1. Preoperative Diagnosis: Chronic tonsillitis. Chronic adenoiditis.
Postoperative Diagnosis: Same.
Procedure:
Tonsillectomy and adenoidectomy. Patient is a 24-year old male who was taken to
the operating room and put under IV sedation by the anesthesia department. An
initial curettage of adenoids was done and packing was placed. The left tonsil
was then identified and dissected out extracapsular and removed with scissors.
Hemostasis was maintained by packing the left tonsil. Next, the right tonsil
was identified and incision was made. Dissection was done extracapsular and the
right tonsil was then removed. Both the right and left tonsil were sent as
specimens as well as adenoid tissue. What are the procedure and diagnosis
codes?
A. 42826,
42831-59, J35.01
B. 42826,
42831-51-59, 42809, J35.03
C.
42821-50, 42809-59, J35.01
D. 42821,
J35.03
2. A 52-year-old
patient is admitted to the hospital for chronic cholecystitis for which a
laparoscopic cholecystectomy will be performed. A transverse infraumbilical
incision was made sharply dissecting to the subcutaneous tissue down to the
fascia using access under direct vision with a Vesi-Port and a scope was placed
into the abdomen. Three other ports were inserted under direct vision. The
fundus of the gallbladder was grasped through the lateral port, where multiple
adhesions to the gallbladder were taken down sharply and bluntly: The
gallbladder appeared chronically inflamed. Dissection was carried out to the
right of this identifying a small cystic duct and artery, was clipped twice
proximally, once distally and transected. The gallbladder was then taken down
from the bed using electrocautery, delivering it into an endo-bag and removing
it from the abdominal cavity with the umbilical port. What CPT and ICD-10 codes
should be reported?
a. 47564,
K81.12
b. 47562,
K81.1
c. 47610,
K81.1
d. 47600,
K81.12
3. A 70-year-old
female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic
evaluation and repair. An incision was made in the epigastrium and dissection
was carried down through the subcutaneous tissue. Two 5-mm trocars were placed,
one in the left upper quadrant and one in the left lower quadrant and the
laparoscope was inserted. Dissection was carried down to the area of the hernia
where a small defect was clearly visualized. There was some omentum, which was
adhered to the hernia and this was delivered back into the peritoneal cavity.
The mesh was tacked on to cover the defect. What procedure code(s) should be
used?
A. 49560,
49568
B. 49653
C. 49652
D. 49653,
49568
4. The patient is a
50-year-old gentleman who presented to the emergency room with signs and
symptoms of acute appendicitis with possible rupture. He has been brought to
the operating room. An infraumbilical incision was made which a 5-mm VersaStep
trocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm
trocar was placed suprapubically and a 12-mm trocar in the left lower quadrant.
A window was made in the mesoappendix using blunt dissection with no rupture
noted. The base of the appendix was then divided and placed into an Endo-catch
bag and the 12-mm defect was brought out. Select the appropriate code for this
visit:
A. 44970
B. 44950
C. 44960
D. 44979
5. An 82-year-old
female had a CAT scan which revealed evidence of a proximal small bowel
obstruction. She was taken to the Operating Room where an elliptical abdominal
incision was made, excising the skin and subcutaneous tissue. There were
extensive adhesions along the entire length of the small bowel: the omentum and
bowel were stuck up to the anterior abdominal wall. Time- consuming tedious
lysis of adhesions was performed to free up the entire length of the
gastrointestinal tract from the ligament to Treitz to the ileocolic
anastomosis. The correct CPT code is:
A. 44005
B.
44180-22
C.
44005-22
D.
44180-59
6. A 20 year-old patient
presented to the hospital with a history of bloody stools for three weeks’
duration. The patient was prepped for a sigmoidoscopy. 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)
45331, K92.1
b)
45333, Z12.11, K62.5
c)
45330, 45331, K62.5
d)
45305, K92.1
7. The
patient is a 78-year-old white female with morbid obesity that presented with
small bowel obstruction. She had surgery approximately one week ago and
underwent exploration, which required a small bowel resection of the terminal
ileum and anastomosis leaving her with a large inferior ventral hernia. Two
days ago she started having drainage from her wound which has become more
serious. She is now being taken back to the operating room. Reopening the
original incision with a scalpel, the intestine was examined and the
anastomosis was reopened , excised at both ends, and further excision of
intestine. The fresh ends were created to perform another end- to-end
anastomosis. The correct procedure code is:
A.
44120-78
B.
44126-79
C.
44120-76
D.
44202-58
8.15 year-old
female is to have a tonsillectomy performed for chronic tonsillitis and
hypertrophied tonsils. A McIver mouth gag was put in place and the tongue was
depressed. The nasopharynx was digitalized. No significant adenoid tissue was
felt. The tonsils were then removed bilaterally by dissection. The uvula was a
huge size because of edema, a part of this was removed and the raw surface
oversewn with 3-0 chromic
catgut.
Which CPT code(s) should be used?
A. 42821
B. 42825,
42104-51
C. 42826,
42106-51
D. 42842
9. PREOPERATIVE
DIAGNOSIS: Diverticulitis, perforated diverticula POST OPERATIVE DIAGNOSIS:
Diverticulitis,
perforated diverticula PROCEDURE: Hartman procedure, which is a sigmoid
resection with Hartman pouch and colostomy. DESCRIPTION OF THE PROCEDURE:
Patient was prepped and draped in the supine position under general anesthesia.
Prior to surgery patient was given 4.5 grams of Zosyn and Rocephin IV
piggyback. A lower midline incision was made, abdomen was entered. Upon entry
into the abdomen, there was an inflammatory mass in the pelvis and there was a
large abscessed cavity, but no feces. The abscess cavity was drained and
irrigated out. The left colon was immobilized, taken down the lateral perineal
attachments. The sigmoid colon was mobilized. There was an inflammatory mass
right at the area of the sigmoid colon consistent with a divertiliculitis or
perforation with infection. Proximal to this in the distal left colon, the
colon was divided using a GIA stapler with 3.5 mm staples. The sigmoid colon
was then mobilized using blunt dissection. The proximal rectum just distal to
the inflammatory mass was divided using a GIA stapler with 3.5 mm staples. The
mesentary of the sigmoid colon was then taken down and tied using two 0 Vicryl ties.
Irrigation was again performed and the sigmoid colon was removed with
inflammatory mass. The wall of the abscessed cavity that was next to the
sigmoid colon where the inflammatory mass was, showed no leakage of stool, no
gross perforation, most likely there is a small perforation in one of the
diverticula in this region. Irrigation was again performed throughout the
abdomen until totally clear. All excess fluid was removed. The distal
descending colon was then brought out through a separate incision in the lower
left quadrant area and a large 10 mm 10 French JP drain was placed into the
abscessed cavity. The sigmoid colon or the colostomy site was sutured on the
inside using interrupted 3-0 Vicryl to the peritoneum and then two sheets of
film were placed into the intra- abdominal cavity. The fascia was closed using
a running #1 double loop PDS suture and intermittently a #2 nylon retention
suture was placed. The colostomy was matured using interrupted 3-0 chromic
sutures. I palpated the colostomy; it was completely patent with no
obstructions. Dressings were applied. Colostomy bag was applied. Which CPT code
should be used?
A. 44140
B. 44143
C. 44160
D. 44208
10. Patient is
going into the OR for an appendectomy with a ruptured appendicitis. Right lower
quadrant transverse incision was made upon entry to the abdomen. In the right
lower quadrant there was a large amount of pus consistent with a right lower
quadrant abscess. Intraoperative cultures anaerobic and aerobic were taken and
sent to microbiology for evaluation. Irrigation of the pus was performed until
clear. The base of the appendix right at the margin of the cecum was
perforated. The mesoappendix was taken down and tied using 0-Vicryl ties and
the appendix fell off completely since it was already ruptured with tissue
paper thin membrane at the base. There was no appendiceal stump to close or to
tie, just an opening into the cecum; therefore, the appendiceal opening area
into the cecum was tied twice using figure of 8 vicryl sutures. Omentum was tacked
over this area and anchored in place using interrupted 3-0 Vicryl sutures to
secure the repair. What CPT and ICD-10-CM codes should be reported?
A. 44950,
K35.2
B. 44960,
49905, K35.3
C. 44950,
49905, K35.2
D. 44970,
K35.3
11. Heather
lost her teeth following a motorcycle accident. She underwent a posterior,
bilateral vestibuloplasty, which allows her to wear complete dentures. How
would you report this procedure?
a. 40845,
15002
b.
40843-50
c. 40844
d. 40843
12. Katherine
had a hernioplasty to repair a recurrent ventral incarcerated hernia with
implantation of mesh for closure. The surgeon completed debridement for
necrotizing soft tissue due to infection. How would you report this procedure?
a. 49566,
11005-51, 49568
b. 49565,
11005-51, 49568
c. 49565
d. 49525,
11006, 49568-51
13. Sharon had
a laparoscopic cholecystectomy with cholangiography. How would you report this
procedure?
a. 47605,
47570-59
b. 47605
c. 47563
d. 47579
14. A patient underwent an EGD
with transendoscopic ultrasound-guided transmural fine needle aspiration. How should you code this
procedure?
a. 43242, 76942-26
b. 43242
c. 43235, 43238-59
d. 43235, 43242-51,
76942-26
15. Diagnostic
upper GI endoscopy of the esophagus, stomach, and duodenum was performed after
esophageal balloon dilation (less than 30 mm diameter) was done at the same
operative session. Code the procedure(s).
A. 43235
B. 43249
C. 43226,
43200
D. 43220,
43235
16. A
13-year-old patient underwent secondary palatoplasty for cleft palate and
bilateral tonsillectomy. The CPT codes are:
a) 42220,
42826-50-51
b) 42225,
42826-50-51
c) 42220,
42826-51
d) 42220,
42825-50-51
17. An obese
patient underwent gastric restrictive surgery with gastric bypass for weight
reduction withn roux-en-Y reconstruction for 100 cm. The surgery was quite
difficult due to lots of adhesions. The doctor took 1 hour extra to finish the
procedure. The appropriate code he should bill for,
a)
43846-22
b)
43621-22
c) 43846-59
d)
44384-23
18. A
radiologist performs an injection procedure for a sialogram in the hospital and
provides interpretation and a written report. Select the CPT codes for the
procedure.
a) 70390
b) 42550
c) 42660,
70390-26
d) 42550,
70390-26
19. A patient
came to the hospital with severe abdominal pain and was diagnosed with common
bile duct stone. The physician did ERCP with sphincterotomy and retrograde
stone removal and provided interpretation and written report. Select the CPT
codes for the procedure.
a) 43260
b)
74330-52
c) 43264,
43262-51, 74330-26
d) 43264,
74330-26
20. A patient of dysphagia is diagnosed
with failure of the sphincter to relax at the GE junction. He undergoes
flexible esophagoscopy and the surgeon performs a balloon dilation of 45 mm
diameter under imaging guidance. Code the CPTs.
a) 43220 x 2, 74360
b) 43200, 43220, 74360
c) 43214, 74360
d) 43214
21. INDICATIONS:
Iron deficiency anemia with low iron saturation. Positive fecal occult blood
test per digital rectal exam.
FINDINGS:
DIVERTICULOSIS: Sigmoid Colon, Not bleeding; few small diverticulum POLYP:
Sigmoid Colon, 5 mm, 45 cm from Anus, pedunculated.
Procedure:
Snare with cautery, Polyp removed; polyp retrieved. Polyp sent to pathology.
HEMORRHOIDS:
Internal, Size: Medium.
ASSESSMENT:
Abnormal examination, see findings above.
COMPLICATIONS:
None
DISPOSITION:
After procedure, patient sent to recovery. After recovery, patient sent back to
hospital ward.
a) 45330,
45333
b) 45333
c) 45338
d) 45330,
45338
22. Dr.Kildare performed a choledochostomy, explored
the common bile duct, drained excess fluid & removed a stone .In addition
the physician performed a division of oddi sphincter to open the lower end of
the common duct to remove impacted stones.
a) 47420
b) 47420, 47460-51
c) 47425
d) 47425, 47460-51
23. Postoperative
Diagnosis: Calculi of the gallbladder Procedure: Removal of gallbladder
Indications: The patient is a 40-year-old woman who has a six month history of
RUQ pain, which ultrasound revealed to be multiple gallstones. She presents for
removal of her gallbladder. Procedure: The patient was brought to the OR and
prepped and draped in a normal sterile fashion. After adequate general
endotracheal anesthesia
was
obtained, a trocar was placed and CO2 was insufflated into the abdomen until an
adequate pneumoperitoneum was achieved. A camera was placed at the umbilicus
and the gallbladder and liver bed were visualized. The gallbladder was enlarged
and thickened, and there was evidence of chronic inflammatory changes. Two
additional ports were placed and graspers were used to free the gallbladder
from the liver bed with a combination of sharp dissection and electrocautery.
Several attempts were made before it was decided that additional exposure was
needed and I converted to an open approach. The trocars were removed and a
midline incision was made. At this time, it was clear that there were multiple
adhesions in the area, and once these were carefully taken down, we were able
to grasp the gallbladder. The cystic duct was carefully ligated and the
gallbladder carefully removed from the field. The area was copiously irrigated,
and a needle biopsy of the liver was taken. Then the skin was reapproximated in
layers. Sponges and needle counts were correct, and the patient was taken to
the recovery room in good condition.
a.
47600-22
b.
47600-22, 47001
c. 47562,
47600-22, 47001
d.
47562-22, 47000
24. A patient
with rectal bleeding undergoes a proctosigmoidoscopy. During the
proctosigmoidoscopy, the physician identifies internal hemorrhoids. The
proctoscope was withdrawn, and the anus was prepped and draped. A field block
with Marcaine 0.25% was then placed. Anoscope was inserted. There was a
prolapsing hemorrhoid in the anterior midline. This was rubber band ligated by applying
two bands. In the posterior midline, there was another hemorrhoid that was
banded in the same manner. Code the procedures.
A. 46221,
45300-51, 46600-51
B. 46221,
45300-51
C. 46945,
45300
D. 46946,
45300-51, 46600-51
25. A patient
diagnosed with GERD presents to the same day surgery department for an upper GI
endoscopy. The procedure is done in order to treat the GERD by delivering
thermal energy to the muscle of the gastric cardia and lower esophageal
sphincter. Anesthesia was administered and as the physician begins the
procedure, the patient’s blood pressure drops to a dangerously low level. The
physician decides not to finish the procedure due to the risk it may cause the
patient. What are the codes for this procedure and diagnosis?
A. 43257-73,
K21.9, Z53.09
B. 43499,
K21.8, I95.0
C.
43257-74, K21.0, I95.9
D.
43257-53, K21.9, I95.89, Z53.09
26. PROCEDURE: Colonoscopy with polypectomy.
INDICATIONS: Iron deficiency anemia with
low iron saturation. Positive fecal occult blood test per digital rectal exam.
ANESTHESIA: Demerol & Versed
FINDINGS: DIVERTICULOSIS: Sigmoid Colon,
Not bleeding; few small diverticulum POLYP: Sigmoid Colon, 5 mm, 45 cm from
Anus, pedunculated.
Procedure: Bipolor Cautery, Polyp removed;
polyp retrieved. Polyp sent to pathology.
HEMORRHOIDS: Internal, Size: Medium
DISPOSITION: After procedure, patient sent
to recovery. After recovery, patient sent back to hospital ward
a) 45333
b) 45337
c) 45338
d) 45385
27. A patient
with esophageal cancer is brought to the OR for subtotal esophagectomy. A
thoracotomy incision is made and the esophagus is identified. The tumor is
carefully dissected free of the surrounding structures. No invasion of the
aorta or IVC is identified. The cervical esophagus is controlled with pursestring
sutures and then transected above the sternal notch. The esophagus is then
dissected free of the stomach and the entire specimen is removed from the chest
cavity and sent to pathology. The stomach is then pulled into the chest cavity
and anastomosed to the remaining cervical esophageal stump. The anastomosis is
tested for patency and no leaks are found. Hemostasis is assured. The chest is
examined for any signs of additional disease but is grossly free of cancer. The
chest is closed in layers and a chest tube is place through a separate stab
incision. The patient tolerated the procedure well and was taken to the PACU in
stable condition.
A. 43101
B. 43117
C. 43107
D. 43112
28. Patient
with RUQ pain and nausea suspected of having a stone or other obstruction in
the biliary tract is brought in for ERCP under radiologic guidance. Procedure:
The patient was brought to the hospital outpatient endoscopy suite and placed
supine on the table. The mouth and throat were anesthetized. Under radiologic
guidance, the scope was inserted through the oropharynx, esophagus, stomach and
into the small intestine. The ampulla of Vater was cannulated and filled with
contrast. It was clear that there was an obstruction in the common bile duct.
The endoscope was advanced retrograde to the point of the obstruction, which
was found to be a stone that was removed with a stone basket. The rest of the
biliary tract was visualized and no other obstructions or anomalies were found.
The scope was removed without difficulty. The patient tolerated the procedure
well.
A. 43260,
74328-26
B. 43264,
74328-26
C. 43265
D. 43260,
74329
29. 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)
43244, K70.30, I85.11, F10.10
b)
43235, I83.008, F10.20, K70.30
c)
43205, K74.60, I85.01, F10.20
d)
43400, I85.11, F10.10, K74.60
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