure and the physician discontinues the procedure, but not before observing and diagnosing a bleeding ulcer on the stomach lining as well a perforated ulcer in the jejunum. A repeat examination is planned. What CPT® and ICD-10-CM codes are reported? A) 43235-52, K25.4, K28.5 B) 43235-53, K25.4, K28.5 C) 43200-52, K25.5, K28.5 D) 43235-53, K25.4, K28.1

A

A 43-year-old male has a chronic posterior anal fissure. The posterior anal fissure was excised down to the internal sphincter muscle. Which CPT® code is reported? A) 46200 B) 46261 C) 46270 D) 46275

A

A 45 year-old patient with liver cancer is scheduled for a liver transplant. The patient's brother is a perfect match and will be donating a portion of his liver for a graft. Segments II and III will be taken from the brother and then the backbench reconstruction of the graft will be performed, both a venous and arterial anastomosis. The orthotopic allotransplantation will then be performed on the patient. What CPT® codes are reported? A) 47140, 47146, 47147, 47135 B) 47141, 47146, 47135 C) 47140, 47147, 47146, 47399 D) 47141, 47146, 47399

C

A 45 year-old woman underwent a laparoscopic cholecystectomy. The procedure was performed for recurrent bouts of acute cholecystitis. What CPT® and ICD-10-CM codes are reported? A) 47605, K81.2 B) 47570, K81.9 C) 47562, K81.0 D) 47600, K81.0

B

A 55-year-old patient underwent a repair of an initial left inguinal hernia. An incision was made at the groin. A hernia sac was readily identified and cleared from the surrounding tissue, inverted into the preperitoneal space, and plugged. Mesh was tacked to the surrounding muscle layers and then placed over the entire floor. What CPT® code(s) is/are reported? A) 49500-LT B) 49505-LT C) 49505-LT, 49568 D) 49650-LT, 49568

C

A 56 year-old patient complains of occasional rectal bleeding. His physician decides to perform a rigid proctosigmoidoscopy. During the procedure, two polyps are found in the rectum. The polyps are removed by a snare. What CPT® and ICD-10-CM codes are reported? A) 45309, 45309, K63.5 B) 45385, K63.5 C) 45315, K62.1 D) 45320, K62.1

B

A 57 year-old patient with chronic pancreatitis presents to the operating room for a pancreatic duct-jejunum anastomosis by the Puestow-type operation. What are the correct CPT® and ICD-10-CM codes for the encounter? A) 48520, K85.80 B) 48548, K86.1 C) 48520, K86.1 D) 48548, K85.90

D

A 7 year-old female presents to the same day surgery unit for a tonsillectomy. During the surgery the physician notices the adenoids are very inflamed and must be taken out as well. The adenoids, although not planned for removal, are removed following the tonsillectomy. What CPT® code(s) is/are reported for the procedure? A) 42825, 42830 B) 42821 C) 42825, 42835 D) 42820

D

A patient is admitted for a simple primary examination of the gastrointestinal system to rule out GI cancer. An Esophagogastroduodenoscopy (EGD) is performed, which includes examination of the esophagus, stomach and portions of the small intestine. During the examination, a stricture of the esophagus is identified and subsequently dilated via balloon dilation (20 mm). What CPT® and ICD-10-CM codes are reported? A) 43235, K22.2 B) 43235, C15.9 C) 43248, Q39.3 D) 43249, K22.2

B

A patient is seen in the ED for nausea and vomiting that has persisted for 4 days. The ED physician treats the patient for dehydration which is documented in the patient's record as the final diagnosis. What ICD-10-CM code(s) is/are reported for this encounter? A) R11.2, E86.0 B) E86.0 C) R11.10, R11.0, E86.0 D) R11.14

C

A patient is seen in the gastroenterologist's clinic for a diagnostic colonoscopy. When performing the service, the physician notes suspicious looking polyps and removes three using a snare technique to send to pathology for further testing. What is/are the correct CPT® code(s) to report? A) 45378, 45385-51 B) 45380 C) 45385 D) 45378, 45380-51

B

A patient is seen in the outpatient GI lab of the hospital for rectal bleeding. A colonoscopy revealed three polyps in the transverse colon. The polyps were removed by snare technique and determined to be benign. What is the correct diagnosis code for this procedure? A) K63.5 B) D12.3 C) K92.1 D) K62.5

C

A patient is seen to have an esophageal motility procedure with acid perfusion study performed. What CPT® code(s) is/are reported? A) 91010 B) 91030 C) 91010, 91013 D) 91020

A

A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This attempt was unsuccessful. The physician then dilates the esophagus transendoscopically using a balloon (25mm). What CPT® code(s) is/are reported? A) 43220 B) 43450-53, 43220 C) 43450, 43220 D) 43220, 43450-52

A

A patient presents with a 2 cm benign lip lesion. The provider decides to remove the lesion along with a portion of the lip by performing a wedge excision. Single-layer suture repair is performed. What CPT® code(s) is/are reported for this service? A) 40510 B) 11442, 12011-51 C) 40510, 12011-51 D) 11442, 40510

CPT®: 44625 ICD-10-CM: Z43.2, Z85.048

CASE 1 Preoperative Diagnosis: History of rectal carcinoma. Postoperative Diagnosis: History of rectal carcinoma. Procedure Performed: Closure of loop ileostomy with small bowel resection and enteroenterostomy with intraoperative flexible sigmoidoscopy. Description of Procedure: After induction of adequate general endotracheal anesthesia,(General anesthesia.) the patient was carefully positioned in the supine modified lithotomy position in Allen stirrups.(Lying on back with legs in stirrups.) Great care was taken to pad and protect all areas of potential bodily injury. Digital rectal examination revealed a widely patent circumferentially intact pouch anal anastomosis within 1 cm of the dentate line. Flexible sigmoidoscopy was performed revealing healthy pink mucosa. The abdomen was prepped and draped in the usual sterile manner, and a parastomal incision(Cutting around the ostomy opening to release it from the abdominal wall and surrounding area.) was made and carried down sharply into the peritoneal cavity. Meticulous hemostasis was obtained with electrocautery. A 360 degree subfascial mobilization was undertaken until approximately 40 cm of each the afferent and efferent limb reached above the skin in a tension-free manner. Betadine was insufflated down each limb to verify that no enterotomies or seromyotomies were made.(Verification that the colon is without injury or puncture from the dissection.) The mesentery was scored and vessels were divided with a 10 mm LigaSure Impact. The bowel was circumferentially cleared of fat proximally and distally, and each end was divided with a GIA 100 mm stapling device with blue cartridge. The field was protected with blue towels and the antimesenteric border of each staple line was excised. A side-to-side functional end- to-end anastomosis was fashioned with a GIA 100 mm stapling device.(Reattachment of the two ends of the colon in a side-by-side fashion.) The staple line was reinforced for hemostasis with 3-0 PDS 2 suture where necessary and the afferent limb was secured to the efferent limb with 3-0 PDS 2 seromuscular Lembert type sutures. After verification of the meticulous hemostasis, the apical enterotomy was secured with a GIA 100 mm stapling device. The anastomosis was healthy pink and widely patent and circumferentially intact and easily returned into the peritoneal cavity, after copious irrigation and verification of meticulous hemostasis. What are the CPT® and ICD-10-CM codes for this service? CPT®: ICD-10-CM (2):

CPT® code: 45330 ICD-10-CM code: K62.89

CASE 10 Extent of Examination: Proximal sigmoid colon. Reason(s) for Examination: Proctitis. Postoperative assessment: Proctitis. Description of Procedure: Informed consent was obtained with the benefits, risks, including the risk of perforation and alternatives to sigmoidoscopy explained. The patient agreed to proceed. No contraindications were noted on physical exam. Patient was re-examined and no interval changes were noted from the preoperative history & physical. After being placed on the table, patient identification was verified prior to the procedure. Immediately prior to sedation for endoscopy the patient's ASA classification was Class 2: Mild systemic disease. Monitored anesthesia care (MAC) was administered by the anesthesia team. The quality of the prep was adequate. Prior to the exam, a digital exam was performed and it was unremarkable. The procedure was performed with the patient in the left lateral decubitus position. The sigmoidscope was inserted to the proximal sigmoid colon. In the rectum, a retroflex was performed. The withdrawal time from the proximal sigmoid colon was 8 minutes. The patient tolerated the procedure well. There were no complications. The heart rate was normal. The oxygen saturation and skin color were normal. IV moderate sedation was administered under direct supervision of the physician. Upon discharge from the endoscopy area, the patient will be recovered per established procedures and protocols. Findings: In the rectum, mild segmental inflammation with erythema was seen. There was no mucosal bleeding. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM code:

CPT® code: 42145 ICD-10-CM code: G47.33

CASE 3 Procedure: Uvulopalatopharyngoplasty.(The procedure is to repair the uvula and tonsils.) Indication: A 63 year-old with obstructive sleep apnea. He is intolerant of CPAP. Description of Procedure: I identified the patient and he was brought to the operating room. General endotracheal anesthesia was induced without complication. Tonsillar pillars and palate were injected with 0.25% Marcaine. The right tonsil was grasped with an Allis forceps and dissected from the tonsillar fossa(Right tonsillectomy. It's not billable because it's included in the primary procedure.) with a combination of blunt and cautery dissection. The posterior pillar remained intact as I proceeded to do similar mobilization of the left tonsil.(Left tonsillectomy. It's not billable because it's included in the primary procedure - cannot be unbundled.) I then made a mucosa incision across the base of the palate approximately 0.5 cm from the base of the uvula, connecting the anterior tonsillar incisions. The muscular portion of the uvula and edge of the soft palate was then opened. Posterior pillar was opened inferiorly on the right tonsil fossa, and extended through the palate to include the uvula, and then extended inferiorly on the left side. The uvula, edge of the soft palate, and both tonsils were removed in total. Hemostasis was achieved with electrocautery. The mucosal incision was then closed with interrupted Vicryl sutures. The oral cavity was irrigated with clindamycin solution. The patient was awakened, extubated, and brought safely to the recovery room. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM code:

CPT® code: 43775 ICD-10-CM code(s): E66.01, Z68.41

CASE 4 Preoperative Diagnosis: Morbid obesity. Sleep apnea. BMI 40. Postoperative Diagnosis: Morbid obesity. BMI 40. Procedure Performed: Laparoscopic sleeve gastrectomy. Intraoperative esophagogastroduodenoscopy.(Laparoscopic—Sleeve Gastrectomy.) Intraoperative endoscopy Anesthesia: General endotracheal anesthesia. Operative Procedure: The patient was brought to the operating room and placed on the OR table in supine position. Once general endotracheal anesthesia was achieved and pre-op antibiotics were given, the abdomen was prepped and draped in the standard surgical fashion. Access to the abdominal cavity was through a 1 cm supraumbilical incision with an Optiview trocar.(Laparoscopic procedure.) Co2 was insufflated to achieve an intraabdominal(Gas is used to extend the abdomen to improve the visual field.) pressure of approximately 15 mmHg. Accessory trocars were placed in the subxiphoid, right, mid, and left upper quadrants of the abdomen, as well as in the right and left lower quadrants of the abdomen. All this was done under appropriate videoscopic observation. The pyloric channel was then identified and approximately 4 cm proximal to it, the short gastric vessels of the greater curvature are taken down all the way up to the GE junction with the harmonic scalpel. A 38 french bougie is passed into the stomach into the pyloric channel and with the help of the linear cutter, the stomach is transected in a vertical fashion creating a gastric tube which is approximately 100 mm in diameter. The staple line is then over sewn with a running 2-0 Vicryl suture. Good hemostasis was achieved. Then I performed intraoperative esophagogastroduodenoscopy.(This is done to verify patency, hemostasis and integrity. It's not reported separately.) The scope was advanced through the oropharynx, and under direct vision it was taken down through the esophagus and into the sleeve. There was no evidence of leak, bleeding, or any other abnormalities. A patent sleeve was seen all the way down to the pylorus. The scope was then retrieved carefully. A placement of a drain through the subhepatic space and extraction of the specimen through a right lower quadrant incision was done. All trocars were removed under appropriate videoscopic observation. There was no evidence of bleeding from any of the trocar sites. All the trocar sites were suture closed and injected with local anesthesia.(The small incisions are closed. The anesthetic helps with pain control post operatively.) The patient tolerated the procedure well. He was extubated on the table and transferred to the recovery room in stable condition. There were no complications. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM codes (2):

CPT® code: 43644 ICD-10-CM codes: E66.01, I10, Z68.43

CASE 6 Preoperative Diagnosis: Severe obesity. Hypertension. BMI 53. Postoperative Diagnosis: Severe obesity. Hypertension. BMI 53. Procedure Performed: Laparoscopic antecolic Roux-en-Y gastric bypass with 150 alimentary limb, and a 40 cm biliopancreatic limb. Anesthesia: General endotracheal anesthesia. Operative Procedure: The patient was brought to the operating room and placed on the OR table in supine position. Once endotracheal anesthesia was achieved and pre-op antibiotics were given, the abdomen was prepped and draped in the standard surgical fashion. Access to the abdominal cavity was through a 1 cm supraumbilical incision with an Optiview trocar. CO2 was insufflated to achieve an intraabdominal pressure of approximately 15 mmHg. Accessory trocars were placed in the subxiphoid, right, mid and left upper quadrants of the abdomen, as well as in the right and left lower quadrants of the abdomen. All of this was done under appropriate videoscopic observation. The procedure begins with identification of the gastroesophageal junction and dissection of the angle of His. On the lesser curvature of the stomach, a window is dissected into the lesser sac. A linear stapler is passed, and the stomach is transected. Reinforcement of the staple line was done with Steri-Strips, creating a pouch approximately 50 cc in diameter. An Ewald tube is used to calibrate the pouch. At this point, the ligament of Treitz is identified and 40 cm from the ligament of Treitz, the small bowel was transected. The distal limb of the small bowel is then brought to the upper abdomen, and a side-to-side gastrojejunostomy between the pouch and the alimentary limb is performed with a linear stapler. The gastrojejunostomy site is then closed with a double layer of running 2-0 Vicryl sutures. The anastomosis was observed for leakage with air and Methylene blue. There was no evidence of leakage. I then proceeded 150 cm distal from the gastrojejunostomy. A side-to-side jejunojejunostomy was created between the biliopancreatic limb and alimentary limb. This was performed using two applications of the linear stapler. The jejunojejunostomy site was closed with several applications of the linear stapler. Hemoclips were applied to the suture line for hemostasis. Good hemostasis was evident. A 19 French Blake drain was placed over the gastrojejunal anastomosis. All trocars were removed under appropriate videoscopic observation. There was no evidence of bleeding from any of the trocar sites. The trocar sites were suture closed and injected with local anesthesia. The patient tolerated the procedure well. She was extubated on the OR table and transferred to the recovery room in stable condition. There were no complications. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM codes (3):

CPT® code: 43235 ICD-10-CM code: K21.9

CASE 7 Extent of Examination: Upper gastrointestinal endoscopy. Reason(s) for Examination: Gastroesophageal Reflux Disease (GERD). Description of Procedure: Informed consent was obtained with the benefits, risks, including the risk of perforation and alternatives to upper GI endoscopy were explained. The patient agreed to proceed. No contraindications were noted on physical exam. Anesthesia was administered by the ICU staff. (See anesthesiologist report) Monitored anesthesia care (MAC) was administered by anesthesia team. The procedure was performed with the patient in the left lateral decubitus position. The instrument was inserted through the mouth to the second part of the duodenum. The patient tolerated the procedure well. There were no complications. The heart rate was normal. The oxygen saturation and skin color were normal. Upon discharge from the endoscopy area, the patient will be recovered per established procedures and protocols. Findings: The esophagus was examined and no abnormalities were seen. The gastroesophageal junction (upper level of gastric folds) was located 40cm from the incisors. The stomach was examined and no abnormalities were seen. The small bowel was examined and no abnormalities were seen. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM code:

CPT code: 45380 ICD-10-CM codes: D50.9, K64.8

CASE 8 Extent of Examination: Terminal ileum. Reason(s) for Examination: Anemia, Fe Deficiency Description of Procedure: Informed consent was obtained and I explained about the benefits, risks, including the risk of perforation and alternatives to colonoscopy. The patient agreed to proceed. No contraindications were noted on physical exam. Monitored anesthesia care (MAC) was administered by the anesthesia team. The bowel was prepared with GoLYTELY prep. The quality of the prep is based on the Ottawa bowel preparation quality scale. Total score: Right: 1 + Middle: 1 + Left: 1 + Fluid: 0 = 3/14. Prior to the exam, a digital exam was performed; hemorrhoids were noted. The procedure was performed with the patient in the left lateral decubitus position. The instrument was inserted in the anus and advanced to the terminal ileum. The cecum was identified by the following: the ileocecal valve and the appendiceal orifice. In the rectum, a retroflex was performed. The patient tolerated the procedure well. There were no complications. Findings: In the rectum, a few medium-size uncomplicated internal hemorrhoids were seen. The internal hemorrhoids were not bleeding. There was no evidence of inflammation, friability, granularity, or bleeding. Biopsy were taken. In the ascending colon and cecum there was mild granularity and red spots that were nonspecific and possibly due to air insufflation. No friability, ulcerations or bleeding. Biopsy taken. The remainder of the colon was normal. The terminal ileum was normal. What are the CPT® and ICD-10-CM codes for this service? CPT code: ICD-10-CM codes (2):

CPT® code: 45378 ICD-10-CM codes: Z85.048, K52.9

CASE 9 Extent of Examination: Terminal ileum. Reason(s) for Examination: Hx of rectal cancer s/p Low Anterior Resection (LAR) and colonic J pouch for closure of loop ileostomy. Description of Procedure: Informed consent was obtained with the benefits, risks, including the risk of perforation and alternatives to colonoscopy explained. The patient agreed to proceed. No contraindications were noted on physical exam. Monitored anesthesia care (MAC) was administered. The bowel was prepared with Fleets enemas. The quality of the prep was fair. Prior to the endoscopic exam, a digital rectal exam was performed and it was unremarkable. The procedure was performed with the patient in the left lateral decubitus position. The cecum was identified by the ileocecal valve. The withdrawal time from the cecum was 7 minutes. The patient tolerated the procedure well. There were no complications. The exam was limited by poor preparation. Findings: At the splenic flexure, moderate inflammation with erythema, granularity, friability, and hypervascularity was seen. There was no mucosal bleeding. In the proximal descending colon, moderate segmental inflammation with erythema, granularity, friability, and hypervascularity. In the rectum an abnormality was noted. Anastomosis is patent and normal. No evidence of polyp. Just proximal prior to anastomosis - significant diffuse colitis was noted. What are the CPT® and ICD-10-CM codes for this service? CPT® code: ICD-10-CM codes (2):

A

Code proximal subtotal pancreatectomy, with total duodenectomy, partial gastrectomy, choledochoenterostomy, and gastrojejunostomy, with pancreatojejunostomy. What CPT® code is reported? A) 48150 B) 48152 C) 48153 D) 48154

D

Name the three sections of the small intestine. A) Sigmoid, rectum, ilium B) Jejunum, duodenum, ilium C) Cecum, jejunum, ileum D) Duodenum, jejunum, ileum

D

What CPT® and ICD-10-CM codes are reported for diagnosis of a recurrent unilateral reducible femoral hernia repair? A) 49550, K41.91 B) 49555, K41.21 C) 49505, K41.31 D) 49555, K41.91

C

What CPT® code(s) is/are reported for an endoscopic direct placement of a percutaneous gastrostomy tube for a patient who previously underwent a partial esophagectomy? A) 49440, 43116-51 B) 43246, 43116-51 C) 43246 D) 49440

D

What CPT® code(s) is/are reported when a physician makes two separate incisions to perform a laparoscopic appendectomy and laparoscopic cholecystectomy? A) 47562 B) 44960, 47562 C) 47562, 44970-51 D) 47562, 44970-59

D

What ICD-10-CM code is reported for acute gastritis with bleeding? A) K29.70 B) K29.00 C) K29.71 D) K29.01

C

What ICD-10-CM code is reported for internal hemorrhoids? A) K64.4 B) K64.9 C) K64.8 D) K64.0

A

What are the two processes of digestion? A) Mechanical and chemical B) Chewing and absorption C) Ingestion and defecation D) Secretion and propulsion

A

What is the correct ICD-10-CM code for a patient with IBS? A) K58.9 B) K59.2 C) K58.0 D) K59.8

B

What is the correct ICD-10-CM coding for diverticulosis of the small intestine which has been present since birth? A) K57.90 B) Q43.8 C) K57.90, Q43.8 D) K57.10

C

What is the eponym for a pancreatoduodenectomy? A) Meckel's procedure B) Hartmann's procedure C) Whipple procedure D) Kasai procedure

B

What is the name of the large intestine that runs horizontally across the abdomen? A) The sigmoid colon B) The transverse colon C) The descending colon D) The ascending colon

C

When reporting an encounter for screening of malignant neoplasms of the intestinal tract, what does the 5th character indicate? A) History of malignancy in the intestinal tract. B) Laterality of the intestinal tract. C) Anatomic location being screened in the intestinal tract. D) Screening codes for malignant neoplasms of the intestinal tract are only reported with four characters.