1. The 43 yr old female comes in with a
peritonsillar abscess; the patient is brought to same-day surgery & given
general anesthetic. On examination of the peritonsillar abscess an incision was
made & fluid was drained. The area was examined again ,saline was applied
& then the area was packed with gauze. The patient tolerated the procedure
well.
a) 42825
b) 42700
c) 42826
d) 42800
2.Preoperative
diagnosis: History of prior colon polyps Postoperative diagnosis: Colon polyps,
diverticulosis, hemorrhoids Procedure: A rectal exam was performed and revealed
small external hemorrhoids. The video colonoscope was passed without difficulty
from anus to cecum. The colon was well prepped. The instrument was slowly
withdrawn with good views obtained throughout. There was a 3 mm polyp in the
proximal ascending colon. This polyp was removed with hot biopsy forceps and
retrieved. There was a 4 mm rectal polyp located 10 cm from the anus in the
proximal rectum. The polyp was removed by hot biopsy forceps. There was also moderate
diverticulosis extending from the hepatic flexure to the distal sigmoid colon.
Code the CPT® procedure(s).
A. 45384
B. 45384, 45384-51
C. 45380, 45384
D. 45388
3.34-year-old
male developed a ventral hernia when lifting a 60 pound bag. The patient is in
surgery for a ventral herniorrhaphy. The abdomen was entered through a short
midline incision revealing the fascial defect. The hernia sac and contents were
able to easily be reduced and a large plug of mesh was placed into the fascial
defect. The edge of the mesh plug was sutured to the fascia. What procedure
code(s) should be used?
A. 49560
B. 49561, 49568
C. 49652
D. 49560, 49568
4.55-year-old
female has a symptomatic rectocele. She had been admitted and taken to the main
OR. An incision is made in the vagina into the perineal body (central tendon of
the perineum). Dissection was carried underneath posterior vaginal epithelium
all the way over to the rectocele. Fascial tissue was brought together with
sutures creating a bridge and the rectocele had been reduced with good support
between the vagina and rectum. What procedure code should be reported?
A. 45560
B. 57284
C. 57250
D. 57240
5. DIAGNOSIS:
1. Chronic cholecystitis. 2. Chronic cholelithiasis
ANESTHESIA: General, tube balanced
PROCEDURE: This healthy 42-year-old gentleman was taken to surgery with
symptomatic gallbladder disease. In the operating room in the supine position
after induction of adequate general anesthesia without event, the anterior
abdominal wall was prepped with Hibiclens and alcohol and shaved. Drapes were
applied. A routine umbilical port cut down was performed with direct
visualization of the peritoneal cavity. A blunt trocar was inserted.
Insufflation was carried out. The abdominal contents were examined. There were
no gross abnormalities. The gallbladder was tense and thick-walled, but there
were no other findings in the pelvis or upper abdominal regions. The remaining
three trocars were inserted, and a routine laparoscopic cholecystectomy was
performed, identifying the cystic duct, cystic artery, and the top of the
common bile duct. Once said structures were identified, the cystic duct and
artery were doubly clipped distally and singly proximally and divided. The
gallbladder was dissected from the fossa in a retrograde fashion. The specimen
was opened on the back table after it had been extracted through the epigastric
port with removal of two large cholesterol stones. The mucosa was intact. The
wall was definitely thickened with indications of chronic scarring.
Re-inspection of the gallbladder fossa showed excellent hemostasis. No bile
leakage. The clips were intact. The area was irrigated and suctioned dry. This
concluded the procedure. Routine abdominal wall midline closures were carried
out. Band-aid dressings were applied, and the patient was sent to the recovery
room in satisfactory condition. Routine abdominal wall midline closures were
carried out. Band-aid dressings were applied, and the patient was sent to the
recovery room in satisfactory condition.
a) 47579
b) 47562
c) 47563
d) 47564
6. DIAGNOSIS
: Leaking from intestinal anastomosis
OPERATION: Proximal ileostomy for diversion
of colon .Oversew of right colonic fistula
PROCEDURE: This patient was taken back to
the operating room from the ICU .She was having acute signs of leakage from an
anastomosis performed 3 days previously. We took down some of the sutures
holding the wound together .We basically exposed this patient’s entire
intestine. It was evident that she was leaking from the small bowel as well as
from the right colon .This was done in 2 layers & then we freed up enough
bowel to try to make an ileostomy proximal to the area of leakage .We were able
to do this with great difficulty & there was only a small amount of bowel
to be brought out. We brought this out as an ileostomy stoma, realizing that it
was of questionable viability & that it should be watched closely. With
that accomplished we then packed the wound & returned the patient to the
Intensive care unit.
a) 44310
b) 45136
c) 44312
d) 44314
7. DIAGNOSIS
: Melena
OPERATION : Normal endoscopy
PROCEDUIRE PERFORMED: The video therapeutic
endoscope was passed without difficulty into the oropharynx. The
gastroesophageal junction was seen at 40 cm. Inspection of the esophagus
revealed no erythema , ulceration ,varices or other mucosal abnormalities. The
stomach was entered & the endoscope was advanced to the second duodenum.
Inspection of the second duodenum, first duodenum. Duodenal bulb& pylorus revealed
no abnormalities .Retroflexion reveals no lesions along the curvature.
Inspection of the antrum, body & fundus of the stomach revealed no
abnormalities .The patient tolerated the procedure well.
a) 45378
b) 43235
c) 49320
d) 43255
8. An
88-year-old male patient suffering from dementia accidentally pulled out his
gastrostomy tube during the night. Dr. Keys, an interventional radiologist,
takes him into an angiography suite, administers moderate sedation (an
independent observer was present during the procedure), probes the site with a
catheter and injects contrast medium for assessment and tube placement. Dr.
Keys finds that the entry site remains open and replaced the tube into the
proper position. The intra-service time for the procedure took 45 minutes. How
would Dr. Keys report his services?
a. 49440, 99156, 99157
b. 49440, 49450-59
c. 49450, 99152, 99153*2
d. 49450
9. DIAGNOSIS
:Polyps
OPERATION: Proctosigmoidioscopy
PROCEDURE PERFORMED: The physician inserts
the rigid proctosigmoidoscope into the anus & advances the scope. The
sigmoid colon & rectal lumen are visualized & the polyps are
identified. The two polyps were removed by snare technique. The scope is
removed at the completion of the procedure.
a) 45320
b) 45388
c) 45309 x 2
d) 45315
10. DIAGNOSIS
: Morbid obesity
OPERATION: Gastric restrictive procedure
with Roux-en-y gastroenterostomy
PROCEDURE PERFORMED: The physician places a
trochar though an incision above the umbilicus & insufflates the abdominal
cavity .The laproscope& additional trochars are placed through small portal
incisions. The stomach is mobilized & the proximal stomach is divided with
a stapling device along the lesser curvature, leaving only a small a small
proximal pouch in continuity with the esophagus. A short limb of the proximal
small bowel is divided & the distal end of the short intestinal limb is
brought up & anastomosed to the proximal gastric pouch. The other end of
the divided bowel is connected back into the small bowel distal to short limb’s
gastric anastomosis to restore intestinal continuity.The instruments are
removed.
a) 43644
b) 43644, 43846
c) 43645
d) 43645, 43847
11. PROCEDURE:
Sigmoidoscopy
INDICATIONS: Performed for evaluation of
anemia, gastrointestinal Bleeding.
MEDICATIONS: Fentanyl (Sublazine) .1 mg IV
Versed (midazolam) 1 mg IV
BIOPSIES: No BRUSHINGS: No
PROCEDURE: A history and physical
examination were performed. The procedure, indications, potential complications
(bleeding, perforation, infection, adverse medication reaction), and alternative
available were explained to the patient who appeared to understand and
indicated this. Opportunity for questions was provided and informed consent
obtained. After placing the patient in the left lateral decubitus position, the
sigmoidoscope was inserted into the rectum
and under direct visualization advanced to 25 cm. Careful inspection was made
as the sigmoidoscope was withdrawn. The quality of the prep was good. The
procedure was stopped due to patient discomfort. The patient otherwise tolerated
the procedure well. There were no complications.
FINDINGS: Was unable to pass scope beyond
25 cm because of stricture was very short bends secondary to multiple previous
surgeries. Retroflexed examination of the rectum revealed small hemorrhoids.
External hemorrhoids were found. Other than the findings noted above, the
visualized colonic segments were normal.
IMPRESSION: Internal hemorrhoids. External
hemorrhoids Unable to pass scope beyond 25 cm due either to stricture or very
sharp bend secondary to multiple surgeries. Unsuccessful Sigmoidoscopy.
Otherwise Normal Sigmoidoscopy to 25 cm. External hemorrhoids were found.
a) 45330
b) 45330-53
c) 45330-22
d) 45331
12. 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)
42215-76, Q35.7, R56.9
b)
42220-53, Q35.9, R56.9
c)
42220-52, Q35.7, R56.9
d)
42215-53, Q35.9, R56.9
13. A patient underwent hepatic artery
ligation with complex suture repair of a liver laceration following a motor
vehicle accident.
a) 47361
b) 47350
c) 47360
d) 47360-51
14. 55-year-old
patient was admitted with massive gastric dilation. The endoscope was inserted
with a catheter placement. The endoscope is passed through the cricopharyngeal
muscle area without difficulty. Esophagus is normal, some chronic reflux
changes at the esophagogastric junction noted. Stomach significant distention
with what appears to be multiple encapsulated tablets in the stomach at least
20 to 30 of these are noted. Some of these are partially dissolved. Endoscope
could not be engaged due to high grade narrowing in the pyloric channel. It
seems to be a high grade outlet obstruction with a superimposed volvulus. What
code should be used for this procedure?
A. 43246-52
B. 43241-52
C. 43235
D. 43213
15. A
patient with right lower quadrant pain underwent emergent diagnostic
laparoscopy. The surgeon found severe appendicitis on laparoscopic examination
and did laparoscopic appendectomy. What codes the surgeon should bill for:
a) 44970
b) 44950, 44955
c) 44970, 44320
d) 44950, 49320
16. Patient
underwent flexible sigmoidoscopy to 60 cm with removal of two small polyps
using snare technique.
a) 44364
b) 44401
c) 45385
d) 45338
17. A person with a history of snoring
undergoes surgical resection of unnecessary palatal and oropharyngeal tissue
(uvulopalatopharyngoplasty). Give the CPT.
a) 42120
b) 42145-22
c) 42145
d) 42235
18. Preoperative
Diagnosis: Lower left inguinal pain Postoperative Diagnosis: Inguinal hernia
Procedure: This 30-year-old patient presented with lower left inguinal pain and
on examination was found to have a left inguinal hernia. The decision to
perform a left inguinal hernia repair was made. The procedure was performed in
the outpatient hospital surgery center. Risks and benefits of the surgery were
discussed with the patient and the patient decided to proceed with the surgery.
A skin incision was placed at the umbilicus where the left rectus fascia was
incised anteriorly. The rectus muscle was retracted laterally. Balloon
dissector was passed below the muscle and above the peritoneum. Insufflation
and deinsufflation were done with the balloon removed. The structural balloon
was placed in the preperitoneal space and insufflated to 10 mm Hg carbon
dioxide. The other trocars were placed in the lower midline times two. The
hernia sac was easily identified and was well-defined. It was dissected off the
cord anteromedially. It was an indirect sac. It was taken back down and reduced
into the peritoneal cavity. Mesh was then tailored and placed overlying the
defect, covering the femoral, indirect, and direct spaces, tacked into place.
After this was completed, there was good hemostasis. The cord, structures, and
vas were left intact. The trocars were removed. The wounds were closed with 0
Vicryl for the fascia, 4-0 for the skin. Steri-Strips were applied. The patient
was awakened and carried to the recovery room in good condition, having
tolerated the procedure well. What are the correct procedure and diagnostic
codes?
A. 49505-LT, K40.90
B. 49505-LT, 49568, K40.91
C. 49507-LT, K40.11
D. 49501-LT, 49568, K40.90
19. In
a patient suffering from parotid gland tumour, the doctor needed to removal the
whole parotid along with unilateral radical neck dissection. During the surgery
the facial nerve was sacrificed and had to be sutured back extracranially. What
CPT(s) will the doctor bill for?
a) 42426, 64864
b) 42426, 64864-51
c) 42426, 69990-26
d) 42425
20. What
code would you use if the physician performs a pyloroplasty&vagotomy in the
same surgical session?
a) 43865
b) 50433
c) 43635
d) 43640
21. This
patient is brought back to the operating room during the post operative period
by the same physician to repair an esophagogastrostomy leak, transthoracic
approach, done 2 days ago. The patient is status post esophagectomy for cancer.
Code the procedure & the diagnosis for the complication.
a) 44320- 78, K91.81
b) 43340- 78, K91.81
c) 43341, K91.81
d) 43415-78, K91.89
22. The
patient was taken to the operating room for a repair of a recurrent
strangulated inguinal hernia.
a) 49521
b) 49520
c) 49492
d) 49521-78
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